Summary of impacts to April 9 immigration rule change to Healthcare Visas and Skilled Worker Visa

LONDON April 13: Here is the impacts of the changes to the UK immigration policy as of April 9, 2025. NHS Employers have published information on how changes to the immigration system will impact international recruits across NHS trusts, following the UK government update on April 9.

Latest Updates
1) Care providers in England seeking to recruit care workers and senior care workers from overseas, or those switching from another visa route, must provide proof that they have attempted to recruit a worker resident in England through working with Regional Partnerships.
2) Minimum salary thresholds increased to £25,000 (£12.82 per hour), which applies to Skilled Worker and Health and Care visa holders on Agenda for Change pay scales.
3) Deductions from a sponsored worker’s salary for business costs, immigration costs or business investment will need to be considered when determining salary thresholds.
4) Certificate of Sponsorship fees increased to £525 for new work visas as well as renewals, and immigration and visa fees increased by 7 per cent.

Care worker restrictions
Care workers (SOC 6135) and senior care workers (SOC 6136) recruited after 11 March 2024 cannot bring dependants when they migrate to the UK. All other occupation codes can continue to bring dependants as normal.
Only CQC-registered providers can sponsor care workers in England.
Care providers seeking to recruit a new worker from overseas, or those switching from another visa route, for a role in England, after 9 April 2025 must first confirm that they have attempted to recruit a worker resident in England who is in need of new sponsorship because their employer has lost their licence or not provided them with sufficient work, or have been identified as requiring a new sponsorship. This will not apply to international workers who are already being sponsored as a care worker or senior care worker, or where providers are seeking to sponsor someone switching from another immigration route who has already been working for them for at least three months.

Salary thresholds
Certificates of Sponsorship issued after 9 April 2025 will see the minimum salary threshold for Skilled Workers increase to £25,000 per year (£12.82 per hour) from £23,200 (£11.90). This is the absolute base general threshold and will apply to those extending their visas and new applicants.
The increase also applies to the Health and Care Visa route for those occupations paid by NHS bands. Minimum rates increase to reflect the latest national pay scales or £25,000 (whichever is higher).
This means that entry-level Band 3 roles that do not receive a High-Cost Area Supplement (HCAS) will not be eligible for international sponsorship. Employers will need to wait until the Agenda for Change 25/26 pay award is announced to determine if it will be above the £25,000 salary threshold.
Band 3 roles that require renewals on the top step point of the Agenda for Change 24/25 pay scales will meet the required skills and salary threshold and can continue to be sponsored.
Roles that are not on a national pay scale or the Immigration Salary List will need to meet a general salary threshold of either £29,000 or the lower going rate for the role, whichever is higher. This will apply to both new applications and to extensions to existing visas.
The salary threshold for a general Skilled Worker Visa (such as data analysts, IT and finance professionals, etc) sponsored by an NHS organisation will need to meet a salary threshold of at least £38,700.
When assessing salary thresholds, employers who recoup business costs, immigration costs or business investments (such as visa fees) via repayment clauses will need to count this against the salary stated on their Certificate of Sponsorship. If this takes the salary below the relevant eligibility requirements, then the individual will not be able to apply for a visa.
Those already on a Skilled Worker Visa before 4 April 2024 are exempt from the £38,700 salary threshold (and standard going rates) when they change occupation or sponsor, or settle. However, they will be required to meet the lower salary threshold (and lower going rate) for their role (and their pay should progress in line with resident workers).

Immigration Health Surcharge
The Immigration Health Surcharge has increased to £1,035 per person per year for those required to pay, such as skilled workers and their dependants. There is a lower surcharge of £776 per year for applicants under age 18. All Health and Care Visa holders will continue to be exempt from paying the Immigrational Health Surcharge (IHS).

Certificate of Sponsorships and Visas costs
From 9 April 2025, Certificate of Sponsorship fees increased from £239 to £525, and immigration and visa fees increased by 7 per cent. Certificate of sponsorship costs should be paid by the sponsor and not passed on to the individual. The new fees will apply to new visa applications and renewals for all working visas, including Skilled Worker Visa and Health and Care Visa.

