Certificate of Sponsorship for Nurses: How to Get a CoS in 2026
A certificate of sponsorship (CoS) is not a paper certificate at all. It is an electronic record with a unique reference number that a UK employer licensed by the Home Office assigns to you once it has confirmed your job offer — and you cannot apply for the Health and Care Worker visa without one. You never apply for a CoS yourself and you never pay for it: the employer requests it, pays the £525 assignment fee, and is legally barred from passing that cost on to you. For most international nurses this is the hardest step of the whole UK journey. Here is how it works in 2026.
What a certificate of sponsorship actually is
When a licensed employer decides to hire you, it logs into the Home Office's Sponsorship Management System and assigns a CoS in your name. What reaches you is simply a reference number plus a summary of what the employer reported: your job title, salary, start date and work location. You enter that number in your visa application, and UKVI checks everything you submit against it.
Two consequences follow. First, no job offer means no CoS — the real task is winning the job, not chasing the document. Second, the CoS is the version of events UKVI treats as authoritative: if your application contradicts it — a different salary, a different start date, a name spelt differently from your passport — you invite a refusal.
Defined vs undefined CoS: which one you'll get
There are two types of CoS, and which one you receive depends only on where you apply from.
| Defined CoS | Undefined CoS | |
|---|---|---|
| Who it is for | Nurses applying from outside the UK — Pakistan, India, Nigeria, the Philippines, the Gulf | Applicants already in the UK switching visas — for example, from a Student visa after a UK nursing degree |
| How the employer gets it | Requested from UKVI individually for each overseas hire; normally approved within one working day unless extra checks apply | Assigned from the sponsor's annual allocation with no per-worker request |
As an overseas nurse you will almost always receive a defined CoS. If there is a gap between accepting an offer and receiving your number, the employer is usually waiting on UKVI or your pre-employment checks — not going cold on you.
What your CoS contains — and how long it stays valid
Check every field on the day the CoS statement arrives. It records:
- Your personal details, exactly as they appear in your passport.
- Your job title and occupation code — registered nurses come under code 2231.
- Your gross annual salary — this is the figure UKVI tests against the thresholds below.
- Your start date and the sponsorship end date.
- Your work location and the employer's sponsor licence number.
- Whether the employer certifies your maintenance — if it does, you do not need to show the £1,270 in personal savings normally required.
Three timing rules govern the CoS. You must use it in a visa application within 3 months of it being assigned, or it expires. You cannot apply more than 3 months before the start date printed on it. And it is single-use: once entered into an application — approved or refused — it is spent, and a refusal means the employer must assign a fresh one before you can reapply.
Who can sponsor nurses — and how to check the licence
Four kinds of employer sponsor most international nurses: NHS trusts and health boards, private hospital groups, CQC-registered care homes and home-care providers, and hospices. A recruitment agency cannot sponsor you to work somewhere else — the sponsor on your CoS must be the organisation that actually employs and pays you.
Before you sign anything, spend five minutes on the register of licensed sponsors — a free spreadsheet published on gov.uk and updated most working days. Search for the employer's exact legal name from your offer letter (an NHS trust's legal name often differs from the hospital name you interviewed with), and confirm it holds a Worker licence covering the Skilled Worker route. If the organisation is not on the register, it cannot sponsor anyone, whatever it has promised you — walk away.
From first application to PIN: the realistic sequence
The CoS sits in the middle of a longer chain, mapped in full on our nurses hub. For a nurse hired from overseas in 2026, the order usually runs:
- NMC groundwork. Open your NMC application, pass the CBT in your home country (£83 as of 2026) and secure your English evidence — OET or IELTS at the NMC's required level.
- Apply for jobs. NHS vacancies are advertised openly; many trusts run dedicated international recruitment rounds.
- Interview online. Usually 30–45 minutes by video: clinical scenarios, values-based questions and your NMC progress.
- Conditional offer. Subject to references, occupational health, police clearance and your NMC eligibility — most employers want your CBT passed and your NMC decision letter in hand.
- CoS assigned. Once pre-employment checks clear, the employer requests your defined CoS and emails you the reference number.
- Visa application. Apply within 3 months of assignment. The Health and Care Worker fee is £324 for up to 3 years (£628 for longer) as of 2026, most out-of-country decisions arrive within about 3 weeks, and many employers reimburse the fee.
- Travel and start work as a pre-registration nurse while preparing for the OSCE — our NMC OSCE programme covers the stations in detail.
- Pass the OSCE, receive your PIN and move onto the full Band 5 role.
End to end, budget 6–12 months from CBT to landing in the UK. Country-specific walkthroughs are in our guides for Pakistani nurses and Indian nurses.
