A Fairer Pathway to Settlement: What the New Proposals Mean for Medical Workers

The UK Government’s consultation on “A Fairer Pathway to Settlement”, published in November 2025, sets out the most significant overhaul of the settlement (Indefinite Leave to Remain) system in decades. Central to the plan is a move away from automatic settlement after a set number of years toward an “earned settlement” model based on contribution, integration, and conduct.

For medical professionals working in the NHS or private healthcare—such as doctors, nurses, midwives, allied health professionals and clinical specialists—these proposals represent major changes to long‑term career planning in the UK.

1. A Longer Journey to Settlement – Up to 15 Years for Roles below Level RQF6

Under current rules, most Skilled Workers—including many in the healthcare sector—can apply for settlement after five years of continuous residence.

The consultation proposes dramatically extending this:

● A 10‑year baseline qualifying period

This becomes the standard pathway for most migrants.

● A 15‑year qualifying period for roles below RQF6

The consultation explicitly proposes increasing the qualifying period to: “15 years for those in the Skilled Worker route in a role below RQF Level 6 (equivalent to a bachelor’s degree).”

This means that nursing auxiliary roles, assistant practitioner roles, senior carers, and other health‑service roles classified below RQF6 may face a three‑fold increase in the time required to reach ILR.

2. Who Counts as RQF6 and Above?

RQF6 roughly corresponds to degree‑level roles.

For the healthcare sector, the following roles are at RQF6 or higher, and therefore not expected to fall under the 15‑year requirement:

• Doctors (generalist and specialist)
• Registered nurses (all specialisms)
• Midwives
• Pharmacists
• Radiographers
• Dentists
• Physiotherapists
• Occupational therapists
• Psychologists
• Paramedics
• Other regulated allied health professions

Roles below RQF6, which may therefore face the 15‑year timeline, include:

• Nursing auxiliaries and assistants
• Health associate professionals not elsewhere classified
• Senior care workers
• Laboratory technicians (unless meeting specific shortage criteria)

This classification issue is crucial: many frontline health and social care roles—despite being essential—are not degree‑level and therefore fall outside RQF6.

3. Why Medical Workers Are Affected Differently

The Government’s reasoning, as outlined in commentary around the proposals, is that degree‑level roles more reliably demonstrate:

• Long‑term economic contribution
• High levels of integration
• Strong fiscal impact through taxation

However, the proposals have raised concerns because lower‑paid health and care workers already form the backbone of the NHS and social care system, and many work in roles below RQF6 despite providing vital patient‑facing services. It is clear that the government themselves are not aware of the potential impact this may have – health minister Karin Symth admitted last week that she did not know how many NHS staff would be affected by the proposed changes.

Additionally, medical professionals are likely to work longer hours than the average (non-medical) Skilled Worker. Therefore, they would have less free and flexible time to contribute to society, 

4. Contribution-Based Reductions Rarely Assist Health & Care Workers

The model allows reductions from the 10‑year baseline where applicants demonstrate high income or extensive volunteering. But analyses show these benefits overwhelmingly favour high earners:

• Workers earning above £50,270 for three years may reduce the period by five years
• Those earning above £125,140 may reduce it by seven years

However:

• Health and Care Workers’ median earnings were approx. £30,900, far below the thresholds for reduction
• Even many registered nurses (RQF6) will not meet the higher income thresholds
   

This means reductions are unlikely to meaningfully benefit the health and social care workforce.

5. Settlement Will Be Earned, Not Automatic

Across the board, the proposals emphasise:

Mandatory requirements:

• Good character (no criminal record)
• Demonstrated integration
• English language proficiency
• Contribution through National Insurance and tax
   

There will be no ability to offset negative factors (e.g., accessing public funds). Those who receive public funds, even temporarily, could see 5–10 extra years added to their baseline.
 

This could further disadvantage lower‑paid care-sector workers who may face situations requiring limited public support.

6. Major Implications for Medical Migration Pathways

For Degree-Level Medical Roles (RQF6+)

Doctors, nurses, midwives and allied health professionals will typically remain eligible at the 10‑year baseline, though the model is more demanding than the current 5‑year route.

For Below Degree-Level Healthcare Roles (Below RQF6)

The reforms could have severe long‑term consequences:

• Settlement taking 15 years
• Little realistic chance of “reductions” due to income requirements
• Increased instability across the care workforce
• Reduced attractiveness of the UK for international recruits

This is particularly significant for nursing assistants, senior carers, community support workers and others currently relied upon by the NHS and social care providers.

7. Shift Toward a More Selective System

The Government describes the new pathway as the “most controlled and selective settlement system in Europe.”

The aim is to reduce long‑term net migration, but the health and social care sectors—which rely heavily on international recruitment—are likely to feel the strain most acutely.

Conclusion

The “Fairer Pathway to Settlement” proposes sweeping changes that will profoundly reshape the long‑term immigration landscape for medical workers in the UK. While high‑skilled and degree‑level clinicians may still reach settlement within 10 years, the proposal to require 15 years for roles below RQF6 will disproportionately affect:

• Nursing auxiliaries
• Senior care workers
• Non‑degree clinicians
• Certain technical and support staff

At a time when the NHS and social care sectors face chronic staffing shortages, these proposals may significantly impede recruitment and retention by extending settlement timelines far beyond what many workers can realistically commit to.