Changes to overseas

registration
For applicants educated outside the European Union
and European Economic Area

Effective from autumn 2014

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This briefing provides an overview of changes to the application process for
registration in the UK of nurses and midwives educated outside of the European Union
(EU) and European Economic Area (EEA). The new process will replace the overseas
nursing programmes (ONP) and adaptation to midwifery programmes (AMP) with a
more robust application process with a test of competence at its heart. This
document details the new process and the impact on new applicants, as well as the
transition options for applicants with a valid decision letter who may be considering an
ONP or AMP.

About the Nursing and Midwifery Council

Our regulatory role is to protect patients and the public. We achieve this by
maintaining a professional register and regulating who can work as a registered nurse
or midwife in the UK.

We recognise the major contribution overseas (non-EU/EEA) nurses and midwives

make to patient care and the UK healthcare workforce and we believe it is important
that our application process is robust and fair. The planned changes offer enhanced
public protection along with an improved applicant journey and demonstrate our
commitment to equality, fairness and transparency throughout the application
process.

Background

Between February and April 2013, we reviewed our overseas registration policy and
processes and recognised the need to increase assurance of non-EU/EEA
applications that lead to UK registration. We made some immediate process changes
to strengthen public protection but also committed to a more fundamental review of
the overseas registration process.

We reviewed the approaches of other healthcare regulators in the UK and

internationally and in September 2013 we proposed that the ONP and AMP would be
replaced with a more robust application process centred on a test of competence.
The test will be based on our education and competence standards for pre-
registration and used to assess against requirements specific to either nursing or
midwifery.

We consulted with stakeholders about the proposed changes. Support for the
proposals was balanced, with many recognising the value of testing the competence
of an individual nurse or midwife.

Changes

We will launch a revised overseas application process which will introduce a test of
competence from autumn 2014 for all new non-EU/EEA educated applicants after
that date. The test will be based on current nursing and midwifery pre-registration
education and competency standards.

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The test of competence

This will consist of two parts: a computer-based multiple-choice examination and a

practical objective structured clinical examination (OSCE).

The computer-based multiple-choice examination will be accessible in many countries

around the world including those where significant numbers of non-EU/EEA educated
nurses and midwives are recruited to the UK. A list of available locations will be
published as part of the revised process. Nurses and midwives eligible for the test
who are living in the UK will be able to access the test here. Pearson Vue, a computer-
based exam provider, will deliver the test of competence at the various global
locations on our behalf.

The practical exam (OSCE) will always be held in the UK, initially at a test centre at the
University of Northampton. After an initial bedding-in period this will subsequently be
broadened out to encompass more centres.

The cost of the tests have yet to be finally agreed, however they will be clearly
identified by both test providers and published before the changes are made. Future
changes to test costs approved by us will be published by both test providers before
they are implemented.

Transition arrangements for non-EU/EEA educated applicants who have already

applied to join our register

 Applications processed before October 2014 will continue to be processed using

our current arrangements. Applicants will receive a decision letter requiring them
to complete the ONP or AMP within two years from the date of the decision letter.

 In October 2014, non-EU/EEA educated applicants who have been issued with a
decision letter prior to September 2014 will be informed of the new test of
competence and offered a choice of accessing the current programme or the
test of competence.
 For applications received from October 2014, the test of competence will be
the only route to UK registration for non-EU/EEA educated nurses and
midwives.

Application process

Non-EU/EEA educated nurses and midwives will complete an online application. At this
point the applicant will confirm they have met all eligibility requirements including the
following and will confirm that they can provide the required evidence later in the
process.

 IELTS 7.0 (academic version) or above in all sections

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  Successful completion of a three-year (or equivalent) undergraduate education
and training programme
 12 months post-registration practice experience
 A self-declaration that they are of good health and good character

The following items will be required at a later stage in the process.

 Digital copies of ID documents

 Evidence of training
 Evidence of registration
 Two employment references
 Evidence of good health and good character

After we receive this confirmation, our online registration system, NMC Online, will
provide the applicant with a candidate number for the computer-based test. The
applicant will contact the computer-based test centre to book a test date and time.
Test centre staff will seek formal assurances and conduct identity checks to ensure
the person is the correct applicant sitting the test. The applicant will then complete
the multiple-choice examination under secure conditions.

The OSCE test of competence

After the candidate successfully completes the computer-based test, we will assess
their education, training, registration and employment history to confirm they meet all
eligibility requirements. If all requirements are met, the candidate will be put forward
for the nursing or midwifery OSCE.

The applicant will book the date of the OSCE directly with the OSCE test centre. This
will allow the applicant to plan their financial and domestic arrangements for coming
to the UK.

Materials to help prepare for the OSCE will be available to all candidates. This includes
access to any documentation which may be used in the OSCE, for example, the
National Early Warning Score patient assessment documentation.

Before the test, candidates will have access to:

 outline videos of OSCEs;

 details of behaviours which indicate active listening and caring; and

 details of how they will be observed and assessed by examiners.

Before the test, candidates will be able to book a visit to the test centre to familiarise
themselves with the setting and equipment that may be used. All candidates will be
assessed in the same manner, against the same set of standards.

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Each OSCE station will have one examiner present and the exam will be video recorded
for quality-assurance purposes. All candidates will sit OSCEs which are of an overall
standardised level of difficulty.

After an applicant successfully completes the OSCE, we will complete all final ID and
documentation checks required for registration.

Benefits of the test of competence

All non-EU/EEA educated applicants will be assessed in the same manner against
either the standards for pre-registration nursing education or standards for pre-
registration midwifery education.

The new application process enables applicants to prepare for the test of
competence in their own country before relocating to the UK. This means that
candidates can take the computer-based test near to home without disrupting their
domestic life or existing nursing or midwifery role.

The computer-based examination is the first part of the test of competence and
must be successfully completed before nurses or midwives can undertake the OSCE in
the UK. This enables nurses and midwives to plan for the cost of coming to the UK to
complete the OSCE.

An applicant may not require a sponsor or employer to complete the process and so
will be at less risk from exploitation and poor recruitment practices that have been
reported to us.

The computer-based examination and the OSCE have been approved as reliable and
valid assessments that meet the pre-registration standards of competency for
nursing and midwifery education. Details of the pre-registration nursing and midwifery
standards, competencies and essential skills to be assessed will be available on our
website. Links to supporting materials will also be included.

The design and structure of the test of competence will be publically available to help
candidates prepare for the test. This information will indicate which competencies will
be assessed in the computer-based test and those which may be assessed in the
OSCE.

Each test centre will provide sample questions to ensure candidates are aware of the
style and format of questions.

The test of competence assessment policy and regulations for conduct, appeals,
complaints, reasonable adjustments and mitigation will be set by us and available for
all candidates.