Sharp drop in international recruitment slows overall growth of UK Register

As of 30 September, the NMC Register includes 793,694 nurses (+0.7% since 1 April), 47,481 midwives (+1.9%) and 13,433 nursing associates (+5.1%). There are 6,193 dual registrants (-0.8%) who are both a nurse and a midwife. There are a record 96,593 nursing and midwifery professionals who identify as men.

This represents 0.8% growth (7,094 professionals) of the overall Register between April and September. However, during the same period in 2024, the Register grew by 1.8% (14,940 professionals).

Underlying this, the past six months have seen a 25.7% drop in the number of professionals joining the Register for the first time, and a 6.6% rise in those leaving (compared to the same period last year).

In particular, there has been a sharp fall in the number of internationally educated professionals joining the Register for the first time.

In the six months to 30 September, 6,321 international professionals joined. That’s a 49.6% drop compared to the 12,534 international joiners between April and September 2024. It is also the lowest six-monthly intake of new international professionals for five years.

This changes the overall balance of recruitment to the Register. During the April to September periods from 2021 to 2024, there was an even or near-even split of UK and international recruitment to the Register – with the proportion of international joiners always ranging from 45.7–50%.

However, from April to September this year, only 31.1% of joiners were from outside the UK.

Factors behind this may include changes for professionals on the Health and Care Worker visa.

There has also been greater emphasis on domestic recruitment in England under the NHS Long Term Workforce Plan.

Additionally, analysis by the Health Foundation last year highlighted better earnings potential in countries such as Australia, New Zealand and the US.

Despite the slowdown in recruitment from countries such as India, the Philippines and Nigeria – major sources of recruitment to the UK workforce in recent years – the NMC Register has continued to become more ethnically diverse.

There are now 286,058 nurses, midwives and nursing associates who are Black, Asian or minority ethnic. That is a third of the Register at 33.2% – an increase of 0.7 percentage points since April (277,716 professionals) and 13.2 percentage points over the last five years (since September 2020).

This makes it more important than ever that the whole health and care sector takes a zero-tolerance approach to the racism and discrimination that persists in society and in health and care. For its part as the regulator, the NMC has:

• Signed the UNISON Anti-Racism Charter
• Pledged to de-bias its regulatory processes and to eliminate disproportionate Fitness to Practise referrals received from employers in relation to ethnicity by 2030
• Increased ethnic diversity among panel members who decide on Fitness to Practise hearings involving nurses, midwives and nursing associates. 26% of lay panel members and 24% of registrant panel members are now from Black, Asian and minority ethnic backgrounds, respectively.

Paul Rees MBE, NMC Chief Executive and Registrar, said:

“The high-growth era of international recruitment appears to be ending. At the same time, domestic recruitment is steady. The resulting impact is that overall growth of the UK’s nursing and midwifery workforce has slowed sharply.

“Nonetheless, there are now more nurses, midwives and nursing associates on the Register than ever – and we regulate one in 50 working-age people in the UK. The Register has also continued to become more ethnically diverse. A third of nursing and midwifery professionals are now Black, Asian or minority ethnic.

“However, these professionals are often held back by their experiences of racism and other forms of discrimination that sadly persist in society. Some of our registrants see the situation as being worse now than at any time in the last 30 years, suggesting we have reached a crisis point.

“The whole health sector must do more to confront racism wherever it occurs, so that every nurse, midwife and nursing associate can feel safe, valued and able to deliver the high-quality care that we will all rely on at some point in our lives.”

Read this report on our registration data reports webpage.

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