NHS Doctors’ Refused Tier 2 Visa Applications

International recruitment offers a rapid and immediate response to the demand for qualified, experienced healthcare professionals in the NHS. So why is the health service being hindered in its efforts to access overseas talent and ease staffing shortfalls?

Rising shortages of trained medical professionals across the NHS have been well-documented and well-publicised.

NHS staffing issues – or some would say, crisis – are being attributed to a number of factors:

  • Low supply of qualified medical practitioners in the resident labour market.
  • Failure of student nursing commissions to match demand.
  • Current focus on safe staffing levels and care standards.
  • Exodus of EU medical professionals.
  • Fall in number of EU national workers coming to UK.

A worrying state of affairs, in clear need of resolution. Which makes recent reports of overseas doctors being refused their Tier 2 visa applications to come and work in the health service somewhat baffling.

Tier 2 for highly skilled workers

The Tier 2 visa route is designed to allow non-EEA medium and highly skilled individuals to work in the UK on a temporary basis to alleviate shortages in resident labour for certain roles.

So given current healthcare staffing issues, foreign healthcare professionals would seem to be ideally suited for the Tier 2 visa.

But, as has been reported recently, a number of Tier 2 visa applications from overseas doctors have for the past two months been rejected by the Home Office.

The issue also affects individuals switching to the Tier 2 visa, who may already be in the UK, but are now unable to secure the necessary permission to work under a new visa.


Initial speculation was that the refusals were due to immigration criteria being tightened, presumably by some under-the-radar change in Home Office policy.

But there’s no clear evidence that this is the case. The salary thresholds for the Tier 2 visa have not changed. Likewise, the Tier 2 annual quota set in 2011 by the Coalition government (at a level driven largely by a broader aim to lower net migration) has also remained the same.

So what has changed?

The Tier 2 route is limited each year to a quota of 20,700 Certificates of Sponsorship (CoS), divided into monthly allocations.

When CoS applications fall below the monthly allocation, they are carried over to the next month to be drawn against by new applications. At the year-end in April, the reset button is pressed.

When applications exceed the month’s allocation of Tier 2 visas, priority is given to high-scoring applicants, such as those filling a shortage or PhD-level occupation, those with a higher salary.

Looking at the most recent Home Office figures for allocations of Certificates of Sponsorship, an unprecedented number of ‘exceptional grants’ were allocated outside of the usual allocation process in December (388), resulting in CoS applications exceeding the allocated quota and crucially meaning the available CoS were granted as priority to applications with higher points scores.

The result – doctors on lower salaries who would otherwise and ordinarily be eligible under Tier 2, have seen their applications rejected.

Who these exceptional CoS were granted to isn’t clear at this point, but they have in effect been given precedence over NHS doctors.

This causes issues on a number of levels.

First, how is the NHS to resolve the very real staffing shortages if they are being prevented from filling vacancies by a numbers game?

The NHS has to operate business as usual, high standards and patient care.

In the absence of alternative solutions, international recruitment offers a rapid and immediate response to labour demand. This recent issue impacts the ability to plan for recruitment and front-line staffing.

Second, it is curious to note that Tier 2 visa priority is given on the Shortage Occupation List to applicants in certain areas of medical practice such as emergency and paediatrics.

I’d guess the logic behind giving precedence to some practitioners is based on a politically-motivated target to reduce migration and limit allowances. But surely, given the continued staffing issues, this policy needs to change to encompass all, if not a substantially broader, range of healthcare specialisms.

Third, attracting highly skilled workers is a challenge in the best of circumstances. The global market is competitive, countries offer their own special visas and allowances to attract much sought-after medical professionals (among other skilled professions). The current system is in effect turning away willing and able talent.

Applicants are required as part of the Tier 2 application process to pass an extensive recruitment and selection process including General Medical Council tests and the language tests. Any degree of uncertainty around the likely prospect of a visa rejection is likely to put candidates off applying in the first place.

Around one third of Tier 2 applications are for NHS applicants, but the debate following these recent refusals has raised the ongoing plight of already-stretched doctors, and it’s clear this allocation is still not enough.


There has been suggestion the Home Office recognises salary thresholds for example, are not adequate, which is putting off overseas candidates. But clearly the issue goes beyond individual criterion – it is the underlying immigration rules and policy that are hindering a health service in need of support.

The short answer to this recent issue is that immigration policy has not kept pace with the real world.

It remains to be seen whether this was a short-term ‘blip’ and figures return to usual levels, or whether the message to foreign medical professionals has been off-putting.

The current treatment of medical professionals under UK immigration rules is clearly unfit for purpose and needs to be looked at again, particularly since the Brexit vote and EU employee exodus will only put more pressure on staffing levels.

The arbitrary quota is preventing the healthy operation of the public health service.