Health and Care Worker Visa to ILR: Complete 2026 Guide

Overview: the Health and Care Worker visa route

The Health and Care Worker visa is a subcategory of the Skilled Worker visa, created in August 2020 specifically for medical professionals, nurses, social workers, and adult social care workers coming to work in the UK. It provides a route to Indefinite Leave to Remain (ILR) after 5 years of continuous residence.

This visa was introduced to address critical workforce shortages in the NHS and social care sector. It offers several significant advantages over the standard Skilled Worker visa, including exemption from the Immigration Health Surcharge (IHS), a lower salary threshold, and historically faster processing times. These concessions reflect the UK government's recognition of the vital contribution that international health and care workers make to the country.

If you hold a Health and Care Worker visa, the path to ILR follows the same general framework as the standard Skilled Worker route — 5 years of continuous residence, compliance with the absence rules, and meeting salary and language requirements. However, the financial advantages are substantial. This guide covers every aspect of the journey from Health and Care Worker visa to permanent settlement.

The rules are set out in the GOV.UK Health and Care Worker visa guidance and the settlement guidance for work visa holders. Always check the latest official guidance or consult an immigration adviser for your specific situation.

Key advantages over the standard Skilled Worker visa

The Health and Care Worker visa is not a separate immigration route — it is a variant of the Skilled Worker visa with enhanced benefits. Understanding these advantages is important because they affect your financial planning throughout the 5-year qualifying period and at the point of ILR application.

The savings are considerable. A Health and Care Worker visa holder applying for ILR after 5 years will have saved over £5,000 in NHS surcharge payments alone compared to a standard Skilled Worker visa holder. With the lower visa application fee, the total savings over the 5-year period can exceed £6,000. For a family of four (main applicant, partner, and two children), the IHS exemption saves over £20,000.

Eligibility requirements for ILR

To qualify for ILR as a Health and Care Worker visa holder, you must meet all of the following requirements at the time of your application:

1. Five years of continuous residence

You must have completed 5 years of continuous residence in the UK on a qualifying visa. The Health and Care Worker visa and the standard Skilled Worker visa both count, so if you switched between the two during your qualifying period, the time accumulates. Time on the former Tier 2 (General) visa also counts.

2. Eligible role with an approved employer

You must be employed in an eligible health or social care role with a licensed sponsor. Your role must be at RQF Level 3 or above (equivalent to A-levels). The employer must be either the NHS, an NHS supplier, or an organisation providing CQC-regulated adult social care. Your employer must confirm that you are still employed in an eligible role at the time of your ILR application.

3. Salary meets the current threshold

Your salary at the time of your ILR application must meet the going rate for your SOC code or the general threshold of £29,000, whichever is higher. This is assessed at the point of application. See the salary requirements section below for full details.

4. English language at B1 level

You must demonstrate English language ability at CEFR level B1 or above. Most Health and Care Worker visa holders already met this requirement when their visa was granted. Nationals of majority English-speaking countries are exempt. Nurses and midwives registered with the NMC have typically already demonstrated English proficiency through their professional registration.

5. Life in the UK test

You must have passed the official Life in the UK test. This is a 24-question multiple-choice test with a pass mark of 75% (18 out of 24). You can take the test at any point before submitting your ILR application.

6. Absence limit compliance

You must not have exceeded 180 days of absence in any rolling 12-month period during your qualifying period. This is the same rule as the standard Skilled Worker visa. See the absence rules section for details.

Summary of eligibility requirements

Salary requirements

The salary requirements for Health and Care Worker visa holders are more favourable than the standard Skilled Worker route, but you still need to understand how they work to avoid problems at the ILR stage.

Lower general threshold

The Health and Care Worker visa has a general salary threshold of £29,000, compared to £38,700 for the standard Skilled Worker visa. This lower threshold reflects the reality that many health and care roles — particularly in social care — have lower pay scales than other skilled occupations.

Going rate still applies

Even with the lower general threshold, you must still meet the going rate for your specific occupation as published in the Immigration Rules Appendix Skilled Occupations. Your salary must be the higher of £29,000 or the going rate for your SOC code. For many NHS roles paid on the Agenda for Change scale, the going rate is straightforward to verify.

