Changes to UK work permits for international nurses, August 2006

On 3 July 2006 the DH announced changes to the Home Office shortage occupation list, which will impact on work permit applications for nurses. These changes are effective from 14th August 2006 and apply to all four countries in the UK.

What are the changes?

From 14 August 2006, registered nursing posts in Bands 5 and 6 of Agenda for Change are being removed from the shortage list. The shortage list will still include certain nursing posts which includes nurses employed in Bands 7 and 8 of Agenda for change and those engaged or employed in the following specialities:

• audiology
• sleep/respiratory physiology
• neurophysiology
• cardiac physiology
• operating theatre nursing
• clinical radiology
• pathology
• critical care including neo-natal intensive care

In addition, midwifery remains on the shortage list. 

Why change?

In May 2006, Work Permits (UK) asked for the RCN’s views on their recommendation to remove “all Registered Nurses and Midwives” from the national shortage occupation list, and replace this with specific specialist nursing posts. 

The recommendation was justified on the basis of “a thorough labour market research exercise” on nursing carried out by the Department of Health Workforce Review Team liaising with key stakeholders, such as the Royal College of Nursing (RCN), the Nursing and Midwifery Council (NMC), the Sector Skills Council - Skills for Health, and are now able to identify which specialist posts are still in shortage.

We were asked to provide relevant, robust evidence, if not content with this recommended approach. We pointed out that the ‘thorough’ labour market research was conducted in acute hospitals in relation to elective work.  It had no input from the Care Home sector, long term care or primary care and was an England only exercise. We said it did not seem prudent to take a UK position on the outcome of this survey.  To say it was carried out in liaison with the RCN gives a thoroughly misleading impression about the degree of our involvement.

The RCN was also very clear in its response that we did not support the decision to amend the current position. Our reasons for adopting this position include our belief that the Department of Health (DH) has very limited information in respect of recruitment difficulties or vacancies across the NHS, the long term care or Independent sector. The DH has not provided detailed evidence to support their claim that the demand and supply of nursing staff are now ‘in balance’.  Our own research, the RCN Labour Market Review and Employment Survey 2005  sets out an unstable situation in the labour market and uncertainty regarding morale and motivation, recruitment and retention.

Member survey

The RCN believes that organisations do not choose overseas recruitment as a first choice when filling a vacancy.  However, we are aware that, in some sectors of health and social care, there is a higher dependency on internationally recruited nurses.  Our member survey indicates that 23 per cent of IRN’s work in Care Homes compared to 4 per cent of UK resident nurses.

The proposal to amend the shortage list seems to be based on the unsubstantiated belief that the supply of nursing staff in the NHS is now “In Balance”, the current deficits position and the difficulties newly qualified nurses are experiencing in finding posts in the NHS. 

Whilst the RCN believes that all newly qualified nurses should have access to suitable employment, we believe that there are other solutions to the current problem; for example, the decision by the Scottish Executive to guarantee one year’s employment for all newly qualified nurses.  Those newly qualified overseas nurses in Scotland will, of course, under the new regulations require a Work Permit to undertake this employment.  We are concerned that workforce data for services outside of the NHS has not been considered.

What are the implications of the change?

Taking AFC Bands 5 and 6 off the shortage list means that employers will have to
demonstrate that they have nationally advertised the vacancy and they have been unable
to recruit a suitable applicant who is a UK resident or EEA National in order to obtain Work Permit approval.  In the case of nurses, national advertising usually means Nursing Standard, Nursing Times, NHS Jobs web site or Job Centre Plus.  Advertisements with Job Centre Plus are free of charge. 

Why does this change only apply to bands 5 & 6 nurses?

Work permits (UK) and the Department of Health believe that the UK nursing labour market has stabilised and there are no workforce shortages for certain grades of nursing staff – namely bands 5 and 6.  They believe, however, that there are still shortages in certain specialities among the most advanced and senior nurse grades in bands 7 & 8. The Government has committed to keeping this policy under review and the RCN will continue to lobby Government on changing this restrictive policy, which we believe is short term and does not take account of the wider healthcare market.