Immigration Salary List
The Immigration Salary List (ISL) replaced the Shortage Occupation List (SOL) from 4 April 2024. Occupations on the ISL can be recruited to on a salary below the general salary threshold. These occupations will still need to meet a threshold of either £25,000 (for Health and Care Visas), £30,960 (for general Skilled Worker visas), or their occupation-specific threshold, whichever is higher.

Family visas
The minimum income requirement for family visas increased to £29,000 from 11 April 2024. The plans to increase the family visa salary threshold to £38,700 are on hold until a MAC review is complete. The salary threshold will stay at £29,000 pending completion of the review.
Below is a description of how these changes will impact various international staff across the NHS and social care. All scenarios are based on the Agenda for Change pay scales 2024/25, which are subject to annual review.
The Home Office intends to continue updating going rates each April based on the latest available salary data. Employers should bear in mind that the current going rates may increase for future applications.

Health and Care Visa
Applies to those on a Health and Care Visa (such as nurses, doctors, allied health professionals, etc).
The Health and Care Visa is a sub-type of the Skilled Worker Visa. During the application process, candidates will be asked if they are applying for a Health and Care Visa and will need to select ‘yes’.
Only CQC-registered providers in England will be able to sponsor care workers or senior care workers.
The cost of a Certificate of Sponsorship is £525 and applies to both new work visas and renewals. The fee should be paid by the sponsor and not passed on to the individual.
Salary threshold – national pay scale roles: the minimum salary threshold is £25,000 for occupations on national pay scales where applicable. This will apply to both new applications and to extensions to existing visas.
Salary threshold – not on national pay scale roles: the general salary threshold is £29,000 for occupation not on national pay scales (such as biomedical scientists). This will apply to both new applications and to extensions to existing visas.
Salary threshold – assessments: employers who recoup business costs, immigration costs or business investments (such as visa fees) via repayment clauses will need to count this against the salary stated on their Certificate of Sponsorship. If this takes the salary below the relevant eligibility requirements, then the individual will not be able to apply for a visa.
Immigration Salary List: for Health and Care Visa occupations on the ISL (laboratory technicians, pharmaceutical technicians, care workers and home carers, and senior care workers), the salary threshold is set at either £25,000 or their occupation-specific threshold, whichever is higher.
Immigration Health Surcharge: current and new visa holders will continue to be exempt from the IHS.
Dependants: Health and Care Visa holders can still bring dependants to the UK as part of their visa (except care workers or senior care workers). Dependants have a general right to work meaning that they can be employed by the NHS, in another sector or not work.
Regional partnerships: there is no need for employers to provide proof that they worked with regional partnerships for roles such as nursing auxiliaries and assistants (SOC 6131). This only apply to employers in England sponsoring care workers and senior care workers

Skilled Worker Visa
Applies to those roles not eligible for a Health and Care Visa (general Skilled Worker Visa) but sponsored by an NHS trust (such as IT and finance professionals, administrative staff, etc).
Salary threshold: New applications will need to meet the increased general salary threshold of £38,700. The minimum salary threshold for Skilled Workers is £25,000 per year (£12.82 per hour). This is the absolute base general threshold and will apply to those extending their visas and new applicants.
Those already in the Skilled Worker route before 4 April 2024 are eligible for a lower going rate when changing sponsor, job role or extending. The Home Office would expect their pay to progress at the same rate as resident workers in the same role; therefore, they would be subject to the updated 25th percentiles using the latest pay data when they next make an application to change employment, extend their stay, or settle. This is in-line with normal practice.
The cost of a Certificate of Sponsorship is £525 and applies to both new work visas and renewals. The fee should be paid by the sponsor and not passed on to the individual.
Salary threshold – assessments: employers who recoup business costs, immigration costs or business investments (such as visa fees) via repayment clauses will need to count this against the salary stated on their Certificate of Sponsorship. If this takes the salary below the relevant eligibility requirements, then the individual will not be able to apply for a visa.
Immigration Salary List: for occupations on the ISL, a threshold of either £30,960 or their occupation-specific threshold, whichever is higher.
Immigration Health Surcharge: they will need to pay the increased immigration health surcharge (IHS) of £1,035 per year per applicant (£776 per year for dependants under age 18).
Dependants: they can still bring dependants to the UK as part of their visa. Dependants have a general right to work meaning that they can be employed by the NHS, in another sector or not work.
Regional partnerships: there is no need for employers to provide proof that they worked with regional partnerships for roles, other then care workers and senior care workers

