The NHS has issued updated guidance to its HR and recruitment teams in response to significant changes to the UK’s immigration system, which came into effect in April 2025. The changes impact both Health and Care Worker visas and Skilled Worker routes, with new salary thresholds and stricter recruitment rules now in place for overseas hires.
These adjustments are part of a wider government strategy to reduce net migration and encourage the recruitment of British workers into key sectors such as health and social care. Employers must now demonstrate they have taken “genuine steps” to recruit domestically before sponsoring candidates from overseas — a shift that has caused concern among care providers already struggling with staff shortages.
Under the revised rules, the minimum salary threshold for new Skilled Worker visa applicants has increased from £26,200 to £38,700 per year, with some sector-specific exemptions, such as those in nursing, still applying. Care providers must also provide clear evidence of job advertising, interview records and local candidate rejections before being granted permission to recruit internationally.
The changes have prompted fears among health and social care leaders that filling critical roles will become significantly harder, particularly for smaller providers without dedicated HR or legal support. The NHS Confederation and Care England have both expressed concern that the new thresholds and evidence requirements could lead to delays and staffing gaps, especially in adult social care.
A spokesperson from NHS Employers said: “We understand and support the long-term ambition to grow the domestic workforce. However, in the short term, many providers still rely heavily on international recruitment to maintain safe staffing levels. It is essential that guidance is clear, fair and workable.”
The updated guidance advises NHS employers to review their recruitment policies, ensure all documentation is fully compliant with new Home Office requirements, and prepare for longer processing times. Training sessions and webinars are being rolled out nationally to support HR professionals in understanding the new landscape.
Recruiters within the NHS are being encouraged to plan earlier, document their recruitment efforts more rigorously, and communicate transparently with overseas candidates who may be affected. The guidance also reminds employers of their responsibilities under the Code of Practice for the international recruitment of health and social care personnel, including ethical recruitment standards and support for overseas workers.
Health leaders have warned that any slowdown in international hiring could have knock-on effects for patient care. Many hospitals, care homes and community health providers are already reporting difficulties filling essential frontline roles. Without a clear and well-funded plan to train and retain UK-born staff, critics argue the new policy risks worsening the workforce crisis rather than solving it.
Meanwhile, the Department of Health and Social Care has said that these reforms are part of a longer-term plan to invest in domestic skills. Ministers point to the NHS Long Term Workforce Plan, which includes new targets for training places, additional apprenticeships, and measures to support retention and career progression.
However, many in the sector have questioned whether those ambitions can be achieved quickly enough to address immediate challenges. The social care sector alone currently faces an estimated shortfall of 150,000 workers, and with demand rising, any reduction in international recruitment could widen that gap further.
Some stakeholders have called on the government to introduce a transition period or more flexible criteria for critical shortage roles. Others have urged for better funding for training providers and more accessible routes into health and care careers for young people, returners and career changers.
While immigration reform may address public and political pressure to reduce reliance on overseas staff, many health leaders believe the real solution lies in long-term workforce investment, fair pay, and a national conversation about the value of care work.
For now, NHS and care sector employers are being advised to act with urgency — reviewing existing sponsorships, updating job adverts and working closely with legal teams to avoid breaches that could impact future licence renewals. The months ahead will test not only policy, but the system’s ability to balance compliance with compassion and practical workforce need.