SIFE for employers

As an employer, you may be able to support your employee’s application to join the NMC register by providing evidence of their English language skills 

Contents 

What is SIFE? 

Everyone who applies to our register must show they have the necessary knowledge of English to practise safely and effectively in the UK. 

Supporting information from employers (SIFE) is a form of employer reference. It can be used to support internationally educated professionals to register with the NMC, but only alongside other forms of English language evidence. 

Only applicants who meet specific requirements are eligible to use SIFE. This to ensure that we have robust evidence of their ability to communicate effectively in English and to practise safely as a registered professional in a UK health and care setting. 

Employers should only provide a SIFE reference if they have seen clear evidence of the applicant’s English language skills in practice, over at least 12 months. As an employer, the decision to provide SIFE is at your discretion. You do not have to agree to provide SIFE, even if your employee meets the requirements for this evidence type.  

Who can use SIFE? 

SIFE is supplementary evidence, which means that we can only accept it alongside other forms of English language evidence. Applicants may be eligible to use SIFE if they have: 

  • Completed a pre-registration programme which was taught and examined in English, in a country where English is not the majority spoken language 

or  

  • Attempted two English language tests and have narrowly missed the required score in any one language domain by no more than 0.5 in IELTS or half a grade in OET  

To use SIFE, the applicant must have: 

  • Been working in a non-registered role in a UK health or care setting, for a minimum of 12 months full-time (or full time equivalent), at the point they submit their NMC application 
  • Been working with the same employer for at least 12 months, and had the same line manager for at least 6 months 
  • Had no more than two line managers over the whole 12-month period 

The SIFE reference must be from the applicant’s current employer. This means the applicant must still be working with the employer who provided SIFE at the point when they submit their completed NMC application.  

Who can provide SIFE? 

SIFE must be provided by the applicant’s line manager, who should be an NMC registrant at NHS Band 6 (or non-NHS equivalent) or above. 

SIFE must be counter-signed by a senior member of staff at the same employer, who should be an NMC registrant at NHS Band 8a (or non-NHS equivalent) or above. 

We can accept supporting information from up to two line managers (at the same employer) to cover the 12-month period. In this scenario, both line managers will be required to complete the SIFE form, in addition to the counter-signatory. 

Providing SIFE as a line manager 

To be able to provide SIFE, the line manager must have seen substantial evidence of the applicant’s language skills in practice. They should only agree to provide SIFE if they have worked closely with the applicant and have been able to observe their clinical interactions, in English, with people who use services, their families, carers, and other healthcare professionals. 

If you are providing SIFE as a line manager, you will need to consider whether the applicant has shown they can communicate safely and effectively in a clinical setting, according to the communication requirements of the NMC Code. For more information, look at what evidence you should consider when completing SIFE. 

The decision to provide SIFE is at the discretion of the employer. If you do not feel confident that the applicant can communicate effectively in English, or you have not seen enough of their practice to confirm this, you can decline the request to provide SIFE, or indicate this when completing the SIFE form. 

Because of the requirement for close observation by the employer, we know that SIFE will not be a suitable option for all applicants. Professionals in some work settings, such as bank or agency staff, may not work closely with their line manager and may therefore not have completed enough employer-supervised practice to be able to provide this type of evidence. 

Providing SIFE as a counter-signatory 

The counter-signatory needs to hold a senior position at the same employer as the applicant/line manager, but they do not need to have worked closely with the applicant to be able to counter-sign the SIFE reference. 

The role of the counter-signatory is to check that the line manager has worked closely enough with the applicant to observe their clinical interactions in English, and taken a fair and objective approach in providing SIFE for the applicant. To assess whether the line manager’s approach has been fair and objective, you can refer to our information for line managers on what evidence to consider when provide SIFE. 

What evidence is needed for SIFE? 

To be able to provide SIFE, employers must have seen substantial evidence of the applicant’s language skills in practice.  

Line managers should only agree to provide SIFE if they have worked closely with the applicant and have been able to observe their clinical interactions in English, with people who use services, their families, carers, and other healthcare professionals. 

Employers should ensure that applicants have demonstrated key communication competencies, based on the CEFR framework and the requirements set out in our Code. Line managers may wish to refer to the resources below, when considering how applicants have demonstrated these competencies. 

