This article is part of our guide: Work as a nurse in the UK.
Part of our Nursing Councils of the World series. Last checked: 9 November 2026.
The Nursing and Midwifery Council (NMC) regulates nurses, midwives and nursing associates in England, Scotland, Wales and Northern Ireland. It holds the register, sets education and practice standards, publishes The Code, runs revalidation and investigates concerns. If you trained outside the UK, you must be on the NMC register before you can work as a nurse or midwife in the UK. This guide covers each step.
Quick answer: Joining the NMC register from abroad costs about £1,226 if you pass first time, then £143 a year to stay registered.
- Qualification evaluation: £167 (NMC, non-refundable)
- CBT: £83 per sitting
- OSCE: £794 per full sitting
- Registration: £182
- English tests, visa and travel are extra. Many NHS employers refund the OSCE and registration fees. Source: NMC costs page, from 1 October 2026.
The overseas registration route, step by step
- Check you’re ready: you need a nursing or midwifery qualification, current registration in good standing in your home country, and English evidence.
- Eligibility and qualification application: open an NMC Online account, submit your identity, qualification and registration details, and pay the evaluation fee. The NMC verifies your documents with your home regulator and school.
- Test of Competence (if asked): pass the CBT (part 1, in your home country) and then the OSCE (part 2, in the UK).
- Registration application: declare your health and character, provide English evidence, confirm professional indemnity, and pay the registration fee.
- Evaluation and decision: the NMC contacts your referees, then issues your PIN.
Most internationally recruited nurses take the CBT before they travel, and then sit the OSCE within their first few weeks in the UK. During that time they work as pre-registration nurses or healthcare assistants with their sponsoring employer.
Fees (from 1 October 2026)
| Fee | Amount | Paid to |
|---|---|---|
| Qualification evaluation | £167 | NMC (non-refundable) |
| CBT, first sitting | £83 | Test provider |
| CBT resit: full / clinical only / numeracy only | £83 / £70 / £50 | Test provider |
| OSCE, first sitting | £794 | Test centre |
| OSCE resit: full (8+ stations failed) / partial (up to 7) | £794 / £397 | Test centre |
| Registration | £182 | NMC |
| Total (no resits) | £1,226 | Excludes the English test, visa, flights and accommodation |
| Annual registration fee (every year after joining) | £143 | NMC, for fee notices issued from 1 Oct 2026 |
English language requirements
You can meet the requirement in one of three ways:
- Pass an accepted test: IELTS Academic or OET (Nursing).
- Qualify in English: your pre-registration nursing or midwifery qualification was taught and examined in English. Extra conditions apply, so check NMC guidance for your country.
- Recent practice in English: one year of recent practice as a nurse or midwife in a country where English is the majority spoken language.
| Test | Listening | Reading | Writing | Speaking |
|---|---|---|---|---|
| IELTS Academic | 7.0 | 7.0 | 6.5 | 7.0 |
| OET (Nursing) | B | B | C+ | B |
- You can combine results from two sittings of the same test within 12 months, but each score must meet a minimum floor (IELTS: 6.5, or 6.0 in writing; OET: C+, or C in writing).
- Results must be no more than two years old when the NMC assesses your full application.
- OET@Home is accepted. IELTS Online and IELTS Indicator are not.
Not sure which test to take? Read our OET guide.
The Test of Competence
Part 1: the CBT
- The CBT is taken at Pearson VUE centres worldwide, including in Lagos, Abuja, Accra, Nairobi, Manila and many Indian cities.
- Part A, numeracy: 15 short-answer questions in 30 minutes. You need 13 or more correct.
- Part B, clinical: 100 multiple-choice questions in about 2.5 hours, specific to your field (adult, mental health, children’s, learning disabilities or midwifery).
- The two parts are scored separately, so you only resit the part you failed.
Part 2: the OSCE
- The OSCE is a practical exam held at NMC-approved test centres in the UK.
- For nursing, it has 10 stations: four linked stations that follow one patient scenario (assessment, planning, implementation and evaluation), four clinical skills stations, and two “silent” stations on professional values and evidence-based practice.
- If you fail up to seven stations, you resit only those (£397). If you fail eight or more, you resit the full exam (£794).
- Prepare with the NMC’s published marking criteria and mock OSCEs. Most NHS employers run in-house OSCE training for their recruits.
The CBT and OSCE have time limits and a limit on the number of attempts. If you use up your attempts, your application closes and you must wait before reapplying. Check the current rules in the NMC’s Test of Competence candidate information before you book.
After you join: staying on the register
- Pay the annual fee on time. If you don’t, your registration lapses.
- Revalidate every three years: 450 practice hours, 35 hours of CPD, five pieces of feedback, five reflective accounts, a reflective discussion and confirmation. See our full NMC revalidation guide.
- Keep your contact details up to date in NMC Online, and declare any cautions or convictions straight away.
Fitness to practise: how discipline works
Anyone can raise a concern about a nurse with the NMC: patients, employers, colleagues or the police. The NMC’s process is designed to protect the public, not to punish.
- Screening: the NMC checks whether the concern is about a registrant and raises a question about their fitness to practise. Most concerns are closed at this stage, often because the employer is dealing with them locally.
- Interim order (if urgent): where there is a serious risk, a panel can impose interim conditions or an interim suspension while the investigation continues.
- Investigation: the NMC gathers evidence, and the nurse is invited to respond.
- Case examiners: they decide whether there is a case to answer. They can close the case, issue advice or a warning, agree undertakings with the nurse, or refer the case to a hearing.
- Fitness to Practise Committee: a hearing or meeting decides the facts and whether the nurse’s fitness to practise is currently impaired.
- Sanctions: no further action, a caution order (1–5 years), a conditions of practice order, suspension (up to 12 months), or striking off.
- Appeal: to the High Court (in England and Wales) within 28 days.
Practical advice: if you receive an NMC letter, respond within the deadline. Contact your union (RCN, Unison or RCM) or a regulatory lawyer, and never ignore the letter. Insight, remorse and evidence of remediation, such as training and reflective pieces, carry real weight with panels.
Common mistakes
- Letting English test results expire while waiting for documents. Get your home council verification started early.
- Inconsistent names or dates of birth across your passport, certificates and licence.
- Booking the OSCE before you have practised the stations. A full resit costs £794.
- Not declaring a past disciplinary finding or police caution. Failing to declare is treated as dishonesty.
Read also: Band 5 to Band 6 promotion · Bringing your family on the Health and Care Worker visa · ILR for nurses
Sources: NMC, “How much is it going to cost?” for nurses and midwives trained outside the UK (fees from 1 October 2026); NMC news release on the annual fee rising to £143; NMC accepted English language tests (IELTS Academic and OET pages, checked November 2026); NMC Test of Competence 2021 specification; NMC fitness to practise guidance. Always confirm on nmc.org.uk.
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