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Information for internationally trained Nurse applicants

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Test of Competence 2021 for Nurses and Midwives:


The new Test of Competence (ToC) 2021 for nurses and midwives was launched on August 2, 2021.
Reflecting updated standards, the test includes changes to both the Computer-Based Test (CBT) and Objective Structured Clinical Examination (OSCE).

Test Components:
CBT is divided into Part A (numeracy) and Part B (clinical questions).
OSCE now consists of ten stations, assessing additional skills, values, behaviors, and evidence-based practice.

Who Needs to Take the Test:
Required for those applying for initial registration or readmission after a long period away from practice.
EU general nursing and midwifery qualifications may be recognized; otherwise, the Test of Competence is necessary.

Test Validity:
CBT and OSCE must be passed within two years of each other.
Validity lasts for five years upon successfully passing both components.

OSCE Test Providers:
Number of OSCE test providers increased to five.
Providers include Oxford Brookes University, University of Northampton, Ulster University, Leeds Teaching Hospitals NHS Trust, and Northumbria University.

CBT Details:
CBT comprises Part A (numeracy) and Part B (clinical).
Fees for both parts are £83, with additional fees for resits.
Pearson VUE is the CBT test provider.

OSCE Details:
OSCE has 10 stations assessing clinical, communication, values, behaviors, and evidence-based practice.

OSCE fee is £794, with a reduced resit fee for 7 or fewer stations.

Booking and Preparation:
CBT and OSCE can be taken in any order but must be completed for registration.
Preparation materials and practice tests are available.
Test results and feedback are provided within specific timelines.

Webinar Recordings:
Webinars covering different aspects of the Test of Competence 2021 are available for viewing.
All details and materials mentioned can be found on the official website provided at the end.

Proving English Proficiency for Practice in the UK
To show that you have the necessary English skills for practicing in the UK, you can provide different types of evidence. If what you submit doesn’t meet our criteria, we may ask for alternative proof.

Evidence Type 1: English Language Test Scores
You can demonstrate your English skills by achieving the required scores in tests like IELTS or OET in reading, writing, listening, and speaking.
If you’ve taken the test at least twice and missed the required scores in one area by no more than half a grade, you might use supporting information from your UK health and care employer as extra evidence, but this can’t stand alone.

Evidence Type 2: Completion of English-Taught Program
If you’ve finished a nurse, midwife, or nursing associate program in English, it can serve as evidence.
If your program was in a country not on our majority English-speaking list, you can use supporting information from your UK health and care employer as extra proof, but it can’t stand alone.
To use this supporting information, you need to have worked in a UK health or care setting for at least 12 months full time or an equivalent part-time period when applying for registration.

Evidence Type 3: One Year of Practice in an English-Speaking Country
A reference from your employer confirming one year of practice as a registered nurse, midwife, or nursing associate in an English-speaking country is accepted evidence.
This can be proven through an Academic version of IELTS or OET scores.

Important Points:
For OET, specific grade requirements apply for reading, listening, speaking, and writing.
If you’ve taken OET at least twice and missed required scores in one area by no more than half a grade, you might use supporting information from your UK health and care employer, but it can’t stand alone.
The work experience must be in an unregulated role in a UK health or care setting for at least 12 months when submitting your registration application.

As of March 11, 2024, noteworthy adjustments to the regulations governing the Health and Care Worker Visa, particularly concerning dependents, have been instituted. The Health and Care Worker Visa is specifically tailored for qualified medical practitioners, including doctors and nurses, as well as other professionals within the realms of health and adult social care. This visa allows individuals to engage in eligible positions within the NHS, its affiliates, or in the sector of adult social care.

Presently, all Health and Care Workers possess the privilege of being accompanied by a dependent partner exceeding the age of 18 and/or a dependent child under the age of 18. However, commencing from March 11, 2024, care workers classified under the Standard Occupational Classification (SOC) code 6145, and senior care workers under SOC code 6146, will no longer be permitted to bring dependents to the United Kingdom.

For those care workers and senior care workers currently within the Health and Care Worker route, provisions have been made to enable them to continue residing with their dependents. This includes the flexibility to extend their stay, change employers within the aforementioned SOC codes, and pursue settlement.

In instances where a care worker or senior care worker is already part of the Health and Care Worker route before the aforementioned amendment in Immigration Rules, and has not yet availed the opportunity to bring dependents, they will retain the right to do so during the sponsorship period on the route.

Furthermore, as of March 11, 2024, a prerequisite for care homes in England seeking to sponsor migrants under the Health and Care Worker visa route is the obligatory regulation by the Care Quality Commission (CQC). This signifies that care providers engaged in non-regulated activities before the stipulated rule change, and thus were not mandated to be registered with the CQC, can continue sponsoring existing workers under the prevailing terms. However, the recruitment of new workers under these conditions will not be permissible.

These nuanced alterations to the Health and Care Worker route are scheduled to be implemented on March 11, 2024, through a Statement of Changes to the Immigration Rules, which will be formally presented before Parliament on February 19, 2024.

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Murat Metin

UK Visa Consultant

Regulated to provide immigration advice services by the Immigration Services Commissioner. Ref No. F202000206

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