The National Health Service (NHS)
The United Kingdom (UK) has one of the most revolutionary and progressive healthcare systems in the world. Whether you’re working for the National Health Service (NHS) or a private healthcare provider, you can be sure that you are part of a national workforce who not only provide first-class care, but who are making history each and every day.
The UK lifestyle offers a fantastic wealth of activities and opportunities not only in employment but also recreationally. Steeped in history, the UK offers the perfect mix of vibrant, modern cities and a wealth of countryside landscapes – from the snowy mountain ranges in Scotland and the rolling Oxford countryside to the sandy shores of the West Country.
The NHS was founded in 1948 to provide healthcare free at the point of use to the entire UK population. Since the creation of the NHS there have been significant changes in the structure and funding of NHS healthcare. It still covers the whole of the UK population and is still mostly free at the point of delivery.
Exceptions to this include outpatient dental treatment, some health appliances and sight testing, for which patients are expected to pay in part, or fully, themselves. Patients also pay a fixed amount for drugs prescribed in primary care, although there are exemptions or reductions for certain groups, such as children, the elderly, the unemployed, those on low incomes and some patients with chronic conditions. There are no charges for seeing a doctor or for treatment in hospital.
The private medical sector is small. Just over 11 per cent of the population have some private healthcare insurance, but the cover provided can be limited and the private sector relies heavily on the support provided by the NHS. Most doctors in the UK practise in the NHS, even if they do some private work as well.
Healthcare structure in the UK
The NHS is funded mainly through general taxation and national insurance contributions, which all employed people and employers are required to pay. Health service provision has been devolved, resulting in slightly different systems within the four nations comprising the UK – England, Northern Ireland, Scotland and Wales.
Staff working in the NHS are employed by the hospitals. Most doctors are employed under the terms and conditions of service negotiated nationally by the Bristish Medical Association for NHS employed medical staff, but not all employers are obliged to apply them.
The Department of Health for England is the Government department responsible for the management of health and social care services to the people of England and sets the overall policy on health issues. In July 2010 plans were introduced by the Government to reform the NHS. The resulting Health and Social Care Bill is still being discussed and debated in Parliament.
The responsibility for developing strategies for local health services and ensuring high quality performance did rest with 10 strategic health authorities (SHAs) which also managed the NHS at a local level. Each SHA was then split into different types of NHS Trusts that run different services in particular areas: acute trusts, ambulance trusts, care trusts, mental health trusts and primary care trusts (PCTs). NHS Trusts are independent with their own boards of directors.
In 2004 foundation trusts were also introduced. These are run by local managers, staff and members of the public and are tailored to the needs of the local population. They also have more financial and operational freedom than other NHS Trusts. As part of the NHS reforms the aim is that all Trusts become Foundation Trusts in the future.
The Health and Social Care Act will introduce changes in how services are commissioned; Strategic Health Authorities and Primary Care Trusts will be disbanded, new GP consortia will commission the majority of services locally and every GP practice will be required to become part of a consortium. The changes to the NHS are extremely detailed and are constantly being updated. Visit our definitive section on NHS reforms on our website and stay up to date.
The administration of the Northern Ireland HSC (Health and Social Care) lies with the Department of Health, Social Services and Public Safety (DHSSPS). Health and personal services are provided as an integrated service by four health and social services boards (Eastern, Northern, Southern and Western). The boards commission and purchase services for their areas. HSC Trusts provide health and social services within commissioning arrangements agreed with the health and social services boards.
With the exception of the regulation of the professions and legislation on abortion, decisions on health legislation are taken by the Scottish Parliament in Edinburgh. The Scottish Government Health Directorate is responsible for the leadership of the NHS and implementing health and wellbeing policies.
There are 14 area NHS boards in Scotland responsible for planning and delivery of health services. Hospital divisions are responsible for the delivery of secondary care and Community Health Partnerships, which encourage closer working between primary care and social services, are responsible for providing services in local communities.
For more information visit the NHS Scotland website.
