Over 5,000 international nurses join UK register through employer-backed English language route

More than 5,000 internationally educated nurses, midwives and nursing associates have joined the UK register in the past year after employers confirmed their high standards of English, according to new data from the Nursing and Midwifery Council (NMC).

Between April 2024 and March 2025, a total of 5,316 professionals successfully registered using Supporting Information from Employers (SIFE), a flexible route introduced to recognise English language competence demonstrated in practice. This group represents around a quarter of all international registrants during the period. Of those, 63 percent were educated in India, 11 percent in the Philippines, and seven percent in Ghana.

The figures follow reforms to the NMC’s English language requirements in 2023, prompted by concerns that some skilled professionals working in UK health and care settings were narrowly missing classroom-based test scores despite showing strong communication skills in clinical environments. The NMC’s public consultation on the proposed changes received over 34,000 responses—its highest ever engagement.

SIFE allows international applicants to submit employer references confirming their ability to communicate effectively in English. To be eligible, applicants must have been educated and assessed in English in a country where English is not the majority spoken language, and must have worked for at least 12 months in the past two years in a UK health or social care setting. The reference must be signed off by an NMC registrant at the same employer.

The NMC has reported no fitness to practise concerns related to English language competency among professionals who joined the register via SIFE. The regulator will continue to monitor the impact of the route as part of its registration process, which now supports over 853,000 professionals across the UK.

Sara Kovach-Clark, Assistant Director of Policy at the NMC, welcomed the data as evidence of the positive impact of regulatory flexibility. “These data show the material impact our standards have on nursing and midwifery professions,” she said. “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.”

She added that the NMC is continuing work to modernise its standards, including a review of the Code and revalidation process, to ensure it remains a “modern, fit for the future regulator.”

The NMC has published further information and case studies about the SIFE route to support applicants and employers.

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