Working and coming to work in the UK

There are many reasons to join the RCN:

• Professional development. As a professional body we support life-long learning with access to libraries, education, training, online resources, forums and networks. 
• Workplace support. As the only nursing specific trade union in the UK, we can provide you with specialist workplace support and guidance.
• Legal advice. You’ll receive comprehensive support and information from the largest in-house legal team of any UK trade union.
• Member support. We also provide practical support with immigration advice, welfare guidance to support your financial wellbeing, career coaching on CV writing, preparing for interviews, career planning, emotional support with telephone counselling and peer support for members with disabilities.

Visit our membership pages to find out more and how to join.

The NHS is the UK’s National Health Service. The four countries that make up the UK are England, Wales, Scotland and Northern Ireland. They all have slightly different health systems.

To learn more about the NHS visit:

UK wide
Full Fact: What is the NHS?

England
The King’s Fund: How does the NHS in England work? An alternative guide (video)

Wales 
NHS Wales – structure
NHS Wales Shared Services Partnership: Organisation structure of NHS Wales

Scotland 
Our NHS Scotland: NHS Scotland - how it works
Scotland's Health on the Web: About NHS Scotland

Northern Ireland
Northern Health and Social Care Trust: Health and social care in Northern Ireland
Belfast Health and Social Care Trust: Health service structure.

The Nursing and Midwifery Council (NMC) is the professional regulator for nurses and midwives in the UK, and nursing associates in England. It is illegal to work as a nurse or midwife unless you are registered with them.

For more information, visit the NMC website.

It can sometimes be difficult to decide what role is best for you.

Our nursing careers resource can help you. See the section on overseas nurse to registered nurse in the UK. It covers what you need to do, examinations, along with personal characteristics.

To join the NMC register as a nurse or midwife, you will need to pass certain tests.

Objective Structured Clinical Examination (OSCE) 
The OSCE forms part of the registration process for nurses who qualified outside the EU/EEA. Nurses and midwives who qualified inside the EU/EEA and apply to join the NMC register after 1 January 2021 must follow the same route to UK registration as nurses and midwives who trained outside the EU/EEA.

Newly arrived nurses and midwives resident in the UK must pass the OSCE within eight months of entering the UK with a Health and Care Worker visa.

For more information, please see:

• RCN guidance on preparing for IELTS, OET and OSCE exams
• NMC - OSCE and test providers
• NMC - Computer Based Test known as the CBT

International English Language Test System (IELTS) and Occupational English Test (OET)
Nurses who qualified overseas may have to complete an English language test to demonstrate their knowledge of English. The NMC currently accepts two tests as evidence of English language competence. These are the IELTS and the OET. Taking either the IELTS or OET tests may be required before registering with the NMC. 

These tests may not be required if an NMC approved pre-registration programme has been completed; if a programme was completed in a majority English speaking country; or if they had recent practice in a majority English speaking country, further details can be found on the NMC website. 

Full guidance on the evidence the NMC requires including transcripts, where you can use supporting evidence from your employer as supplementary evidence and other information can be found on the NMC’s guidance on Providing language evidence web page.

See: 

• RCN guidance preparing for IELTS, OET and OSCE exams
• NMC – English language requirement
• NMC – Guidance on registration language requirements Updated June 2023.

As a registered nurse, midwife in the UK or as nursing associate (England), you will need to revalidate with the NMC every three years. This is so you can remain fit to practise.

Find out about the requirements of revalidation, what you can do to prepare and how the RCN can support you on our revalidation page.

As an employee, you should be offered a permanent or fixed term contract. Both types of contracts are likely to be terminable by either party with a notice period. 

A contract is a legally binding document. You should always read any contract fully and make sure you understand it before you sign it.

Our contract checklist can help and as an international member coming to the UK, always check any repayment clauses.

If you are a member and need advice, contact us.

An employment contract records the terms upon which an employer agrees to employ the employee and the employee agrees to be employed.

It should be agreed and signed before employment starts.

If you are a member and your employer is trying to change your contract after it has been signed, see our contracts advice guide.

If you are considering signing a new contract, our contracts checklist can help.

Remember, if you are a member and you need support, contact us for advice.

As a nurse coming to the UK, always check your contract and any repayment clauses carefully. Your agency or employer may incur costs during recruitment, relocation and training and they may seek to recover those costs if you leave within a certain period of joining them.

Check any costs, ask for a breakdown and only sign the contract if you agree with them. Remember once signed, a contract is legally binding.

Immigration Skills Charge 
Employers should not seek to recoup the Immigration Skills Charge from employees, and employees may wish to question this with the employer if the contract offered refers to this. 

If you are a member and need support, contact us for further advice.

It is illegal for an agency based in the UK to charge a fee for finding (or trying to find) work, these charges must be paid by employers. Agencies or employers found operating unlawfully could face prosecution.  

We strongly advise that members do not use an agency if it asks for payment to find work, as this is likely to be a scam.  

