Education and training routes (Tiers 1 to 5)
Find out about the different Tiers of education and training for overseas qualified healthcare professionals.
Tier 1 (General): highly skilled workers
This route is now closed to new applicants and extension applicants as of April 2015.
Tier 1 (Post-study work)
This route closed to all new applicants in April 2012. This route previously granted individuals, who had graduated from a UK university under Tier 4, two years of leave to remain with the ability to work without a sponsor. From April 2012, individuals who have graduated after studying in the UK under Tier 4 will continue to be entitled to apply for leave to remain but will need to apply directly into Tier 2 (General).
Tier 2 (General): skilled workers
The Tier 2 (General) route allows NHS organisations to sponsor individuals from outside the European Economic Area (EEA) and Switzerland to fill vacancies that cannot be filled by a resident worker.
Before you can apply for entry into the UK under this Tier, you must have a valid Certificate of Sponsorship from a UK employer. The certificate of sponsorship is not an actual certificate or paper document but a unique reference number which will be issued to you by your sponsor and will form part of the documentary evidence required when making your visa application.
A certificate of sponsorship can be issued for a maximum of five years. This can be extended as long as the total stay is not more than six years, after which you may qualify for settlement. If you change employment whilst in the UK, you will need a new certificate of sponsorship from your new employer.
Please note that the Government controls the number of migrants coming into the UK to work and places a limit on the number of certificates of sponsorship that are available to issue. Doctors and nurses were removed from the overall limit in July 2018.
More information can be found on the UKVI website.
Tier 4: students
Tier 4 applies to individuals from outside the EEA who wish to study at a UK university. Individuals will need to be sponsored by the educational establishment to undertake their studies.
Students who are part of the 2020/21 intake will be able to obtain a two-year post-study work visa, which allows them to look for work after graduating for two years and then switch onto the skilled work visa if they find a suitable role. Further information is available on the UK Government website.
Some students at college or university who hold a Tier 4 visa are permitted to undertake supplementary work whilst in the UK, this depends on the level of the course you are studying and the type of sponsor you have.
For students following a course at degree level (NQF level 6 or above) with a sponsor which is a recognised body or a UK higher education institution, the following work is allowed:
- up to 20 hours a week during term time
- any duration during vacations
- employment as a postgraduate doctor or dentist on a recognised Foundation Programme
- can include work placements as part of a recognised course (no more than half of the total length of course).
For students following a course below degree level (NQF level 3, 4 or 5) with a sponsor which is a UK higher education institution, the following work is allowed:
- up to 10 hours a week during term time
- any duration during vacations
- on a work placement as part of a recognised course (no more than 33 per cent of the total length of course).
Students following a course at any level with a Tier 4 sponsor which is a publicly funded further education college (from 3 August 2015) or a private college (from 2011) are not allowed to work whilst in the UK.
Foundation Programme training for doctors and dentists
There are the following exceptions to university or college sponsorship for Tier 4:
- Two-year foundation programme for doctors - sponsorship is granted by Health Education England
- Two-year foundation programme for dentists - sponsorship is granted by Health Education England
In order to be issued with a Tier 4 visa to undertake a recognised foundation programme in either medicine or dentistry, you must have graduated from an accredited UK university with a UK degree in either medicine or dentistry. You will be issued with an extension to your Tier 4 visa by the new sponsor, to cover the duration of the foundation programme training up to a maximum of three years.
Upon completion of the foundation programme training, you will be able to apply to transfer into Tier 2 to either continue your core or specialty training or pursue another career route.
If you have successfully completed foundation programme training under Tier 4, you are entitled to apply for leave to remain by moving into Tier 2, where you meet the criteria for that route.
Health Education England (HEE) is now responsible for the sponsorship of all medical and dental trainees for their Tier 2 visa application in England. This single sponsor system means trainees will not need to apply for new sponsorship if they change employers / location in England during their training.
Guidance on the eligibility of individuals applying for entry to specialty training programmes is available on the HEE website.
Other medical and dental posts
All other doctors and dentists requiring 'limited leave to remain' must meet the requirements of the Tier 2 category.
Tier 5: temporary workers
The temporary worker category of Tier 5 allows UK employers to recruit individuals from outside the EEA and Switzerland for up 24 months through approved government schemes. Your sponsor will be an overarching body who manages the government authorised exchange scheme.
The Medical Training Initiative (MTI) is an authorised exchange scheme that provides one possible entry route for overseas doctors wishing to work in the NHS. The scheme enables suitably qualified overseas postgraduate medical specialists to undertake a fixed period of training in the UK.
The Academy of Medical Royal Colleges is the co-ordinating body in England responsible for sponsorship of the MTI scheme. See the Academy website for the MTI application forms and the MTI guide.
The temporary worker category does not include short-term skilled worker posts such as locums, these fall within Tier 2 of the system.
Tier 5: youth mobility
The youth mobility category of Tier 5 is for young people from participating countries and territories who want to come and experience life in the UK. Individual countries apply to join the Youth Mobility Scheme (YMS), and if successful, the national Government will be automatically licensed by the UKVI as sponsors to issue certificates of sponsorship to nationals of their country. Each year, the UK Government allocates a number of places on the scheme for each country and territory.
A YMS entry clearance will allow you to:
- enter the UK for a period of up to 24 months
- undertake lawful work of any type (except for working as a doctor in training) for as much of your stay as you wish.
The YMS is a temporary migration route which does not lead to settlement. Participants will be expected to leave the UK at or before the expiry of their 24-month stay.