5,000 international professionals join the register after employers vouch for their high standards of English

Between April 2024 and March 2025, a total of 5,316 internationally educated professionals successfully joined the register using supporting information from employers (SIFE) about their high standards of English.

This accounts for approximately a quarter of all nurses, midwives and nursing associates from outside the UK who joined during this time. Of these, 63 percent were educated in India, 11 percent were educated in The Philippines, and seven percent were educated in Ghana.

This follows changes to our English language requirements in 2023. We had heard that there were skilled professionals working in UK health and care who were narrowly missing out on the required test score in the classroom environment but demonstrating English language competence in practice.

We received more than 34,000 responses to our public consultation on proposals to introduce flexibility including SIFE – a record for any NMC consultation.

How does SIFE work?

SIFE – a form of employer reference – helps professionals to demonstrate their ability to communicate effectively in English, as part of their application to join the register.

International applicants can provide this information – signed off by an NMC registrant at the same employer – providing that:

• They were educated and assessed in English in a country where English is not a majority spoken language

• They have worked for their employer for a minimum of 12 months within the last two years, in practice in a health and social care setting in the UK.

We have received no fitness to practise concerns about English language competency for professionals who have used SIFE to join the register. We will continue to monitor the impact of SIFE as part of our registration process – supporting these skilled and knowledgeable professionals to join the 853,000 nurses, midwives and nursing associates across the UK.

Sara Kovach-Clark, Assistant Director of Policy at the NMC, said:

“These data show the material impact our standards have on nursing and midwifery professions. It is positive that this degree of flexibility has enabled nurses, midwives and nursing associates to join the register at a time of rising demand for care.

“We're now underway with further work to modernise our standards including a review of our Code and revalidation process – ensuring we can build an NMC which is a modern, fit for the future regulator.”

Further information:

• More information about SIFE is available here.
• Some case studies about using SIFE are available here.

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