If you are an RCN member and have paid an agency a fee to find you a job, please contact us for support and guidance on this issue.

You can also report any evidence of such wrongdoing to:

• Employment Agency Standards Inspectorate (for England, Scotland, and Wales)
• Employment Agency Inspectorate (for Northern Ireland)
• Gangmasters and Labour Abuse Authority: What we do

Under the Equality Act 2010, in the UK it is unlawful to discriminate against someone because of what is described as a protected characteristic. This includes:

• age
• disability
• gender reassignment
• marriage and civil partnership
• pregnancy and maternity
• race
• religion or belief
• sex
• sexual orientation.

The Act covers the whole spectrum of employment including recruitment, training, promotion, terms and conditions, redundancy, discipline and dismissal.   

The principles also apply to ‘workers’ in general (rather than simply ‘employees’) meaning that you are protected from discrimination if you are a bank or agency worker too. 

Read more about this on our discrimination advice guide.

If you are a member and believe you may have been discriminated against, it is important to contact us as soon as possible for further advice.

If your immigration status is dependent on you working in the UK, for example, those working and residing on a Health and Care/Tier 2 visa, then you are particularly vulnerable if your ability to continue working is at risk. 

If you leave your employment for whatever reason, you must obtain sponsorship to work.  If you remain in the UK and you are no longer in employment, the Home Office can take steps to reduce your current leave to remain to 60 days.  If you do not find a sponsor/employer within that timeframe, you will be expected to leave the UK.

The rules for individuals wishing to join a family member in the UK are dependent on the immigration status of the UK Resident. Not all family members are eligible to apply to come to the UK for the purpose of settlement. It is important to get advice from an accredited immigration advisor regarding family member applications. 

RCN members can get bespoke advice from our team of immigration solicitors.

If employees are sponsored by an employer to work in the UK, their spouse/partner can apply to join as the employee’s dependent in the UK and they will be allowed to work. Spouses of British citizens and those with Indefinite Leave to Remain (ILR) will also be allowed to work in the UK.

Spouses/partners wishing to come to the UK to join their spouses in any other category should seek advice from an accredited advisor with regards to the right to work in the UK.

A county court judgment (CCJ) is a decision by the county court that a debt is owed and that it must be repaid.  The court can order that the full debt must be paid in one lump sum, or that it must be paid in instalments over a period of time.  Applications to the Home Office to extend leave to remain and for settlement will ask whether you have had a CCJ.  A CCJ on its own will not lead to a refusal of leave to remain, or for indefinite leave to remain.

If you have been issued with a CCJ, you must state this truthfully on a Home Office application. The Home Office will want to see that you are acting positively to reduce the sums owed.  If you have made an arrangement to repay the debt in instalments, or that the debt has been repaid in full, you should include evidence of repayments being made.

If you are unsure as to whether a CCJ has been issued against you, you can check the official register of CCJs online here.  

If you are employed
Immigration rules do not prohibit skilled workers from leaving employment with their sponsor.  If a worker chooses to leave their employment, they can extend their leave to remain in the UK with another sponsor as long as they follow the correct process for switching employers under the immigration rules.

Once a worker leaves their employment, they are advised to seek work with a new employer promptly. The Home Office will notify the worker in writing that their existing permission to reside in the UK will be cut short to 60 days. This means that on receipt of that notification, the worker must find a new sponsor, or leave the UK.

Agency workers
If you have a poor experience with your recruitment agency, please contact us. There are guidelines and principles that all recruitment agencies must follow if they are recruiting from overseas.  This is known as the Code of Practice for the international recruitment of health and social care personnel. 

The Code sets out key principles to ensure that agencies and employers follow good and ethical recruitment practices. If a recruitment agency is found by NHS Employers to have breached the Code, this can result in removal from the list of approved agencies. This means that employers will not be able to use that agency for international recruitment.

Maternity leave 
If you are employed, you will be entitled to 52 weeks’ maternity leave. This comprises 26 weeks' ordinary maternity leave and 26 weeks' additional maternity leave. 

Maternity pay 
There are two types of maternity pay: Statutory Maternity Pay (SMP) and contractual maternity pay.

Your pay will depend on your circumstances,  see our having family toolkit for more information. 

For strike information and what this means for you as an internationally educated nurse, visit our strike hub.

You can also read about the experience of a member who has been involved in our Fair Pay for Nursing campaign.

The UK's tax authority is known as HM Revenue & Customs and often referred to as HMRC. Tax is usually deducted from salaries by employers and paid to the Revenues Collection on the employee’s behalf. The amount of tax paid depends on factors such as how much is earned. 

Further details of tax and National Insurance (NI) payments whilst working in the UK can be found on the government website. 

Visit Income tax and National Insurance contributions on the government website. 

If you are a member, our advice guides can help you with a wide range of employment issues. 

It is important that you contact us for support if you are having issues at work or if you feel discriminated against.