Certificate of Sponsorship and Skilled Worker visa basics for a hiring healthcare employer
To employ an internationally-qualified doctor who needs UK immigration permission, the employer must hold a Home Office sponsor licence, assign the doctor a Certificate of Sponsorship (CoS) against an eligible role, and the doctor must then be granted a Skilled Worker visa β most often under its lower-threshold Health and Care Worker sub-category. Here is what each step actually requires.
Quick answer
- Sponsor licence
- Required before any CoS can be assigned. Most established NHS trusts and hospital groups already hold one; new or first-time sponsors must apply and pass a Home Office compliance check.
- Certificate of Sponsorship
- A digital reference, not a document β assigned per worker, per role, and must be used within its validity window before it expires.
- Visa route
- Skilled Worker visa, usually via the Health and Care Worker sub-category for NHS/eligible healthcare roles β lower application fee, and exempt from the Immigration Health Surcharge.
- Salary requirement
- Must meet the general Skilled Worker minimum and the occupation-specific "going rate" β health and care occupations have separately published, often lower, going rates. Confirm the current figure for the exact SOC code.
Three things to get right before you make an offer
1. Confirm the role and salary meet the visa routeβs rules
Check the current going rate for the specific occupation (SOC) code the role sits under. A role that looks like a clear medical post on paper can fail eligibility if it is coded or paid outside the current threshold β check before, not after, the offer is made.
2. Assign the Certificate of Sponsorship correctly and promptly
The CoS records the job details, salary, and start date the visa application will be assessed against β errors here cause avoidable refusals. Once assigned, it has a limited validity window; align your internal offer-to-start timeline so the doctor applies well within it.
3. Decide which route: standard Skilled Worker or Health and Care Worker
For most NHS and eligible independent healthcare roles, the Health and Care Worker sub-category applies and is cheaper for the applicant (lower visa fee, no Immigration Health Surcharge) β but whether the Immigration Skills Charge applies to the employer still depends on the specific occupation code, not the route name alone. Confirm both the eligible-occupation list and the current ISC exemption list before budgeting.
Frequently asked questions
What is a Certificate of Sponsorship, exactly?
It is a digital record (not a physical certificate) that a licensed sponsor assigns to a specific worker for a specific role, confirming the job meets the visa routeβs requirements. The worker needs this reference number to apply for their visa β it is not itself a visa or a guarantee of one.
Do we need a separate sponsor licence for the Health and Care Worker visa?
No β Health and Care Worker is a sub-category of the Skilled Worker route, sponsored under the same Worker sponsor licence. What differs is the fee structure and eligible occupation list, not the licence itself.
What salary threshold applies?
Skilled Worker visa salary thresholds are set by a general minimum plus an occupation-specific "going rate," with lower going rates published for health and care occupations under the Health and Care Worker route. Thresholds are reviewed periodically β always check the current published rate for the specific occupation code (SOC code) before making an offer contingent on sponsorship.
How long is a Certificate of Sponsorship valid for?
It must be used within a defined period of being assigned (check the current period on GOV.UK, as this has changed over time) or it expires and cannot be reused β plan the offer-to-visa-application timeline so the CoS does not lapse before the doctor applies.
Can a doctor start work before their visa is granted?
No. The doctor must hold a valid visa (or, in narrow cases, permission under a prior visa route) before starting the sponsored role β starting early is a compliance breach for both the doctor and the sponsor.
Sources & further reading
These are the primary, official sources for everything on this page. Where figures appear, confirm the current value at the source before relying on it.
- GOV.UK β Get a licence to sponsor a worker visa
How an employer applies for and holds a sponsor licence, including current sponsor-licence fees by organisation size.
- GOV.UK β Skilled Worker visa
Official eligibility, fees and application process for the visa route most internationally-qualified doctors use to work in the UK.
- NHS Employers β Skilled Worker: Health and Care Visa
Employer-facing guidance confirming the Health and Care Worker visaβs exemption from the Immigration Health Surcharge, and its other cost differences from the standard Skilled Worker route.
- GOV.UK β Immigration Skills Charge guidance for employers
Which occupation codes are exempt from the Immigration Skills Charge and the current per-worker, per-year rates.
- GOV.UK β Pay for UK healthcare as part of your immigration application
The current Immigration Health Surcharge rate and which visa routes are exempt.