Salary at time of ILR application

The Home Office assesses your salary at the point of your ILR application, not when your visa was first granted. If the going rate for your SOC code has increased since you got your visa, you must meet the new figure. For NHS workers, regular Agenda for Change pay uplifts usually ensure salaries keep pace with going rates.

Salary comparison by route

NHS surcharge exemption

The NHS surcharge exemption is the single biggest financial advantage of the Health and Care Worker visa. Understanding how it works helps you appreciate the full cost savings of this route.

What is the Immigration Health Surcharge?

The Immigration Health Surcharge (IHS) is a fee that most visa applicants must pay to access NHS services. It is currently set at £1,035 per year per person (with a reduced rate of £776 per year for students and Youth Mobility Scheme applicants). The IHS is paid upfront when you apply for or extend your visa, covering the entire duration of the visa grant.

Complete exemption for Health and Care Workers

Health and Care Worker visa holders are fully exempt from the IHS. This means you pay £0 in health surcharge fees — both when you first apply for your visa and at each extension. You still have full, unrestricted access to NHS services.

This exemption was introduced because it was considered unfair to charge NHS and care workers for the very healthcare system they were helping to deliver.

Dependants are also exempt

Crucially, the exemption extends to your dependants. Your partner and children do not pay the IHS either. For a family, the savings multiply significantly.

Savings over the 5-year qualifying period

These are substantial sums, particularly for care workers on lower salaries. The IHS exemption alone can make the difference between the visa route being affordable or not for many families.

Eligible roles and SOC codes

Not every health-related job qualifies for the Health and Care Worker visa. The role must fall within specific occupational categories and be with an eligible employer.

Employer types that qualify

• NHS bodies: NHS Trusts, Foundation Trusts, Clinical Commissioning Groups (now Integrated Care Boards), NHS England, and other NHS organisations.
• NHS suppliers: Organisations providing services to the NHS under contract, including private hospitals treating NHS patients.
• CQC-regulated providers: Social care providers registered with the Care Quality Commission (CQC), including care homes, domiciliary care agencies, and supported living providers.

Key eligible SOC codes

The following are some of the most common SOC codes that qualify under the Health and Care Worker visa route. This is not exhaustive — check the full list in the Appendix Skilled Occupations.

Skill level requirement

All roles must be at RQF Level 3 or above. This is equivalent to A-level qualifications. Most professional health and care roles meet this threshold. Care worker and senior care worker roles (SOC 6145 and 6146) were specifically added to the eligible occupations list to address the severe shortage in the adult social care sector, despite historically being classified at a lower skill level.

Timeline: visa to ILR

The Health and Care Worker visa can be granted for up to 5 years at a time. Here is a practical timeline for the journey to ILR.

Initial visa grant (up to 5 years)

Your Health and Care Worker visa can be granted for up to 5 years in a single grant. If your initial grant covers the full 5 years, you will not need to extend before applying for ILR. If you received a shorter initial grant (e.g., 3 years), you will need to extend your visa to reach the 5-year mark. Each extension must be in an eligible role.

Year 1: settle and start tracking

• Arrive in the UK as close to your visa start date as possible to minimise the late entry gap.
• Collect your BRP within 10 days of arrival.
• Register with your professional body (NMC, GMC, HCPC, Social Work England, etc.).
• Begin logging every trip abroad from day one.
• Keep all payslips and save your P60 at year end.

Year 2-3: build your record

• Continue tracking all trips meticulously.
• If your initial visa was for less than 5 years, prepare your extension application (you will need a new CoS from your employer).
• Start studying for the Life in the UK test — early preparation gives you flexibility.
• Verify your salary still meets the going rate for your SOC code.
• Check your absence status periodically using the ILR Absence Calculator.

Year 4: active preparation

• Take the Life in the UK test. Book early — centres can have waiting lists. The test costs £50 per attempt. Practice with our free Life in the UK practice quiz.
• Begin gathering documents. Ask your employer about writing your ILR support letter.
• Ensure your passport is valid and will not expire before or shortly after your ILR application date.
• Review your full travel history against the absence rules.