CEFR language levels

We require applicants to demonstrate English language competence to CEFR (Common European Framework of Reference for Languages) Level C1 (‘Proficient User’). This means the applicant must be able to: 

  • understand a wide range of demanding, longer texts, and recognise implicit meaning 
  • express themselves fluently and spontaneously without much obvious searching for expressions 
  • use language flexibly and effectively for social, academic and professional purposes 
  • produce clear, well-structured, detailed text on complex subjects 

The SIFE application sets out a number of core skills that the applicant must have demonstrated to evidence their language proficiency. The line manager will be asked to confirm whether they have seen evidence of these skills in practice and will have the opportunity to provide any further evidence they think is relevant. These core skills and competences include: 

  • Communicating clearly and effectively in English  
  • Interacting with patients and people who use services  
  • Demonstrating clear and compassionate communication that reassures and informs 
  • Clearly relaying plans of care  
  • Clearly understanding and implementing delegated instruction 
  • Responding to feedback from patients, people who use services and families 
  • Using terms that people in their care, colleagues and the public can understand 

If the employer is at all unsure about the applicant’s ability to demonstrate such competences, they should not agree to provide SIFE. 

Communication standards and the Code

The Code sets out the professional standards that nurses, midwives and nursing associates must uphold to be registered to practise in the UK. It emphasises the need for professionals to communicate clearly and effectively, keeping clear and accurate records and sharing skills, knowledge, and experience where appropriate.  

To achieve this, professionals must (according to the Code): 

(7.1) Use terms that people in your care, colleagues and the public can understand.  

(7.2) Take reasonable steps to meet people’s language and communication needs, providing, wherever possible, assistance to those who need help to communicate their own or other people’s needs.  

(7.3) Use a range of verbal and non-verbal communication methods, and consider cultural sensitivities, to better understand and respond to people’s personal and health needs.  

(7.4) Check people’s understanding from time to time to keep misunderstanding or mistakes to a minimum.  

(7.5) Be able to communicate clearly and effectively in English.  

(8.2) Maintain effective communication with colleagues.  

(8.3) Keep colleagues informed when you are sharing the care of individuals with other health and care professionals and staff.  

(8.6) Share information to identify and reduce risk.  

It is every nurse, midwife and nursing associate’s responsibility to adhere to the Code and to preserve the safety of those receiving care. Line managers should consider these responsibilities when deciding whether to provide SIFE. 

 

External resources and supporting materials

Line managers and applicants may find the following resource useful when navigating the SIFE process and considering relevant evidence of English language proficiency. Please note this is an external supporting document and was not produced by the NMC. 

How to assess a candidate’s English language proficiency for the SIFE pathway - a Guide

What are my responsibilities as an employer when providing SIFE? 

We can only accept SIFE from NMC-registered professionals, as we want employers to consider seriously whether the applicant has the necessary level of English to engage in clinical interactions as a nursing or midwifery professional.  

When deciding whether to provide SIFE, line managers and counter-signatories should consider their responsibilities under the Code to preserve the safety of those receiving care. 

If you are asked to provide SIFE as a line manager and you do not think that the applicant has the necessary knowledge of English language, you should outline your concerns to them.  

If you are unsure whether the applicant has the required communication skills to practise safely and effectively, you should not agree to provide SIFE. 

You can agree to provide SIFE even if you do not have the capacity to employ the applicant as a nursing and midwifery professional following their registration. You do not need to have open vacancies to be able to provide SIFE, and an agreement to provide this evidence is not a job offer. It may be helpful to discuss this with the applicant before beginning the SIFE process, to ensure they are clear about what to expect. 

Applicants should not be asked for payment or any other additional conditions in exchange for receiving SIFE. 

Supporting new registrants 

All newly registered professionals need support, education and training post-registration, to ensure they can adjust to their new working environment, build confidence, and address any knowledge gaps. 

Applicants who provide English language evidence to join the register may need support from their employer to navigate any challenges involving language and intercultural communication in the workplace. This includes applicants who have passed a language test or studied or practised in an English-speaking environment, as well as those who join the register using SIFE. 

Future Fitness to Practise concerns and employer accountability 

We expect NMC-registered professionals to use their knowledge and judgement to make appropriate decisions, and to act with honesty and integrity when providing evidence for SIFE.  

If an applicant uses SIFE to join the register, and then is subject to future referrals or fitness to practise concerns, these will be investigated thoroughly and in line with our FtP procedures. If the individual’s practice is found to be impaired due to their not having the necessary knowledge of English language, we may need to look at the circumstances of their joining the register. We would need to consider whether the employer’s decision to provide SIFE was made in good faith and whether they took a fair and objective approach through this process. 

