Working in UK care and narrowly missed your OET score? How the NMC's SIFE route works

Many internationally educated nurses work in a UK care home or hospital as carers or healthcare assistants while they work towards NMC registration. If that is you, and you have narrowly missed an OET score, the NMC has a route designed for your situation. It is called supporting information from employers, or SIFE.

This post explains SIFE as the NMC describes it on nmc.org.uk (checked in October 2026). The NMC can change its rules, so read its SIFE pages before you rely on any of this.

What SIFE is

SIFE is a form of employer reference about your English. It is supplementary evidence: the NMC only accepts it alongside other English language evidence, never on its own.

SIFE can support you in one of two situations:

• you completed a pre-registration programme taught and examined in English, in a country where English is not the majority language, or
• you have taken two English language tests and narrowly missed the required score in any one domain, by no more than half a grade in OET (or 0.5 in IELTS).

This post is about the second situation. Note the detail: it is two attempts, and a near miss in one domain (one sub-test) only. The NMC's SIFE page does not explain exactly how it measures half a grade, or which combinations of tests count as two attempts. If you are unsure whether your scores qualify, ask the NMC directly.

The work you need to have done

By the time you submit your NMC application, you must have:

• worked in a non-registered role in a UK health or care setting (for example as a carer or healthcare assistant) for at least 12 months full time, or the same total hours part time (the full-time equivalent)
• been with the same employer for at least 12 months
• had the same line manager for at least 6 months, and no more than two line managers over the whole 12 months

The reference must come from your current employer. You must still work there when you submit your completed application.

Who signs it

Two people at your employer are involved:

• Your line manager, who must be on the NMC register (an NMC registrant) at NHS Band 6 or above, or the equivalent outside the NHS. They must have worked closely with you and seen your clinical interactions in English, with patients or people who use services, families, carers and other healthcare professionals.
• A counter-signatory, a senior manager at the same employer who signs as well. They must be an NMC registrant at NHS Band 8a or above, or the equivalent outside the NHS.

If you had two line managers during the 12 months, both complete the SIFE form.

The NMC says SIFE will not suit everyone. For example, bank or agency staff may not work closely enough with their line manager. Check that the right people exist at your employer before you plan around SIFE.

It is your employer's choice

The NMC says that providing SIFE is at your employer's discretion. They do not have to agree, even if you meet every requirement. Employers should only agree if they have seen clear evidence of your English in practice over at least 12 months. The NMC's benchmark is CEFR level C1, an international level for English, which means expressing yourself fluently and spontaneously without much obvious searching for words. If your manager is unsure, the NMC tells them not to provide it.

So the first step is a conversation. Ask your manager whether they would feel able to support you before you rely on SIFE in your plans. The NMC has a SIFE for employers page you can point them to.

Never pay for SIFE. The NMC says you should not be asked for payment or any other conditions in exchange for SIFE. If this happens, tell the NMC at overseas.enquiries@nmc-uk.org.

How it works in practice

1. Talk to your employer about SIFE.
2. If they agree, your line manager and counter-signatory give you their names and NMC PINs.
3. You nominate your employer in your MyNMC registration application.
4. Your line manager gets a link in their own MyNMC account and answers Yes/No questions about your English in practice, plus your employment details.
5. The counter-signatory then completes their part in their MyNMC account.

The NMC says you will usually need to submit your SIFE evidence and the rest of your full application before you take your Test of Competence (the NMC's CBT and OSCE exams). Your 12 months of work must be complete before you submit.

Timing traps

• Changing jobs before you submit. If you move to a new employer after your employer provides SIFE but before you submit your completed application, the NMC cannot accept that SIFE.
• Changing jobs after you submit. If you move while your application is being processed, the original SIFE can still be accepted. The NMC will also want a letter from your new employer confirming your role and dates, and that there are no concerns about your English.
• Maternity or sick leave. You can still apply using SIFE while on leave, as long as you have been with your current employer for the required time.
• Stay on any English course. If you enrolled on an English language programme through your trust or bureau, the NMC says stay on it until the NMC confirms your English evidence is enough.
• It is not a guarantee. The NMC assesses the SIFE form and your whole application before it decides.

The best plan is still the score

SIFE is a safety net for a narrow miss, and it depends on your employer agreeing. Aim to pass every sub-test outright, and treat SIFE as a backup if one domain falls just short. Clodia's free 2-minute score check shows whether Reading, Listening or clinical language is costing you the most marks, so you know where to start.

Check the current rules. The NMC sets these requirements and can change them. The authoritative source is the SIFE for applicants page on nmc.org.uk. This article is general information, not regulatory or employment advice.