In this practical guide, we walk you through the medical and English language qualifications you need to work in the UK healthcare system. We also give you advice on how to register as a UK doctor or nurse upon arrival, expected salaries vs. cost of living in the UK and some cultural pointers to consider when working here. Let’s dive in!
The values of the NHS (National Health Service) are: community, respect, dignity, teamwork, compassion, inclusion and life improvement. Even if you want to work in the private sector, medical professionals across the UK aspire to these core values.
Working in the UK health sector can be challenging; you will be under pressure, work long hours and experience some difficult situations. At the same time, it can be an incredibly rewarding sector to work in, and the impact you can have on someone’s life is impossible to measure.
If this sounds like the working environment and values for you, then working in the UK healthcare system could be the right choice.
That being said, it is important to do research on your possible career path before deciding which area you want to move into. In this guide, we will focus on doctors and nurses, but there are a huge number of professions and opportunities in the UK. For example, check out this link to see current vacancies in the NHS.
Trainee doctors can expect to earn around £28,000 per year and consultants can earn up to around £84,000 per year. Nurses (depending on their level) can earn between £27,000–£55,000 per year. Paramedics can make between £27,000–£34,000. Pharmacists can make an average of £39,000 per year. Radiographers take home around £29,000 per year.
Pay depends on the band your position is under and the number of years you have worked. For more information, read this page about NHS bands and salary ranges.
Another concern you may have is whether you can afford to live in the UK. Like everywhere in the world, living expenses have increased. The average house price in England is now £275,000. Rent averages £725 per month. Gas, electricity and water bills average £208 per month. Food spending averages £318 per month and transport spending is about £428 per month.
Of course, these numbers vary a lot and depend on where you live in the country. For example, living in the city of Hull will be a lot cheaper than living in London, but you will receive a higher salary in London.
You will need to compare these numbers, along with any other spending (luxuries, clothing, insurance, entertainment, etc.), to your potential salary as a doctor or nurse in the UK.
To be a doctor in the UK, you need to have a medical degree. These degrees can last between four and six years. In the UK, you will graduate with an MB (Bachelor of Medicine) or an MBBS (Bachelor of Medicine, Bachelor of Surgery).
Before you think about working in the UK, you will need to do some research to see whether your country’s medical qualifications are recognised and/or whether you will need some additional training before registering.
Check out this page for international qualifications that may be recognised in the UK. It is also a good idea to make inquiries directly to the BMA (British Medical Association) or GMC (General Medical Council) to double check.
When you are sure you have the right academic training, the next step is to register for a licence to practise. It is illegal to work in the NHS, military, mental health and prisons (or to write prescriptions) without this licence.
To find out how to apply to the register for a licence to practise, contact the BMA or GMC directly. Your potential employer may also be able to help you with this process. A good starting point is the GMC’s how to register page.
The yearly cost for registering (at the time of writing) can be up to £433. There are discounts for newly qualified doctors and other groups, so check to see whether you can get a discount based on your circumstances.
Future international healthcare professionals outside the UK and EEA (European Economic Area) in addition to Switzerland also need to take a test with PLAB (Professional and Linguistics Assessment Board) to demonstrate their understanding of English. The PLAB is a two-part test: part one is a multiple-choice exam and part two is an OSCE (Objective Structured Clinical Examination), which involves a practical test of sixteen situations, each one lasting eight minutes. The pass mark required for PLAB 1 is 80% and for PLAB 2 is around 55%.
Part one of the PLAB costs £247 (rising to £255 as of April 2023). Part two costs £906 (rising to £934 in April 2023).
Before you take the PLAB, you also need to prove that you have a good level of English; we will discuss this in more detail later in this guide.
In 2024, the UK will replace the PLAB with an MLA (Medical Licensing Assessment). This is a similar two-part exam with the first part being another multiple-choice test called the AKT (Applied Knowledge Test) and the second part another type of OSCE called a CSPA (Clinical and Professional Skills Assessment). This is the test that native English speakers already take here in the UK.
The next stage of the process to become a doctor in the UK is a two-year foundation programme (FP) on which you will gain practical experience in a number of healthcare environments. You will also need to sit more tests to apply for this programme, including another multiple-choice and practical test called an SJT (Situational Judgement Test). You do not have to pay for FP training, as you will be a trainee doctor who earns a salary.
After the foundation programme, you will specialise for three years to become a GP (General Practitioner) or longer for other areas of medicine, such as consultancy in a specific medical field.
Whatever you choose to specialise in, it will take a lot of time, money and effort. You will also continue training throughout your career to broaden your skills and knowledge and keep yourself up to date with medical advances.
As with educational training for doctors, people wishing to work in the UK nursing profession also need to complete some academic and on-the-job training. There are two main ways to do this in the UK:
Both options last around four years depending on previous experience. As an international graduate, you will need to check if your academic qualifications match UK requirements. To do this, contact the Royal College of Nursing.
Graduates need to register with the NMC (Nursing and Midwife Council) to be able to practise nursing in the UK. How you join the NMC will depend on whether you in the EU or outside it. Check out the appropriate option for you on this page to find out how to register.
At the time of writing, the yearly fee for registration is £120.
Before you register, instead of the PLAB for doctors, all prospective international nursing staff need to pass a ToC (Test of Competence) before they can register. This is a two-part test that includes a CBT (Computer-Based Test), which is a multiple-choice exam, followed by a practical OSCE. You need at least a pass on both exam sections to succeed in the ToC. Here is some useful advice on how to prepare for your ToC exam.
