Indefinite Leave to Remain for IMGs

Most international medical graduates moving to the UK to work for the NHS do so under the Health and Care Visa (previously known as the Tier 2 Visa). The Health and Care Visa allows IMGs to work and live in the UK for up to five years while also allowing them to bring dependants.

During this time, many IMGs settle down in the UK. They might decide that they like life here and want to stay on a more permanent basis. While there is always the option of applying for another Visa, there is another (arguably more desirable) option – indefinite leave to remain.

Indefinite leave to remain allows IMGs to settle in the UK more permanently; it grants additional benefits and means there’s no need for immigration fees or control. So, if you want to stay in the UK as an IMG, this is the route you will likely want to take.

The Benefits of Indefinite Leave to Remain

Indefinite leave to remain allows a lot more freedom than the Health and Care Visa. For starters, it grants you permanent residence in the UK. There’s no need for any more immigration applications or fees. Plus, you have access to free healthcare and public funds. For example, if you need income support, you can apply for Universal Credit. Under indefinite leave to remain, you are also free to start your own business in the UK.

After being on indefinite leave to remain for one year, it also provides a route to British citizenship, which is the goal of many IMGs wanting to reside permanently in the United Kingdom.

Indefinite Leave to Remain: Eligibility and Cost

As of April 2026, indefinite leave to remain costs £3,226 and that is charged per person, so each dependant pays the same.

In terms of eligibility, you will need to prove the following:

• Have lived and worked in the UK for five years
• Passed the Life in the UK test
• Not spent more than 180 days outside the UK in any rolling 12-month period
• A record of absences
• Have a job that meets the salary requirements

The absence rule is the one that catches people out. It is measured across any rolling 12-month window rather than per visa year, so two long trips home either side of a visa anniversary can break your continuous residence even though neither trip looked excessive on its own. Some absences can be disregarded, including serious illness or the death of a close family member, humanitarian or environmental crises, travel disruption and approved research activity. Keep a record of every trip. Do not confuse this with the citizenship rule, which is a separate test of 450 days across five years.

As an IMG doctor, you can apply for indefinite leave to remain after spending five years working for the NHS, usually under the Health and Care Visa (previously named Tier 2 Visa).

Please note that for IMGs living in the UK on a Temporary Work Visa (Tier 5 Visa), their years on the MTI scheme do not count towards indefinite leave to remain. This still applies to doctors completing placements now that the scheme has closed to new applicants.

One to keep an eye on. In March 2026 the government confirmed it intends to move the standard qualifying period for settlement from five years to ten, with reductions for public service roles including doctors, and to apply the change to people already in the UK who do not yet hold settlement. As of August 2026 nothing has been laid before Parliament and no start date has been set, so the five-year route described here is still the rule. We will update this page when that changes.

Applying for Indefinite Leave to Remain

Applying for indefinite leave to remain is relatively simple – you can do so online in an online form. You will fill out the form and upload the necessary documents before being invited to an appointment at UKVCAS to provide your biometric information.

It can take up to six months to receive confirmation of a decision. However, you can pay for a priority service to speed things up. The Priority Service means getting a decision within five days, while the Super Priority Service means receiving confirmation within two days.

The Life in the UK Test

One of the tests you need to pass to qualify for indefinite leave to remain is the Life in the UK test. You can book the test three days in advance, where you will fill out a form asking for your email address, credit or debit card and photo ID. BRPs have now been replaced by eVisas, so you no longer need one for this. You must be between 18 and 64 to take this test – anyone who falls out of this category won’t need to take it.

The Life in the UK Test costs £50 in total. To pass the first time, there is an official handbook to study from. During the test, you get 45 minutes to answer 24 questions, all of which revolve around life in the UK. Here are some example questions so you can familiarise yourself with the structure:

Q: Which Flower is Associated with England?

A: Shamrock B: Daffodil C: Thistle D: Rose

Q: Which is a Famous Classical Music Event in the UK?

A: T in the Park B: The Proms C: Glastonbury Festival D: Creamfields

Q: When is St David’s Day?

A: 30th November B: 17th March C: 23rd April D: 1st March

Indefinite Leave to Remain vs British Citizenship

While indefinite leave to remain provides much more freedom than a Visa, it still has some barriers. For example, if you leave the UK for two years, you will no longer have it. Plus, you cannot vote in the UK elections.

On the other hand, having full British citizenship means you are a citizen for life, and you can reside permanently in Britain no matter how many times you exit or how long. Basically, you are under no restrictions. You can also vote and apply for a full British passport.

Generally, IMG doctors who use indefinite leave to remain eventually choose to apply for British citizenship.

Applying for British Citizenship

If you want to reside permanently in the UK, it makes sense to eventually apply for British citizenship, which you can do after being on indefinite leave to remain for one year. Here is everything else you’ll need to prove to apply for British citizenship:

• Passed the Life in the UK Test
• Knowledge of the English Language
• Over five years in the UK
• Not Broken UK Immigration rules
• Prove Good Character

Keep in mind that you must have lived and worked in the UK for five years at least by the time the Home Office receives your application, otherwise, it will get rejected.

Applying for British citizenship can be done online on the government website. It can take up to six months to hear a response. Once it is confirmed, you become a full British citizen with no barriers to living or working in the UK. This lasts for a lifetime.

In Summary

After five years under the Health and Care (previously Tier 2) Visa, you are able to apply for indefinite leave to remain. After another year of that, you can apply for full British citizenship. Many IMG doctors find this route worthwhile, as it means more freedom and no immigration fees. So, if you want to reside permanently in the UK in your NHS role, this is definitely a route to consider.

The road to British citizenship might seem like a long one but it starts with simple steps like registering with the GMC and finding your first job in the NHS – that’s what we’re here to help with so get in touch to learn more.