Changes to the Tier 2 immigration route for general practice employees are now in effect as of 6 April.

The changes will impact on how practices will be able to source and recruit staff from outside of the European Economic Area (EEA).

There minimum salary thresholds for Tier 2 applicants has increased to £30,000 for experienced workers but will remain at £20,800 for new entrants.

The criminal records check process for new Tier 2 applicants and their dependants has also been altered. Applicants will now be required to provide a criminal record certificate from each country they have lived in consecutively for 12 months or more in the past ten years.

Practice managers can download the Tier 2 changes infographic summary and visit NHS Employers’ Tier 2 policy changes web section for more information.

£1,000 per employee

The introduction of the Immigration Skills Charge (ISC) now requires all employers with overseas staff coming to the UK on a Tier 2 visa to pay £1,000 for each employee. The charge will result in bodies such as Health Education England (HEE), the sponsor for all doctors in training in England, incurring substantial costs.

The British Medical Association (BMA) has called on the Governemnt to exempt health professionals from the immigration skills charge or risk adding millions to annual budgets and worsening the GP crisis.

A Government spokesperson responded: ‘This Government is committed to building home-grown skills and wants to encourage employers to do the same. There are already 30,000 students training to be doctors, and more than 52,000 training to be nurses, and the introduction of the Immigration Skills Charge will help encourage employers to invest in training so that UK workers have the right skills to fill jobs.

‘We are continuing to invest in the NHS frontline – there are over 34,800 more professionally qualified clinical staff, including over 11,600 more doctors and over 13,400 more nurses on our wards since’.

In a letter to home secretary Amber Rudd, BMA council chair Mark Porter and Royal College of Nursing (RCN) chief executive and general secretary Janet Davies have warned that failing to exempt overseas health staff would ‘strip frontline services of vital funds’.

The letter says: ‘Given the ongoing pressures on both NHS and social care finances, the sustainability of services and the recruitment and retention of staff, we are asking you to exempt the NHS and the wider health and social care system from the ISC [immigration skills charge].

‘It cannot be appropriate to divert funding away from the budget for frontline health services and the training of health professionals in this way.’

The Government has suggested that funds raised from the charge may be reinvested back into the UK workforce and health system, but the BMA said they have been given ‘no guarantees to that effect’.

Added millions

Ministers have said that the charge, as part of the Immigration Act 2016, is designed to ‘reduce demand for migrant labour’ in the UK. However, the BMA and RCN responded that ‘healthcare cannot be treated as a business’.

Data shows that £3.5 million would be taken out of the NHS budget if the ISC was applied to the 3,602 doctors who were granted tier 2 (general) visas for one year from August 2014 to August 2015.

Health Education England would have had to pay £1,627,000 to cover sponsorship costs for their trainees for 2015-2016.

Similarly, HEE, which provides funding for doctors in training in England, would have faced a bill of £1.6m in 2015-16, with £2.1m applied to nursing in the same period.

These costs would continue to grow each year as more overseas staff are recruited.

Recruitment crisis

Dr Porter and Ms Davies argue that upfront cost of the charge could ‘further exacerbate’ workforce shortages by discouraging employers from recruiting staff from outside the EU.

The BMA and RCN said: ‘It is simply not possible to up-skill resident workers or put apprenticeships in place for doctors because of the long and rigorous training process involved and additional regulatory requirements.

‘Checks and balances are already in place to ensure posts are first offered to UK and EU nationals through the resident labour market test.

‘It is unfair therefore, to penalise health and social care employers for recruiting a doctor or a nurse on a Tier 2 visa to fill workforce gaps because a UK or EU national cannot be found to fill the post.’