Year 5: apply for ILR

• You can apply 28 days before completing the 5-year qualifying period. Use the ILR Eligibility Calculator to find your exact earliest date.
• Request your employer letter at least 2-3 weeks before your planned application date.
• Submit the SET(O) application online, pay fees, attend biometrics, and upload documents.
• Wait for the decision: 6-8 weeks (standard), 5 working days (priority), or next working day (super priority).

Absence rules

The absence rules for Health and Care Worker visa holders are identical to those for the standard Skilled Worker visa. You must not be absent from the UK for more than 180 days in any rolling 12-month period during your 5-year qualifying period.

How the rolling window works

The Home Office does not check a single fixed year — instead, every possible 12-month window across your qualifying period is evaluated. This means trips near the end of one calendar year and the beginning of the next can overlap within the same rolling window. This is the most common way people accidentally breach the rule.

Late entry gap

If you arrived in the UK after your visa start date, the gap between those two dates counts as absence. A 30-day late entry uses 30 of your 180 allowed absence days in the first 12-month window. Enter the UK as soon as possible after your visa starts.

Special considerations for healthcare shift workers

Many health and care workers have irregular shift patterns, which can make it tempting to cluster annual leave for longer trips home. Be cautious: a 4-week trip home combined with other shorter trips in the same 12-month window can bring you dangerously close to the 180-day limit. Spread your leave across the year if possible.

For a detailed explanation of how absence counting works, including how departure and return days are counted, see our complete guide to ILR absence rules. To check your current absence status instantly, use the ILR Absence Calculator.

English language requirement

To qualify for ILR, you must demonstrate English language ability at CEFR level B1 (intermediate) or above in speaking and listening. This is the same requirement as the standard Skilled Worker route.

Accepted evidence

• SELT test pass: An approved Secure English Language Test at B1 or above (e.g., IELTS for UKVI, LanguageCert, Trinity College London ISE).
• Degree taught in English: A degree from a UK university or an institution in a majority English-speaking country, or a degree taught in English that has been verified by UK ENIC (formerly NARIC).
• Majority English-speaking country national: If you are a national of a country where English is the main language (e.g., USA, Canada, Australia, Jamaica, Nigeria), you are exempt.
• Professional registration: Nurses registered with the NMC and doctors registered with the GMC have typically demonstrated English language proficiency through their registration process. This evidence may be accepted.

Previously used evidence

In most cases, if you met the English language requirement when you were first granted your Health and Care Worker visa, you do not need to take a new test. You can reuse the same evidence for your ILR application. Keep your original certificates safe.

Life in the UK test

The Life in the UK test is a mandatory requirement for all ILR applicants (with limited exemptions for those under 18 or over 65). It is a computer-based test of 24 questions drawn from the official handbook, covering British values, history, traditions, and everyday life.

• Pass mark: 75% (18 out of 24 correct)
• Time limit: 45 minutes
• Cost: £50 per attempt
• Where to book: The official Life in the UK test booking site

Most people pass first time with adequate preparation. We recommend studying for 2-4 weeks using the official handbook and taking practice tests. You can try our free Life in the UK practice quiz to test your readiness.

For everything you need to know about preparing for and passing this test, see our comprehensive Life in the UK test guide.

Application process

The ILR application for Health and Care Worker visa holders uses the SET(O) form — the same form used by all work route visa holders. Here is the step-by-step process.

Step 1: check your eligibility

Before you apply, confirm that you have completed (or will complete within 28 days) your 5-year qualifying period, that you have passed the Life in the UK test, that you have English language evidence, and that your absence record is clean. Use the ILR Eligibility Calculator to verify your dates.

Step 2: gather documents

Collect all required documents (see the documents section below). Give your employer at least 2-3 weeks to prepare the support letter.

Step 3: submit the online application

Complete the SET(O) form on the GOV.UK website. You will need to provide personal details, employment history, travel history, and declare any criminal convictions.

Step 4: pay fees

Pay the application fee (£2,885) and biometrics fee (£19.20) online. If you want priority or super priority processing, pay the additional fee at this stage.

