Internationally trained professionals on our register make an important contribution to nursing and midwifery across the UK. We want to continue to improve the support we provide to our international applicants. This includes how applicants can demonstrate their English language skills.

Through our consultation, we wanted to understand the impact of our current approach, and identify areas where we can make improvements. Our consultation on English language requirements looked at two main areas.

  • Our English language test approach.
  • Whether we should consider accepting alternative evidence of English language competence. This might include employer references or postgraduate qualifications that are taught and examined in English.

These questions and answers explain some more about the context to this important review and clarify some of the issues we’re looking at in more detail.

Why do you have to consult?

Any changes to our guidance have to be made in line with our statutory obligations. This means that we need to consider the evidence and run a consultation before we can make any changes.

We have agreed to run this consultation as quickly as we can, which means we will start consulting this summer and agree proposals for any changes later this year. We know it is crucial to get our approach right so we can protect the public and support professionals.

We expect to introduce changes in autumn 2022 at the earliest.

How will you ensure the consultation and your approach are fair and inclusive?

As part of our review we have developed a new equality impact assessment (EqIA) to understand the impact of our current requirements and any future proposals on different groups of people. We are working with stakeholders from a range of communities to inform this document and ensure we consider the lived experiences of international registrants and applicants. Our public consultation will also provide an opportunity for us to engage with diverse groups of people.

We know some people say we need to do more to give everyone a fair chance of showing they are competent in English language. We recognise that our English language requirements have a particular impact on people who didn’t initially qualify in a majority English speaking country. We also know that people from a minority ethnic background are significantly overrepresented amongst our international applicants, compared to our register as a whole.

Britain Thinks, our independent partner, is helping us to run this consultation with us. They will help us to work with people from diverse backgrounds during the consultation and make sure a full range of voices are heard. We are working particularly closely with groups representing internationally qualified professionals and will be undertaking qualitative research with these groups during the consultation.

Whatever proposals we bring forward will be supported by a clear analysis of the impacts of any changes on different groups of people. Throughout our consultation, we will comply with our obligations and aims under our Public Sector Equality Duty. We want to ensure our processes are as inclusive as possible while still ensuring that everyone who on our register can communicate effectively in English.

Employer references were acceptable for people with temporary registration. Could this approach not be applied more widely?

Temporary registration was established as an emergency response to the Covid-19 pandemic, to enable us to allow people to respond to during the crisis. We set different requirements for professionals seeking to take up temporary registration as they were contributing to a time-limited emergency response. To help mitigate any concerns we placed conditions of practice on some people with temporary registration. For example, international applicants to the NMC’s register could only practise under the direction of an NMC registered professional. We are no longer accepting new applications for temporary registration, and anyone who wishes to register to work in the UK must apply for permanent registration.

We do not currently routinely accept employer references from international applicants as evidence of their English language skills. This is partly because of the diversity of settings where our applicants work and also because of concerns over how objective this type of evidence is.

In our pre-consultation engagement, we heard that some people would like us to consider employer references while others have concerns about this. As part of the review we are considering how employer references can be used in a way that ensures assure impartiality and objectivity for international applicants. We look forward to hearing everyone’s view during the consultation.

Are the test scores that you ask set at the right level?

Everyone on our register must be able to communicate effectively in English to keep people safe. While we want to ensure the register is accessible, all those on the register must demonstrate that they have the necessary knowledge of English. Last year, 23,408 professionals joined our register from overseas – the vast majority of those took an English language test.

We set the required scores for English language tests in 2019 following consultation with professionals, employers and others, taking account of wider evidence. We know that some applicants currently struggle to achieve these scores. We want this year’s review to carefully examine whether this is because of where we have set the standards or whether there may be other reasons.

We want to use the best available evidence to set test scores at the right place to both allow qualified applicants to join our register and keep people safe.

Our current tests, IELTS and OET, are administered by reputable, not-for-profit organisations and used by many regulators and other organisations around the world.

Why do some people not need to take the test?

Everyone joining our register has to demonstrate that they have a level of English that will allow them to communicate appropriately, including in clinical practice. But there are different ways that people can show this.

Applicants trained in the UK have been taught and examined in English, and have shown that they can interact in English in clinical practice. The same is true of applicants trained in a majority English-speaking country, and applicants who have practised in a registered role in a majority English-speaking country. So we accept this as evidence of effective communication in English. However, applicants trained in a non-majority English-speaking country are likely to be required to provide alternative evidence such as a language test.

Our list of majority English-speaking countries is based on the UK Border Agency’s list. We also include countries where we have independent evidence that they are majority English-speaking.