The National Assembly for Wales has strategic responsibility for the NHS in Wales. Seven local health boards deliver secondary and primary care.
For more information visit the Welsh Assembley Government website.
Nurses trained outside the UK and EEA
They can apply to be on the NMC Register, providing they meet its standards. The NMC will compare the training in your country with that required in the UK. Registration with the NMC does not provide the right to work in the UK.
The requirements for registration are different for nurses who trained in the UK and EEA to those who trained outside the UK and EEA.
Process for nurses educated from outside the EEA
Since October 2014, the only route to registration for all nurses trained outside the UK and EEA with the NMC is through a 2-part application process.
- Part one – a computer based multiple-choice examination which will be accessible in many countries around the world for applicants to access in their home countries.
- Part two – a practical objective structured clinical examination (OSCE) which will always be held in the UK.
This process does not require applicants to complete a period of supervised practice.
EEA nationals who have trained outside the EEA will not be eligible for automatic recognition of their qualification under the EU Directives as they have not trained within an EU member state. Further information is available from the NMC website.
Overseas-trained nurses holding EC Treaty Rights who have had their qualification recognised in another EU member state and have practised in the EU/EEA for three years, will continue to be processed through the EU route.
Nurses trained in the EEA
Following the recognition of qualification, and before entry to the register, all applicants are required to supply evidence that they have the necessary knowledge of English. Communication is defined as speaking, reading, listening and writing.
Nurses who trained in the EEA who are not EEA nationals may be required to undertake one or both parts of the application process above.
You need to be on the UK medical register before you can do any clinical work or write prescription drugs in the UK.
The Nursing & Midwifery Council (NMC) holds the medical register. The NMC is the regulatory and disciplinary body for the medical profession and it keeps the UK specialist and General Practitioner registers.
If you want to work in the UK make sure you do the following:
- Contact the NMC well in advance to find out what you need to do
- Allow plenty of time to complete all the formalities
- Do not expect to go to the NMC and register on the spot as it can be a lengthy process
How do I register?
Arrangements differ depending on where you are from.
Trained in UK – Click here
Trained in EU or EEA – Click here
Trained outside EU or EEA – Click here
What is revalidation?
Nurses /Midwife have to demonstrate to the NMC every three years that they are up to date and fit to practise, although they will have to demonstrate they are up to date throughout the three year period.
The revalidation process is based on ‘Good Medical Practice’ which sets out the principles and values on which good practice is founded, including the duties of nurse / midwife registered with the NMC. The revalidation process started in April 2016.
Guidance on revalidation which is more relevant to nurse’s and midwife’s once they are established in the UK. Even if you are new to the UK it gives a useful background to the subject and a helpful overview of how the process as it relates to your working life.
Note: The following information is intended as a general guide only, and should not be used as a sole source of information.
Any International medical graduate (IMG) coming to the UK must satisfy UK immigration requirements. These are handled entirely separately from registration matters.
Please note that being granted a particular type of registration has no influence on immigration status and does not mean that you will automatically be allowed to remain in the UK.
Immigration law is very complex and nurses/ midwifes should seek detailed advice from UK Visas and Immigration or from a licensed immigration adviser.
Nurses / Midwifes who are still overseas can seek advice from the British High Commission, Embassy or consulate.
English language requirements
Who needs to provide evidence of knowledge of the English language?
All nurses who practise medicine in the UK must have the necessary knowledge of English to communicate effectively so they do not put the safety of their patients at risk. Communicating includes speaking, reading, writing and listening.
Whether we ask you to give us evidence that you have the necessary knowledge of English depends on a number of things.
All applications to join the NMC nurses part of the Register must include evidence of completion of the International English Language Testing System (IELTS) test. You must complete the academic version of the IELTS test and achieve:
- at least 7.0 in the listening and reading section 1
- at least 7.0 in the writing and speaking sections
- an overall average score of 7 (out of a possible 9)
The NMC will not consider applicants who score lower than this standard.
IELTS is an English Language test administered by the British Council, IDP Education Australia and Cambridge ESOL. It is run in over 100 countries. You can find out more on the IELTS website at http://www.ielts.org
For us to accept your IELTS certificate, it must meet our criteria.