Step 5: biometrics appointment

Attend a biometrics appointment at a UKVCAS (UK Visa and Citizenship Application Services) centre to have your fingerprints and photograph taken. You will also upload your supporting documents at this appointment, or you can upload them through the online portal.

Step 6: wait for the decision

Standard processing takes 6-8 weeks. Priority processing (£500 extra) gives a decision within 5 working days. Super priority (£800 extra) gives a decision by the end of the next working day. Once approved, your new BRP (or digital immigration status) confirming ILR will be issued.

Required documents

Prepare all documents well in advance. Missing evidence is a common cause of delays. Use our ILR Document Checklist to track your preparation progress.

Essential documents

• Valid passport: Must be current at the time of application. Also bring any previous passports covering your qualifying period for stamp evidence.
• Current BRP: Your existing Biometric Residence Permit.
• Employer letter: A letter from your employer confirming your job title, SOC code, salary, that the role is eligible under the Health and Care Worker visa route, and that they continue to require you in the role. For NHS employers, the letter should confirm your Agenda for Change band and pay point.
• Payslips: Payslips covering your qualifying period (or at minimum the last 12 months) and P60 certificates for each tax year.
• English language evidence: SELT certificate, degree certificate, or evidence of nationality from a majority English-speaking country. Professional registration evidence (NMC, GMC) may also be accepted.
• Life in the UK test pass: Your unique pass reference number or certificate.
• Travel history evidence: Passport stamps, flight bookings, boarding passes, or bank statements showing overseas transactions to corroborate your travel dates. If you used eGates, consider requesting entry/exit records from the Home Office.

Supporting documents

• Professional registration: NMC PIN confirmation (nurses), GMC number (doctors), HCPC registration (allied health professionals), Social Work England registration.
• Bank statements: To verify employment income and UK residence.
• Council tax bills or utility bills: Evidence of UK residence throughout the qualifying period.
• HMRC records: P60s and tax records confirming continuous UK employment.

Documents checklist at a glance

Costs breakdown

One of the biggest advantages of the Health and Care Worker route is the cost savings. Here is a full comparison of the costs at the ILR application stage and across the full 5-year journey.

ILR application costs

Total 5-year journey costs (single applicant)

The ILR application fee itself is the same regardless of which work visa route you are on. The major savings come from the NHS surcharge exemption and the lower visa application fees during the qualifying period. Note that no NHS surcharge is payable at the ILR stage on either route — the IHS only applies to temporary visa grants.

Dependants

Your eligible dependants can apply for ILR alongside you. This includes your partner (spouse, civil partner, or unmarried partner who has been living with you for at least 2 years) and your children under 18.

Dependant eligibility

• Your dependants must have completed 5 years of continuous residence in the UK on a dependent visa linked to your Health and Care Worker visa.
• Dependants are also exempt from the NHS surcharge for the duration of their visa — this is a significant benefit that extends to the whole family.
• Each dependant aged 18 or over must have passed the Life in the UK test and met the English language requirement.
• Children under 18 are exempt from the Life in the UK test and the English language requirement.

Dependant costs

Each dependant must pay the SET(O) application fee (£2,885) and biometrics fee (£19.20) separately. For a family of four, the ILR application fees alone total £11,616.80 (4 x £2,904.20). This is a significant sum, but remember that the family will have saved over £20,000 in NHS surcharge fees during the qualifying period.

Children born in the UK

If you have children born in the UK during your qualifying period, they may be eligible for ILR as your dependants. Children born in the UK to parents who do not have settled status are not automatically British citizens — they need to be included in your ILR application or apply separately. Once you have ILR, any children subsequently born in the UK will automatically be British citizens.

Common issues and pitfalls

Here are the most common problems Health and Care Worker visa holders encounter on the path to ILR, and how to avoid them.

1. Changing employer without following procedure

If you change employer, your new employer must hold a valid sponsor licence and assign you a new Certificate of Sponsorship (CoS). You must apply to update your visa before starting the new role. Critically, the new role must still qualify under the Health and Care Worker visa route. If you move to a role that does not qualify (e.g., a non-CQC-regulated private care provider), you may need to switch to a standard Skilled Worker visa, potentially losing your NHS surcharge exemption.