What a typical NHS package includes — and the clawback clause
Relocation support varies by trust, but a typical 2026 international nurse package looks like this:
| Item | Typical NHS trust offer | What to check |
|---|---|---|
| One-way flight | Paid or reimbursed | Upfront payment or reimbursement after arrival? |
| Initial accommodation | Free or subsidised, commonly 4–12 weeks | Exact number of weeks, and the rent after they end |
| OSCE fee and training | First attempt (£794 as of 2026) plus in-house preparation | Who pays for a resit if you fail a station |
| Visa application fee | Often paid or reimbursed (£324/£628) | Whether dependants' visa fees are covered — usually not |
| Immigration Health Surcharge | Not needed — Health and Care Worker visa holders are exempt | Nothing; this is automatic |
| NMC application and first registration fees | Varies widely by trust | Ask directly — this is the most commonly excluded item |
| CoS fee (£525) | Always the employer's cost | Charging you is unlawful — a red flag |
| Repayment ("clawback") clause | Common: costs repayable pro-rata if you leave within 1–3 years | Read this clause twice before signing |
The clawback clause is the part of the contract to read most carefully. It is lawful for an employer to reclaim genuine relocation costs on a sliding scale if you resign early — but the amount should shrink month by month, reflect real costs only, and be stated in writing before you accept. What an employer may never recoup, at any point, is the CoS fee, the sponsor licence fee or the Immigration Skills Charge — doing so can cost them their licence.
Salary rules: what the number on your CoS must show
The Health and Care Worker route uses lower salary thresholds than the standard Skilled Worker visa. As of 2026 you must be paid at least £25,000 a year or the going rate for your occupation, whichever is higher — and for nurses the going rate follows the national pay scales, so an NHS offer at Band 5 or above clears the requirement automatically. Band 5 in England starts at a little over £31,000 under the current Agenda for Change scale; check the live scale before you sign, as it moves every April.
If your sponsor is a care home or private hospital, the same pay-scale logic applies — check the salary printed on your CoS against current nurse rates yourself. The route also cuts your costs twice over: the application fee is far below the standard Skilled Worker fee, and the Immigration Health Surcharge exemption saves £1,035 per person per year as of 2026 — well over £8,000 across a three-year visa for a nurse bringing a partner and child.
Ethical recruitment: the red list and what nobody may charge you
UK health employers recruit under the code of practice for international recruitment, which follows the WHO's health workforce safeguards list. Countries on the red list — which as of 2026 includes Pakistan, Nigeria and Ghana — cannot be actively targeted by UK employers or agencies. Crucially, this does not stop you: direct applications you make yourself remain fully allowed, which is exactly how thousands of nurses from red-list countries are hired each year. Our guide for Nigerian nurses covers what this means in practice. India and the Philippines sit under government-to-government agreements, so managed active recruitment there is permitted.
Now the warning. It is illegal for a UK recruitment agency to charge you a fee for finding you work, and a CoS is never for sale — it costs the employer £525 and cannot lawfully be sold or recharged. Every offer of "a guaranteed certificate of sponsorship" for £5,000–£15,000 is a scam, and paying does not just lose your money — a bought CoS risks refusal and a ban. A legitimate process always runs job first, interview second, checks third, CoS last, and at no stage does money flow from you to the employer or agency. If a payment demand appears, stop and re-check the sponsor register.
Frequently Asked Questions
How does a nurse get a certificate of sponsorship in the UK?
By winning a job offer from an employer on the register of licensed sponsors — there is no separate CoS application you can make yourself. Once your interview, references, occupational health and NMC checks are complete, the employer assigns the CoS through the Home Office system and sends you the reference number to use in your Health and Care Worker visa application.
How much does a certificate of sponsorship cost?
Nothing — for you. The employer pays a £525 assignment fee as of 2026, and since December 2024 it has been unlawful for a sponsor to recoup that fee, the licence fee or the Immigration Skills Charge from a worker. Anyone offering to sell you a CoS, at any price, is running a scam, not a recruitment process.
How long is a certificate of sponsorship valid?
You must use it in a visa application within 3 months of the date it was assigned, and you cannot apply more than 3 months before the job start date printed on it. It is single-use: once an application is submitted against it — approved or refused — the employer must assign a new CoS before you can apply again.
Can a recruitment agency sponsor me?
Not for a job with someone else. The sponsor named on your CoS must be the organisation that genuinely employs and pays you, so an agency cannot assign a CoS to place you in a hospital or care home it does not run. Legitimate agencies introduce you to licensed employers and are paid by the employer — never by you.
Do I need to pass the OSCE before getting a CoS?
No. The standard sequence is CBT and English evidence first, then the job offer and CoS, then the visa — with the OSCE taken after you arrive in the UK, usually with your employer funding the first attempt and providing preparation time. Most trusts employ you in a pre-registration role until your PIN arrives.
The difference between a real CoS and an expensive mistake is knowing what a licensed sponsor looks like and what the paperwork should say. Global Pathways checks your sponsor, your offer terms and your visa application before you commit to any of them. Book a free consultation.