We launched the new Test of Competence for nurses and midwives on 2 August 2021.

As well as reflecting our new standards for nurses and midwives, we've made some other changes to the test:

  • The CBT is split into two parts: Part A will cover numeracy and Part B will cover clinical questions related to nursing or midwifery.
  • The OSCE has ten stations, rather than six, to assess additional skills as well as the candidate’s values and behaviours, and evidence-based practice.

This guide covers how to prepare for and take the ToC for nurses and midwives.

We have a different guide if you're taking the nursing associate ToC.

We use the Test of Competence (ToC) to assess the skills and knowledge of people applying to join our register from overseas or rejoin our register after a long period away from practice.

Who needs to take the Test of Competence?

Applying for initial registration

Regulations passed by the UK Government following the UK's departure from the EU allow for certain EU general nursing and midwifery qualifications to be recognised.

If you have a relevant European qualification that meets the requirements for automatic recognition, we’ll recognise your qualification and you won’t need to take the Test of Competence.

This applies even if you are not an EU national, but you have a relevant European qualification.

Check if your qualification is on the list of European qualifications that meet the requirements for automatic recognition.

If you do not hold a relevant European qualification, you will need to take a Test of Competence as we cannot recognise your qualification.

Applying for readmission

If you don’t have enough practice hours for readmission to the register, you can either complete an approved return to practice programme or take a Test of Competence to meet the practice hours requirement.

What does it involve?

Each Test of Competence is split into two parts:

  • A multiple-choice computer based test known as the CBT.
  • A practical test known as the OSCE.

You will need to take a test that's specific to the part of the register you're applying to join or rejoin. These are:

  • adult nurse (RNA)
  • mental health nurse (RNMH)
  • learning disabilities nurse (RNLD)
  • children’s nurse (RNC)
  • midwife (RM)
  • nursing associate (NAR)

How long is it valid for?

You must pass the CBT and OSCE within two years of each other. 

You can sit your CBT or OSCE in any order, but you need to complete both parts to continue with your application for initial registration or readmission.

Once you have successfully passed both the CBT and OSCE, your ToC will remain valid for five years.

Test of Competence review

Since 2019, we've been working in partnership with AlphaPlus to develop a new test that reflects our new standards for nurses and midwives.

We launched the new version of the test for nurses and midwives on 2 August 2021, and on 31 January 2022, for nursing associates. This is known as the Test of Competence. 

From 2 August 2021, until 31 January 2023, eligible candidates were able to complete their registration taking the legacy Test. This transition period ended on 31 January 2023. Since this date, no candidates are allowed to take the legacy CBT or OSCE.  

Number of OSCE test providers increased to five

In October 2021, we announced that we had awarded contracts to five partners to deliver the OSCE from February 2022 onwards.

As well as renewing our contracts with our current OSCE delivery partners – Oxford Brookes University, the University of Northampton and Ulster University – we awarded contracts to Leeds Teaching Hospitals NHS Trust and Northumbria University. This followed a competitive and open bidding process across all four countries of the UK.

By increasing the number of test sites we've increased capacity and improved accessibility for those taking the OSCE. This will support us in meeting demand and to get those professionals with the right skills and knowledge on our register as safely and quickly as possible.

Candidates are now able to book their tests at Northumbria University Test of Competence and Leeds Teaching Hospitals NHS Trust.

Find out more about the OSCE and our OSCE delivery partners