2. Breaks in employment

The Health and Care Worker visa is tied to your employer. If your sponsorship ends — whether through redundancy, resignation, or the employer losing their sponsor licence — your visa may be curtailed. You typically have 60 days to find a new sponsor or leave the UK. A gap in sponsorship does not automatically break your continuous residence, but it creates complications that the Home Office will scrutinise.

3. Role no longer qualifying

The government periodically reviews which occupations qualify for the Health and Care Worker visa. If your SOC code is removed from the eligible list, this could affect your ability to extend your visa on the Health and Care Worker route. However, if you have already been granted a visa, removal of the SOC code during your current visa period does not invalidate your existing visa. It may affect future extensions and your ILR application if the rules change before you apply.

4. Exceeding absence limits

Healthcare workers who travel home for extended periods — especially those from countries far from the UK — are at particular risk of breaching the 180-day rule. Night shifts and irregular rosters can make it tempting to take longer blocks of leave. Track every trip from day one using our ILR Absence Calculator.

5. CQC registration issues (care workers)

If you work in social care, your employer must be CQC-registered. If the CQC deregisters your employer (due to care quality failures, for example), this can affect your visa status. While this is outside your control, it is worth checking that your employer maintains their CQC registration throughout your qualifying period. You can verify registration on the CQC website.

6. Not keeping professional registration current

If your role requires professional registration (NMC for nurses, GMC for doctors, HCPC for allied health professionals), ensure your registration remains current throughout your qualifying period. A lapsed registration could affect both your employment and your ILR application.

Earned settlement and future reforms

The UK government has proposed changes to the immigration system under the "earned settlement" framework. While the details are still being finalised, the proposals may affect the Health and Care Worker route.

What is earned settlement?

The earned settlement concept involves a points-based approach to ILR eligibility, where applicants earn credits based on factors such as tax contributions, salary level, community involvement, and English language proficiency. This would replace or supplement the current 5-year continuous residence requirement.

Potential impact on Health and Care Workers

The government has indicated that essential workers — including NHS and care workers — would likely benefit from favourable treatment under any earned settlement system. However, until specific legislation is passed, the current rules remain in place. If you are currently on a Health and Care Worker visa, continue to plan based on the existing 5-year qualifying period and ILR requirements.

For the latest information on proposed reforms, see our guide to earned settlement changes.

How ILR Tracker helps

The 5-year journey from Health and Care Worker visa to ILR requires careful tracking of trips, documents, and deadlines. ILR Tracker was built specifically for this purpose.

Absence tracking with rolling windows

Log your trips and ILR Tracker automatically checks every rolling 12-month window across your qualifying period. See exactly how many absence days you have used, which windows are at risk, and how many safe travel days remain. This is especially valuable for healthcare workers with irregular shift patterns who cluster their annual leave.

Eligibility date calculator

Enter your visa start date and see your exact ILR eligibility date, including the 28-day early application window. The calculator accounts for late entry gaps and any visa extensions.

Application Planner

Track which documents you have gathered, monitor your readiness score across eligibility, documents, tests, and finances, and see a clear picture of what is still outstanding. The Application Planner includes Health and Care Worker-specific document requirements.

Financial planning

See a clear breakdown of all costs involved in your ILR application. The financial planner accounts for the NHS surcharge exemption on the Health and Care Worker route, showing your true cost savings compared to the standard Skilled Worker route.

Free tools to get started

You do not need an account to try our free calculators:

• ILR Eligibility Calculator — Find out when you can apply for ILR based on your visa start date.
• ILR Absence Calculator — Check your absence days across every rolling 12-month window.
• ILR Document Checklist — See exactly what documents you need for your ILR application.
• UK Visa Cost Calculator — Calculate the total cost of your ILR journey including savings from the NHS surcharge exemption.

For ongoing tracking with saved trip history, trip import, financial planning, and application readiness scoring, create a free ILR Tracker account.