The most likely circumstance in which we would have concerns about a line manager or counter-signatory providing SIFE would be if there were an indication that the SIFE process was completed dishonestly or in bad faith, in conflict with our character requirements under the Code. We would then take appropriate action in response to any such findings. 

Concerns about proficiency  

Language proficiency 

It is a matter of professional judgement for the employer or line manager to assess whether the applicant is able to communicate safely and effectively in English in a clinical setting. While employers must have a fair process for assessing applicants’ language competence, the decision to provide SIFE is at the employer’s discretion.  

We ask line managers to consider seriously whether an applicant has the necessary level of English to engage in clinical interactions as a nursing or midwifery professional. For this reason, we only accept SIFE references from NMC-registered professionals.  

As a line manager, if you do not feel confident that the applicant can communicate effectively in English, or you have not seen enough of their practice to confirm this, you can decline the request to provide SIFE, or indicate this when completing the SIFE form. 

Clinical proficiency 

The SIFE evidence type is for applicants who have been working in unregistered practice in a health and social care setting in the UK for at least 12 months full time (or full time equivalent). Applicants who have not practised as a nurse, midwife or nursing associate for some time will need to discuss this with their line manager in the first instance, to confirm whether the manager is happy to support them through SIFE.  

It’s important to be aware that not all employers are able to support applicants through the Test of Competence which assesses their clinical proficiency for registration, nor are they obliged to cover these costs. 

The SIFE process  

The key steps in this process are: 

  • Applicants who are eligible and wish to use this evidence type should first speak to their employer about the possibility of using SIFE. 
  • The employer should consider whether they are able to support the applicant by providing this evidence. Line managers should refer to the information on these pages to assess whether they have seen enough evidence of the applicant’s English language competence. 
  • If the employer agrees to provide SIFE, the line manager(s) and counter-signatory supporting the application will need to provide their name and PIN for the applicant to enter into their NMC Online registration application. 
  • The applicant can then nominate their employer to provide SIFE via their NMC Online registration application. 
  • When the applicant has completed this step, the line manager(s) will automatically receive a link to provide SIFE information via their own NMC Online account. 
  • When providing SIFE, the line manager will need to confirm, using Yes/No responses, whether they have seen the applicant demonstrate key competencies in their use of English (for example, interacting with patients and people who use services). 
  • The line manager will also need to confirm basic details about the applicant’s employment (for example, their contract type and dates of employment). 
  • When the line manager has completed the relevant sections, they will need to submit this information via their NMC Online account. 
  • The counter-signatory will then receive a link to provide their SIFE information via their own NMC Online account.  
  • When the counter-signatory has completed their sections, they can submit their information via NMC Online. 

Please note that if you are a line manager or counter-signatory providing SIFE, the applicant will need to ask you for your PIN to enter into their NMC Online application. Using the PIN enables us to verify that you are an NMC registrant and helps to prevent any potential fraudulent activity. 

Links to provide SIFE can only be forwarded to the email addresses registered on the line manager and counter-signatory’s NMC Online account. These may not be the same as any work email address. This is to assure us that the person providing SIFE is an NMC registrant.  

We will notify the applicant once the link to provide SIFE has been sent. Please check your spam folder if you haven’t received this link. 

When should you start the SIFE process? 

There is no specified order in which the applicant must complete their Test of Competence and provide the other evidence we need as part of an application (including SIFE where relevant). However, we can only assess an application when it is complete and we have received all the relevant evidence. Our website provides a helpful pre-application checklist for applicants. 

Completing the SIFE application  

We will not review the applicant’s SIFE information until the applicant has submitted their full NMC registration application, including completing their Test of Competence.  

If the applicant moves to a new employer after providing SIFE but before submitting their completed NMC application, we will not be able to accept the SIFE application. 

If the applicant moves to a new employer after submitting their completed application, while their application is still being processed, we can accept the original SIFE application. However, we will need to see additional evidence of the applicant’s language competence to show that their language skills have not deteriorated.  

Submitting SIFE is not a guarantee that the applicant will be able to register and receive a PIN. Our team will need to assess the contents of the form against our criteria, and consider the full application before making a decision. Our standard Service Level Agreement (SLA) for assessments is 30 days.  