Your IELTS certificate is valid for two years.
If you have obtained the required scores in the academic version of the IELTS test over two years ago, you may be able to prove to us that you have maintained your English language skills.
You can do this by submitting your original IELTS certificate showing that you got the required scores and one of the following:
- Evidence that you have successfully completed a postgraduate course of study, where all elements of the course of study, including clinical activities, were taught and examined solely in English, within the past two years.
- A reference from an employer or your tutor or lecturer on a postgraduate course of study from a country where English is the first or native language. The reference must cover at least three months full time employment or study within the last two years.
If you supply a reference we will keep this for our records.
Please note that achievement of IELTS for the purpose of applying for registration with the NMC may not be acceptable evidence of your English language skills for the purpose of obtaining a UK Visa. We recommend you visit the UK Visa and Immigration website to check their requirements.
The Occupational English Test (OET) is an international English language test that assesses the language and communication skills of healthcare professionals who seek to register and practise in an English-speaking environment.
It provides a valid and reliable assessment of all four language skills – listening, reading, writing and speaking – with an emphasis on communication in medical and health professional settings.
OET tests international health practitioners in the following 12 professions:
- Occupational Therapy
- Speech Pathology
- Veterinary Science
OET is recognised and trusted by more than 40 regulatory healthcare bodies and councils in Australia, New Zealand, Singapore, Dubai, Namibia, UK (NMC) and Ireland (NMC). Many organisations, including hospitals, universities and colleges, are using OET as proof of a candidate’s ability to communicate effectively in a demanding healthcare environment. In addition, OET is recognised by the Australian Department of Immigration and Border Protection for a number of visa categories, including work and student visas.
Primary medical qualification taught and examined in English
You may also be able to show us you have the necessary knowledge of English if your primary medical qualification has been taught and examined in English. In this case you would need to send:
- A statement that you have not taken the IELTS test before.
- An original letter or certificate from the institution where you qualified that confirms:
a. all of the course, including clinical activities, were taught and examined solely in Englishb. at least 75% of any clinical interaction, including personal contact with patients, their families and other healthcare professionals, which took place as part of the course of study, was conducted in Englishc. the date you sat your final examination.
Nurse / Midwife working in the UK
Employers must apply for a Certificate of Sponsorship and will usually be required to show that no suitably qualified resident worker is available to do the job. The process is simplified if the post is considered a shortage occupation. Once you have been issued with a Certificate of Sponsorship you will be able to apply for a Tier 2 (general) visa. This is the permission that you will need to stay in the UK and this visa will be specific to a particular post or job. If you then move to another job you would have to make a new application for leave. After a continuous period five years spent on a Tier 2 (General) visa you can apply for indefinite leave to remain (permanent residency) in the UK.
Note: The above information is intended as a general guide only, and should not be used as a sole source of information.
Where to get good immigration advice
It is important to note that under the Immigration and Asylum Act 1999, all organisations and individuals giving immigration advice must be authorised by the Office of the Immigration Services Commissioner (OISC). Lists of advisers can be found on the OISC website.
- Faith / Religion – The UK has one of the most religiously diverse populations in Europe, and the right to religious freedom is embraced. Communities and individuals are free to practice their faith without hindrance and encouraged to openly celebrate it. It is illegal in the UK for anyone to discriminate against you because of your faith or religion. If they do you must report it.
- Discrimination – It is illegal in the UK to discriminate against people because of their colour, race, ethnic or national origins, age, gender, sex or sexual orientation. If you have been discriminated against for any of these reasons, you must report it. If you have been found to have discriminated against someone you could be prosecuted.
- Smoking – In the UK smoking is forbidden in all enclosed public places such as pubs, restaurants, nightclubs, shops, offices, government buildings, factories, private members’ clubs, in cinemas and on public transport. You are allowed to smoke outdoors, at home or in provided smoking rooms in prisons, care homes and hotels. Certain outdoor locations such as sports arenas and railway platforms could have a smoking ban. If you are unsure about whether you can smoke somewhere, look for signs or ask somebody before you light your cigarette. If you are caught smoking in a banned area you could be fined £50.
