Taking the Test of Competence for UK Nurses and Midwives

The United Kingdom (UK) currently has 84,000 registered nursing vacancies, and they’re looking towards hiring overseas workers to help fill the gap. If you are interested in working in the UK as an overseas nurse or midwife, one of the processes you may need to undertake is an evaluation of your professional nursing or midwifery skills, knowledge and attitude. The Nursing and Midwifery Council (NMC), the nursing and midwifery regulator for the United Kingdom, refers to this as the Test of Competence (ToC). 

Who needs to take the Test of Competence (ToC)?

For nurses, nursing associates, and midwives who trained outside the UK, you will need to take the Test of Competence. Once you submit your application, the NMC will first evaluate your qualifications and then confirm if you need to take the exams. Healthcare professionals who hold a relevant qualification from an EU Member state are exempt from the ToC exam. Healthcare workers who are already in the UK but do not have the relevant qualifications, including those already practicing on the COVID-19 temporary register, still need to sit the second element of the ToC, the OSCE.

The Test of Competence

NMC Test of Competence UK Nurse

*Beginning August 2021, there will be changes to the Test of Competence. Please refer to this page from the NMC for more details.

The Test of Competence is divided into two parts. The first part of the ToC is the Computer Based Test (CBT) which can be undertaken under formal standardized examination conditions at various Pearson Vue test centers. The second part of the ToC is the Objective Structured Clinical Examination (OSCE) which is a practical test that can be taken at three test centers across the UK. While the NMC states that you can take the CBT or OSCE in any order, the Oxford Brookes University test centers require you to complete Part 1 (CBT) of the ToC first. If you’re an overseas nurse, it makes sense to take and pass the CBT in your home country before paying for a flight to the UK to take the OSCE. Once you pass both parts of the ToC, you can continue with your application for initial registration or readmission.

Traveling to take the OSCE test is considered essential travel, and all three of these UK test centers continue to operate with COVID-19 security measures in place.

Part 1: Computer Based Test (CBT)

Pearson Vue is the agency responsible for conducting the subject-oriented CBT on behalf of the NMC. If this is your first registration with the NMC, you can book your CBT and pay directly with Pearson Vue. If you are taking the test for readmission, you can book the ToC via your NMC online account.

The Structure of the Nursing CBT

You need to take the CBT for the professional field of practice for which you seek UK registration. For example, if you want to register for Adult Nursing, you need to take the Adult Nursing CBT. 

The nursing CBT is made up of 120 multiple choice questions:

  • 50 questions relate to generic nursing competencies
  • 50 questions relate to the application of generic nursing competencies
  • 20 questions focus on specific competencies required for the field of nursing you’re applying for 

The midwifery CBT consists of 120 questions; 

  • 60 questions focus on general theoretical and technical instruction
  • 60 questions assess subjects specific to midwife activity 

A short video tutorial about the CBT exam rules will be shown to you before the start of the examinations. Make sure you arrive at the test center with plenty of time to orient yourself.

NMC Test of Competence UK Nurse

Pearson Vue Test Centers

There are several Pearson Vue test centers worldwide, and there are country-specific requirements for those who want to take the exam. You can look up your own country’s health and safety requirements directly from the Pearson Vue website

Once you arrive at the test site, you will need to present the same passport used when registering with the NMC. If you were issued a new passport, you need to contact NMC to update your information. However, if your examination date is near (within 7 days), you need to call NMC at this number: (UK country code +44) 020 7333 6600.

CBT Results

The results of your test will be updated on your Pearson Vue account 48 hours after your examination. You can retake the test (if it does not pass the NMC standards) a maximum of three times, after which you need to file a new application for registration with the NMC. Times in between takes should have a buffer period of ten days between examination dates. If you are unsuccessful after three permitted attempts, your application will close. You’ll be required to submit a new application and will not be able to sit the CBT again for a minimum of six months.

Passing Rates

The current overall pass rates for the nursing domains are:

  • Adult Nursing – 68%
  • Mental Health Nursing – 72%
  • Learning and Disability Nursing – 71%
  • Children’s Nursing – 71%
  • Midwifery – 63%

Part 2: Objective Structured Clinical Examination (OSCE)

The OSCE is an exam that tests clinical skill performance and competence in health sciences such as midwifery, nursing and physician assistants. The exam assesses understanding of the medical decision-making process. Aside from that, it also tests for improved decision-making based on evidence-based practice for real-world responsibilities. 

Test Centers

As with the CBT, you can book your OSCE directly with the test centers, or if you are applying for readmission, you can book it via your online NMC account. NMC has three official test centers in the United Kingdom. They are the Oxford Brookes University, the University of Northampton, and Ulster University

Those applying for nurse associate registration need to take their OSCE with the University of Northampton. For information on what to expect during the OSCE, you can get a candidate information booklet from the test center where you will be taking the practical exam. You can also download mock scenarios and other resources. Please refer to the additional resources link at the end of this article.

The Day of the Test

You will be asked to provide your passport as proof of identity. This should be the same passport used to register with NMC. Your picture will also be taken by a test center representative and used as your onsite ID. There will be six stations for the OSCE. The first four stations will be for the assessment, planning, implementation and evaluation based around a scenario. The last two OSCE stations will test your practical clinical skills. Beginning August 2021, there will be an additional four stations. There will be two additional stations to test sets of clinical skills, while the last two stations will test values and behavior and the other will test evidence-based practice.

OSCE Results

The results for the OSCE will be sent to you by email within 5 working days of your examination date. As with the CBT, you can retake the OSCE a maximum of three times, with 10 days in between retakes. You only need to retake the stations that you did not pass.

Additional Resources:

The NMC Code

NMC Test blueprints

CBT Information Booklet

Reading Lists for taking the ToC

2021 Test Resources

For more information about how to get a job abroad, browse our Members’ Area.