New language requirements see thousands more overseas nurses on register

Thousands more international professionals have joined the Nursing and Midwifery Council (NMC) register following the introduction of a new means of proving English language competency.

In 2023, the NMC enabled nurses from overseas to use ‘supporting information from employers’ (SIFE) to demonstrate their ability to communicate effectively in English.

This came about following reports that registered nurses who trained abroad were trapped in lower skilled and lower paid roles because they could not pass the Occupational English Test (OET) or International English Language Testing System (IELT) language exams.

Latest data from the NMC has shown that between April 2024 and March 2025, 5,316 international professionals successfully joined the register using SIFE to verify their high standards of English.

This represents around a quarter (25.7%) of the 20,671 nurses, nursing associates and midwives from outside the UK who joined the register during this time.

Of these, 63% were educated in India, 11% were educated in The Philippines and 7% were educated in Ghana.

How does SIFE work?

SIFE – a form of employer reference – helps professionals to demonstrate their ability to communicate effectively in English, as part of their application to join the register.

International applicants can provide this information which must be signed off by an NMC registrant at the same employer, so long as:

They were educated and assessed in English in a country where English is not a majority spoken language• They have worked for their employer for a minimum of 12 months within the last two years, in practice in a health and social care setting in the UK.

Who can use SIFE?

Any nursing or midwifery professionals who have completed a pre-registration programme which was taught and examined in English, in a country where English is not the majority spoken language

Any nursing or midwifery professionals who have 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

Source: The Nursing and Midwifery Council

Some applicants who have used SIFE might also have been able to join the NMC register via other routes, including OET and IELTS, the NMC told Nursing in Practice.

The NMC said it has not received any fitness to practise concerns about English language competency for professionals who have used SIFE to join the register.

A regulator fit for the future

Sara Kovach-Clark, assistant director of policy at the NMC, said the changes show the ‘material impact’ that NMC standards can have on registrants.

‘It is positive that this degree of flexibility has enabled nurses, midwives and nursing associates to join the register at a time of rising demand for care.

‘We’re now underway with further work to modernise our standards including a review of our Code and revalidation process – ensuring we can build an NMC which is a modern, fit for the future regulator,’ she added.

How is SIFE used in practice?

SIFE offers an alternative route onto the NMC register for internationally educated applications who show English competence in practice but narrowly miss out on passing English language tests.

It also offers an employer-verified route into practice for applicants whose qualification was taught and examined in English but in a country where English is not the majority language.

‘Concerns remain’

Rohit Sagoo is a Queen’s Nurse and founder and director of British Sikh Nurses – a group which represents British Sikh Nurses working in the UK.

He told Nursing in Practice that the interdiction of SIFE provided a more ‘inclusive, evidenced based’ approach to English language testing.

‘This reform reflects the realities of clinical communication, where cultural understanding and patient interaction are as important as written tests,’ Mr Sagoo explained.

‘By enabling thousands of nurses to join the register, SIFE strengthens workforce diversity and improves care for multi-ethnic communities across the NHS.’

But he warned that ‘concerns remain’ about how SIFE will work in practice, with room for ‘variability’ in employer approaches to language verification.

‘Additionally, existing frameworks often fail to reflect the multilingual realities of patient care, particularly in diverse communities,’ he said.

‘A balanced, standardised, and compassionate approach is needed, one that values workplace communication alongside cultural humility to ensure patient safety while retaining and empowering global nursing talent.’

In June, latest NMC data revealed that the number of professionals on the register had reached a record high, but overseas nurse recruitment fell for the first time in six years.

At the Royal College of Nursing (RCN) Congress in May, nurses warned of the ‘incredibly miserable’ consequences of the government’s plans to ban the recruitment of care workers from overseas.

The government has said it will close social care visas to new applications from abroad in a move to ‘end’ overseas recruitment of care workers.

Last December, figures showed a 65% annual drop in visa grants when compared with data from 2023.