- Alcohol – It is illegal to drink alcohol in some public areas in the UK. If you are caught drinking alcohol in a public place where drinking is not permitted, it will be confiscated from you. Excessive drinking can lead to public order offences for which you can be arrested and prosecuted. Remember it is illegal to drive any vehicle whilst under the influence of alcohol or drugs.
- Spitting in Public – Whilst it is not illegal to spit in public, many people will find it offensive. If you need to sneeze or blow your nose, use a tissue or handkerchief so you don’t cause offence.
- Appointments – It is important to arrive on time for meetings and appointments. In places such as hospitals and doctor’s surgeries you are advised to arrive 10 minutes early. This will help to keep waiting times down. If you know that you are going to be late or unable to attend a meeting or appointment, you should let the person know in advance.
- Visiting Friends – If you are invited to someone’s home for a meal, you may wish to take a small gift (such as flowers, chocolates or a bottle of wine) or you could invite them to your home in return. People from the UK will be interested to hear about your home country, so you might like to bring some photographs or small items to show your friends or guests.
- Greeting People – In the UK it is polite to say ‘please’ when you ask for something and ‘thank you’ when you receive something, or if someone is kind to you. If you meet somebody you know say ‘hello’, or if you want make a more formal greeting you can shake hands. In the UK you do this with your right hand.
- Queues – Wait in a queue (or line) for buses, at supermarket checkouts and other public places. People will be offended and think that you are rude if you do not.
- Social Activities – If you take part in social activities you will find it easier to make friends. You can visit your local community centre to find out what social activities they arrange. Going to a public house (pub) is a common social activity for people in the UK. Pubs do sell non-alcoholic drinks and often hold special events in which you can get involved in.
Remember, if you feel uncomfortable about taking part in something you have been invited to do, just say no, you will not cause offence.
Overview One of your primary concerns when moving to the UK is where you will live. If accommodation is not provided by your employer, the information provided here will help point you in the right direction.
Can You Live in the UK?
You must check your immigration status as you may not be permitted to live in the UK. If you are not currently in the UK, you should contact your nearest British Diplomatic post. You will be given detailed advice about your rights concerning living and housing in the UK.
Types of Accommodation
When looking for housing in the UK you have many options, but some of these can be expensive. You must remember to look carefully at what you can realistically afford.
Guest Houses / Bed and Breakfast These are often expensive and would ideally suit short-term stays.
Private Landlords To find listings of available properties try looking at: – Local newspapers – Notice boards in community centres – Local shops – Post Offices –
Cost of Living
Cost of living in United Kingdom is 0.69% lower than in United States (aggregate data for all cities, rent is not taken into account). Rent in United Kingdom is 15.71%lower than in United States (average data for all cities). For a guideline on the cost of your daily/ weekly expenses click here
Grades & Pay Scale
If you are not used to the grades of nurses / midwifes in the UK they can at first seem confusing. However, the main differences lie between the grades that lead to a Certificate of Specialist Training and those that do not.
Education in England is overseen by the United Kingdom’s Department for Education and Department for Business, Innovation and Skills. Local government authorities are responsible for implementing policy for public education and state-funded schools at a local level.
From the age of 16 there is a two-year period of education known as “sixth form” or “college” which typically leads to A-levelqualifications (similar to a high school diploma in some other countries), or a number of alternative qualifications such as BTEC, theInternational Baccalaureate or the Cambridge Pre-U.
Higher education often begins with a three-year bachelor’s degree. Postgraduate degrees include master’s degrees, either taught or by research, and the doctorate, a research degree that usually takes at least three years. Universities require a Royal Charter in order to issue degrees and all but one are financed by the state via tuition fees, which cost up to £9,000 per academic year for English, Welsh and European Union students.
Applying for jobs
Feel free to visit our jobs section to find the latest vacancies as per your grade & specialism.