As our register continues to grow, our role is to make sure nurses, midwives and nursing associates are equipped to deal with a wide range of complex issues. It’s therefore essential that everyone joining our register can demonstrate appropriate English language skills. This means the public can have confidence that those looking after them can provide safe, effective, and kind care.

The consultation process

In 2021 we heard from some people with concerns that there were skilled professionals working in UK health and care services who were demonstrating English language competence in practice, but who were narrowly missing out on passing the tests we accept and therefore couldn’t join our register.

We sought initial views from a wide range of partners and started building an evidence base for change. This included hosting a roundtable event in November 2021 with employers, trade unions, test providers and people who had experiences with our English language processes. We gathered a wide range of opinions and used these to develop proposals for change.

In summer 2022 we consulted on our proposed changes and received a record 34,000 responses from the public, professionals, employers and our partners. This high level of engagement demonstrates just how important it is to people that we make the right changes.

The consultation showed good levels of support for our proposals overall. Internationally educated professionals, employers, other health and care professionals and students were most supportive of the changes. UK educated professionals, educators and the public were more cautious, which reflects how important English language proficiency is for good communication between colleagues and for safe, effective, and kind care.

We considered all the feedback very carefully in the final proposals which were approved by our Council in September 2022.

Fair and proportionate changes that maintain high standards

The changes made in 2023 maintain the high standards of English language that professionals need to demonstrate before joining our register, while making sure our processes are as fair and proportionate as possible.

We’ve standardised the minimum test scores we accept when combining scores across two sittings, and we’ve extended the period for combining test scores from six to twelve months.

We’ve also started to accept supporting information from employers for applicants who trained in English in a country where English is not a majority spoken language, and who have been working for at least one year in an unregulated role in a health and social care setting in the UK. Employers will need to provide evidence of their clinical interactions in English to supplement evidence from the applicant that their training and assessment was in English.

In May 2023, we began accepting supporting information from employers for people who miss the required test score by no more than 0.5 in IELTS or half a grade in OET. The whole process is managed through NMC Online for applicants, their line managers and counter-signatories, to provide assurance of the authenticity of the information.

We’re grateful to everyone that has supported this work by sharing their views. These changes will support more skilled, internationally educated professionals to join the NMC register and make a welcome and vital contribution to people’s health and wellbeing in the UK. They also ensure that nursing and midwifery professionals have the English language proficiency to communicate with patients and colleagues clearly, sensitively, and with kindness, on the often complex issues that arise in the pressurised environments of clinical practice.

See our English language requirements

Additional documents

Additional resources that were developed as part of the consultation:

Britain Thinks report

CRELLA report to the NMC

Public consultation document (English)

Public consultation document (Welsh)

NMC literature review document

Test combining examples

OET report