Maternity and sick leave 

We ask applicants to provide evidence of 12 months’ employment (or full time equivalent) at the point of application. If the applicant is currently on maternity leave or sick leave when completing their NMC application, they are still able to apply using SIFE, as long as they have been with their current employer for the required time period. 

At the point at which someone is re-joining the workforce, we expect employers to support individuals to integrate back into the workforce and practise safely, kindly and effectively. 

Manual SIFE 

If the registration application was submitted after 27 May 2023, nominating the SIFE line manager and counter signatory will happen via NMC Online.

If the registration application was submitted before 27 May 2023, the applicant will be contacted directly via a message on their NMC Online application portal to provide the details of their line manager. This will be only after we have assessed their application and have identified that they may be eligible to use Manual SIFE.

What is the difference between the automated SIFE and manual SIFE process?  

 

Automated SIFE (via NMC Online) 

Manual SIFE  

When do applicants nominate their employer?

Applicants will be asked to provide the details of their line manager(s) and counter signatory via NMC Online when completing their registration application.

Applicants can provide the details of their line manager(s) via NMC Online after they have been contacted by their NMC assessment officer via a ‘request for further information’ (RFI) message.

How will we collect the applicant's SIFE?

A secure link from NMC Online will be sent out to the applicant's line manager(s) as soon as the applicant submits their registration application. Once we have received the managers’ response, we will send a secure link to the applicant's counter signatory.

We will contact the applicant's line manager by email and ask them to provide the applicant's Manual SIFE by return email. They will need to complete Part A on the pdf attachment we send them. The applicant's counter signatory will need to complete Part B.

At what stage of the applicant's application do we contact their line manager and counter signatory?

We will contact the applicant's SIFE line manager and counter signatory once the applicant has submitted their application via NMC Online. This will show on the applicant's NMC Online tracker as the ‘application-preparation’ stage. This could be before or after the applicant takes their CBT and/or OSCE, depending on when they decide to submit their application.  

We will contact the applicant's SIFE line manager during the assessment stage of the process. This is after the applicant has completed their CBT and OSCE, and their application has been assessed by an NMC officer.

What email address is the SIFE request sent from? 

We will send the applicant's line manager a secure link from an automated ‘No reply mailbox’. This will be sent to the email address they have registered with the NMC. This may be a different address to their work email.

We will send the applicant's line manager an email from our dedicated ‘SIFE mailbox’. This will be sent to the email address they have registered with the NMC. This may be a different address to their work email.

How should an employer complete the SIFE request?

Upon receipt of the link, both the applicant's line Manager(s) and counter signatory will need to complete and submit the applicant's SIFE via NMC Online.

The applicant's line manager(s) will need to complete Part A of the pdf form we send them. Once all relevant sections of Part A have been completed, the line manager should send both Part A and B to an appropriate counter signatory to review and sign off.

How is SIFE added to the applicant's application?

Once the applicant's line manager(s) and counter signatory have submitted SIFE, the information will be added to the applicant's application automatically. We will only review this information once we have received the complete application, and it is showing at the ‘assessment stage’ on the applicant's NMC Online tracker.

The applicant's line manager will need to return the fully completed Manual SIFE (Part A and Part B) to our dedicated ‘SIFE mailbox’ that we contacted them from initially. This will then be added to the applicant's application.

What are the processing times? 

The applicant's SIFE is added to their application immediately once it has been submitted via NMC Online. We aim to assess complete applications for the first time within a maximum of 30 calendar days. We may take a further 30 days if we need to Request for Further Information (RFI) from the line manager or counter signatory if there is missing information.

We aim to assess complete applications for the first time within a maximum of 30 calendar days. If we identify that the applicant may be eligible to use Manual SIFE, we will send them a ‘Request for Further Information (RFI)’.

Once we have received a response from the applicant, we’ll aim to review the information within 30 calendar days and contact their line manager or counter signatory and request Manual SIFE.

We are making every effort to attach completed Manual SIFEs to an application as quickly as possible, within 5 working days.

How can applicants find out if their SIFE has been sent out and/or received by the NMC?

Applicants can check their NMC Online tracker. It will show as requested, received, or awaiting.

We will send the applicant a message via NMC Online once we have sent out the Manual SIFE request to their line manager(s). This will be sent as a ‘request for further information’ (RFI) update. Applicants should liaise with their manager in the first instance for further updates. Once the line manager or counter signatory has sent back the Manual SIFE to us, we will aim to attach it to the applicant's application within 5 working days and assess their application within 30 calendar days if no further requirements are outstanding.
 

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