Social care
Only CQC-registered providers can sponsor care workers and senior care workers in England.
Care providers who were sponsoring workers in exclusively non-regulated activities (and therefore not required to be registered with the CQC) before the rules change should be able to continue to sponsor these workers, including for extensions to their visa on those terms, but not hire new ones.
The cost of a Certificate of Sponsorship is £525 and applies to both new work visas and renewals. The fee should be paid by the sponsor and not passed on to the individual.
Salary threshold: the general salary threshold for health and care worker occupations not on a national pay scale is £29,000. This will apply to both new applications and to extensions for existing visas.
Salary threshold – assessments: employers who recoup business costs, immigration costs or business investments (such as visa fees) via repayment clauses will need to count this against the salary stated on their Certificate of Sponsorship. If this takes the salary below the relevant eligibility requirements, then the individual will not be able to apply for a visa.
Immigration Salary List: for Health and Care Visa occupations on the ISL (currently including care workers and senior care workers), the salary threshold will be set at either £25,000 or their occupation-specific threshold, whichever is higher.
Immigration Health Surcharge: they will continue to be exempt from the IHS.
Dependants: Care workers and senior care workers can no longer be able to bring dependants to the UK as part of their visa. Those already in the route will be able to remain with their dependants, including extending, changing employer (within their SOC code) and settlement. Where a care worker or senior care worker was in route before 11 March 2024, but has not yet brought dependants, they can bring dependants during their sponsorship (on this visa).
Individuals who are in the UK on any other route, including where that route permits dependants, who switch into the Health and Care Visa as a care worker or senior care worker after 11 March 2024, will not be able to stay with (or bring over) dependants.
Regional partnerships: Care providers in England seeking to recruit a new care worker (SOC 6135) or senior care worker (SOC 6136) from overseas, or those switching from another visa route, after 9 April 2025 must confirm that they have attempted to recruit a worker resident in England who is in need of new sponsorship because their employer has lost their licence or not provided them with sufficient work, or have been identified as requiring a new sponsorship. This will not apply to international care workers or senior care workers who are already sponsored, or where providers are seeking to sponsor someone switching from another immigration route who has already been working for them for at least three months. This will not apply to other roles, such as nursing auxiliaries and assistants (SOC 6131).

Dependants
Dependants of those on a Health and Care Visa and Skilled Worker Visa can be employed by an NHS trust at any role regardless of skill level or salary threshold, as long as the main visa holder meets the appropriate general salary threshold.
The minimum income requirement for family visas (i.e. British citizens bringing dependents to the UK) starts at £29,000 from 11 April 2024. The incremental rise of the salary threshold to increase to £38,700 by early 2025, has been put on hold until a MAC review is complete.
From 11 March 2024, care workers and senior care workers under the Health and Care Visa will not be able to bring dependants as part of their visa application.
Care workers and senior care workers already in the route will be able to remain with their dependants, including extending, changing employer (within their SOC code) and settlement.
Where a care worker or senior care worker is in the route before 11 March 2024 but has not yet brought dependants, they will be allowed to bring dependants during their sponsorship (on this visa).
Individuals who are in the UK on any other route, including where that route permits dependants, who switch into the Health and Care Visa as a care worker or senior care worker after 11 March 2024, will not be able to stay with (or bring over) dependants.

Please see the FAQs on the NHS Employers and GOV.UK websites for latest information.