At the time of writing, the CBT is £83 and the OSCE costs £749.
There are two ways to provide evidence for your English language skills that satisfy the requirements for working as a medical professional in the UK. These are the IELTS (International English Language Testing System) or the OET (Occupational English Test).
You will need to take the Academic IELTS exam to satisfy UK requirements and evidence your English language skills.
IELTS Academic includes a reading, listening and witing comprehension test that you take on the same day (without a break). This test lasts two and a half hours. The speaking test is 11-14 minutes. You will take this test on a different day from the written test. For more information on exam content, marking criteria etc., see the official IELTS Examinations website.
The OET (Occupational English Test) also has reading, listening and writing sections that last for two and a half hours in total. The speaking test is around 15 minutes. All these tests happen on the same day. The whole thing takes around three hours to complete. For more information, check out our full guide to the OET exam.
Apart from the similarities in format between these English exams and the fact that you can take them at a test centre or at home (make sure your country has this online service available), there are some differences.
IELTS tests your overall English ability in a more general sense even though there are different reading and writing tests that you can choose to suit work purposes. For medicine, you need to take the academic tasks. OET, on the other hand, is designed for medical professionals only.
With the OET, you must take a test for your specific subject area in medicine, nursing, radiography, physiotherapy, dentistry etc. The OET is better for people who wish to study the language they specifically need for work in medicine. The role plays in the speaking test will also be simulations of events that happen in your field.
Another difference is price. An IELTS test costs around £180 depending on whether it is online or at a centre. The OET is more expensive – around £320.
Some candidates say that OET is easier to pass than IELTS, but this is a rumour and is not supported by evidence. The best way to make your decision is to balance the price versus the importance of specifically practising medical English.
They grade the IELTS test from 1 (lowest) to 9 (the highest). The overall test score is an average of all four test parts. To become a doctor in the UK, you need to score at least band 7.5 overall with no lower than a 7.0 in any of the four test sections. The test results are valid for up to two years before you take the PLAB so timing is important!
They grade the OET exam from E (lowest) to A (highest). To be a doctor, you need to take the medicine version of the test and achieve at least a B in each of the four parts of the test. Again, your results are only valid for two years before taking the PLAB.
Doctors must use the scores from one test taken on the same day. You cannot combine scores from several different test attempts in the past to achieve an overall pass.
The grading system works the same as the IELTS for doctors. Again, you need to take the Academic version of the test. The difference with nursing is that you can take the test twice and combine your scores. You need to obtain a 7.0 in reading, listening and speaking, but only 6.5 in writing.
You can also combine your scores from two OET tests, but you cannot mix IELTS results with OET results. For nursing, you need a B in reading, listening and speaking, but only a C+ in writing. Again, for both IELTS and OET, the results are only valid for two years before you take the ToC so bear this in mind.
Many non-native English learners try to learn to speak with a standard British accent. This is a neutral accent that is spoken across the UK. However, even though the UK is a small country, there are many accents that change from region to region. Many of your patients will have regional accents that may be hard to understand.
The best way to familiarise yourself with the accent in the place you are going to work is to live there. However, watching movies and TV series is also a great strategy. Try to find something to watch that has the accent of the place you want live. For example, if you are going to live in Birmingham or the Midlands, watch Peaky Blinders or This Is England. If you want to live in Scotland, try the film Trainspotting or The Angel’s Share. For London accents, watch the popular soap opera Eastenders.
In addition, you will find that UK accents can depend on ethnicity. For example, members of the Asian, black or Chinese community may have their own pronunciation and dialect words.
Your academic and English language qualifications, in addition to your training, will give you an excellent knowledge of the technical language you will use at work.
However, many British people are unfamiliar with medical terminology and complex medical procedures or processes. When communicating about their condition, patients will use more informal and idiomatic language. It is important to know how Brits communicate in everyday life so that you can understand them correctly at work. Using similar language will also help you to appear friendlier and more compassionate towards them.
For example, when a patient describes the symptoms of severe pain, they might say something like: My leg is killing me instead of I have an acute and persistent pain in my leg. A patient is also more likely to understand: Your blood pressure is quite high instead of, You have hypertension.
When giving bad news, it is important to be clear but not too direct in order to avoid upsetting a patient. When communicating the death of someone, it is a good idea to use a lot of apologetic language to soften the blow.
For example, saying something like: I’m really sorry to tell you this, but I’m afraid that, sadly, she has died. Avoiding a euphemism, such as, she has passed, prevents misunderstanding, but really sorry and sadly help to show sympathy for the patient’s loved one.
A patient may have a condition that relates to their lifestyle. In these cases, it is important to be non-judgemental and help the patient make their own choices for a positive change.
Instead of using strong language such as: You must eat healthy food or you will face serious problems, try to ask the patient a question like, What do you usually eat for breakfast/lunch/dinner? If they answer, I eat a lot of junk food, ask them another question such as, How might you be able to improve your diet? They might respond: I could sort my snacking out and order less takeaways.
Using modal verbs like might, could and ought to is more tactful than using words like must or have to. We can further soften our delivery with expressions like: would you possibly consider, do you think you could try, might it be that, etc. Brits are famous for their indirect style and politeness in conversation. However, many overseas doctors and nurses may be considered rude or overly direct if they do not follow this same etiquette.
Knowing how to manage patient situations and use the right language is all part of your training and will help you to succeed on an OET exam, which tests for this local understanding.