What is a band 5 and 6 nurse?

Work permits (UK) is using the NHS pay system “Agenda for Change” to provide a shortcut to identifying nurse grading and roles.  Information on job responsibility and job weight of bands 5 and 6 are available on the RCN website www.rcn.org.uk 

How does this relate to organisations outside of the NHS?

The RCN has offered to work with employer groups and Work permits (UK) to develop a system, whereby some core nurse roles outside of the NHS can be related to the AfC bands. Broadly, band 5 covers staff nurse roles – from newly qualified to experienced staff nurse (under Clinical grading this would generally cover Grades D and E) and band 6 relates to some specialist roles and some management roles (without budgetary or policy responsibilities).

Does this change mean that no new international nurses can work in the UK?

Taking bands 5 and 6 off the shortage list does not stop employers undertaking international recruitment, it only means that they have to demonstrate that they cannot fill a post with a UK resident or EEA National applicant first. If employers are unable to fill a particular nursing post following advertisement, they may then apply to the Home Office for a work permit.

Can an international nurse who is already working for an NHS Trust move to another organisation at the same Agenda for Change band? This would be a lateral move between employers.

Yes, you can move if the post in the new organisation is the same Agenda for Change Band in which you are already working.  For instance if you are a Band 5 nurse wishing to move to a new organisation, you can apply for a job within Band 5.  If you are successfully appointed, the new employer can apply for a change of work permit.  If the work permit is approved, you can then apply for further leave to remain in the UK in the new approved employment.  Work Permit application forms – WP1 are available from the website: www.workingintheuk.gov.uk . 

Further advice for nurses working within the NHS and outside of the NHS can be obtained from the RCN Immigration Advisers. 

Can an international nurse already working in an organisation be employed at a higher Agenda for Change band (going from band 5 to band 6)?

This would be an internal promotion.The employer will have to prove the post could not be filled with a UK resident or EEA National candidate before applying for a work permit and appointing an international nurse.

Can an international nurse who is working in a neighbouring organisation move to a new organisation at a higher Agenda for Change band?

This would be a promotion between employers. The new employer will have to prove the post could not be filled with a UK resident or EEA National candidate before applying for a work permit and appointing an international nurse.

Who should an international nurse already working in the UK contact to renew their work permit?

You should contact your employer at least eight weeks before your present work permit expires.  If you will continue to be employed in your present post, the employer will not need to re-advertise your post. The work permit extension application form – WP1X is available at www.workingintheuk.gov.uk. 

Who should an international nurse already working in the UK contact to renew their visa?

Once your employer has received a letter from Work Permits (UK) approving a work permit extension, they should give a copy to the employee in order that the employee may apply to the Home Office for further leave to remain in the UK in the extended employment – Form FLR(IED) obtainable from www.workingintheuk.nhs.uk . The member of staff should allow at least four weeks before the visa expires.

Does this change affect other professions? Will the Home Office be considering other groups?

No, this change only affects nurses. The Home Office is reviewing the arrangements for other groups, as staff shortages in other professions have also been significantly reduced over recent years.

How does this apply to nurses who are currently undertaking the NMC Overseas Nurses Programme and/ or a Practice Placement?

International nurses undertaking the overseas nurses programme and/or a practice placement require a permit free visa.  Further advice on appropriate visas is available from the RCN Immigration Advisers.

Can Overseas trained nurses still apply for registration with the Nursing and Midwifery Council?

Yes, the NMC has a statutory responsibility to assess all applications for registration from overseas trained nurses.  However there is a cost associated with this assessment and the opportunities for securing employment in the UK have now been reduced. Additional information is available on the NMC website. www.nmc-uk.org .

NB: Nurses should not resign from any work permit approved employment until a nwe work permit has been approved.

Further information

Here you can find general information and guidance on the changes to the Home Office Shortage Occupation list.  Should you require specific immigration advice on your personal situation, please contact the RCN Immigration Advisers.