More support needed for international nurses and midwives

Published on 04 October 2022

The Nursing and Midwifery Council (NMC) is calling on health and care employers to fully support internationally trained professionals into UK practice – and join with UK trained nurses and midwives to create the most inclusive environment possible.

NMC data published in the summer showed a big rise in the number of professionals joining the register for the first time last year. And almost half – 23,444 – had trained outside the UK. That’s 135 percent more than the previous year’s 9,962 international joiners.

Further analysis published today shows almost all international joiners to the NMC register are nurses – less than half a percent are midwives. The overwhelming majority are registering with us as adult nurses, reflecting most international training practices, which use a registered general nurse qualification. This means few professionals are joining the register as children’s or mental health nurses, and last year only one person registered as a learning disabilities nurse.

Almost half the international joiners last year were aged 30 or under, and a similar number were in their 40s. Only five percent were 41 and above compared to 14 percent of UK joiners. Many are settling in and around London, however NMC data does show professionals moving to all corners of the UK and throughout England.

Of the top 20 countries of training, four – Nigeria, Ghana, Nepal and Pakistan – were on the World Health Organisation’s ‘red list’ in 2021–2022. This means active recruitment wasn’t permitted from these countries in line with the Department of Health and Social Care (DHSC) Code of practice for the international recruitment of health and social care personnel in England. The Code doesn’t stop individual professionals from seeking employment independently.

The NMC has previously highlighted that two thirds of international joiners last year came from just two countries: India and the Philippines. There has also been significant growth in the number of joiners who trained in Nigeria, accounting for 13 percent of last year’s total. The next three most common countries of training are also in Africa: Zimbabwe, Ghana and Kenya.

84 percent of international joiners are Asian – Indian, Asian – Filipina/Filipino, or Black – African. The NMC’s data also shows that international joiners are more likely to be men than their UK trained counterparts – almost one in five international joiners are men, but overall, only 11 percent of professionals on the register and nine percent of UK joiners are men.

This is important because NMC research called Ambitious for Change has found that professionals who are men and those who are Black are referred into our fitness to practise process disproportionately by employers. Most of the professionals the NMC spoke to said they felt one or more of their diversity characteristics played a part in their referral from their employer and said an ‘insider/outsider’ culture left them feeling unsupported.

The NMC is currently developing a new workshop for professionals and employers called, ‘Welcome to the UK Workforce’. This will aim to:

  • prepare internationally recruited nurses and midwives for the cultural and ethical differences of working in the UK
  • set the tone for a positive regulatory relationship and raise awareness of the NMC’s role
  • improve retention of internationally recruited nurses and midwives
  • reduce the number of NMC referrals of internationally recruited nurses and midwives.

Andrea Sutcliffe, NMC Chief Executive and Registrar, said:

“Internationally trained nursing and midwifery professionals working in the UK make a vital and welcome contribution to people’s health and wellbeing. It’s important they are fully valued and supported and we cannot take them for granted.

“The detailed analysis we’ve published today reveals that the profile of international professionals registered in 2021–2022 is very different from UK joiners and the register they joined. They’re more likely to be men and they’re much more likely to be ethnically diverse. This matters because our Ambitious for Change research shows employers make disproportionately high referrals of Black people and men to our regulatory processes. A quarter of international joiners are Black, and almost a fifth are men.

“Our data also shows that four ‘red list’ countries were among the top 20 countries of training last year. The Department of Health and Social Care has a code of practice to make sure employers recruit ethically in the NHS and in the private sector. We’re calling on employers to be mindful of this, although we appreciate that people from across the world want to come and work in the UK.

“Working with employers and our other partners, we want to make sure internationally trained nurses and midwives are fully supported. Together we must create the most inclusive environment possible – one that supports international recruits to thrive not just survive.”


  • This report is supplementary to our annual registration data report for 2021–2022, published on 18 May 2022.
  • ‘Joiners’ means people joining the NMC permanent register for the first time. People returning to the register after a break are not included in this data.
  • The NMC is not responsible for recruitment of professionals to the register. DHSC has a code of practice for international recruitment to make sure employers recruit ethically in the NHS and in the private sector. Our role is to make sure that people who meet our standards can join the register quickly and safely.
  • Nepal was on the WHO ‘red list’ in 2021–2022, the period this data covers.

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