Finishing Your MTI Placement? How to Switch to a Health and Care Worker Visa

If you came to the UK on the Medical Training Initiative then there’s a good chance you’re here on a Temporary Work - Government Authorised Exchange visa (still widely called a Tier 5). It runs for two years and then it ends.

The MTI scheme closed to new applicants on 31 March 2026, but around 1,600 doctors are still completing placements. If you are one of them and you’ve decided you want to stay in the NHS, the best route is to switch to the Health and Care Worker visa. This guide explains how to make that switch, what it costs and the traps worth knowing about.

You can switch without leaving the UK

You do not need to go home and apply from there. Government Authorised Exchange is not on the Home Office list of routes barred from switching in-country, so you can apply from inside the UK while you are still on your MTI visa, providing your current Trust are happy to sponsor you or you find a new employer to act as sponsor.

That said, do not travel outside the UK, Ireland, the Channel Islands or the Isle of Man until you have a decision. If you do, your application is withdrawn so plan any trips home around this.

Switching in-country also saves you paperwork. A criminal record certificate is only needed if you apply from outside the UK and you won’t need a TB test if you have been living here for six months or more.

When to start

Ideally, start three to four months before your MTI visa expires as it can take some time to secure a new post, the application itself is usually decided within three weeks and the work before it takes longer - your Trust has to assign a Certificate of Sponsorship and employment checks take time.

The critical point is that you must submit your application before your current visa runs out. If you submit but don’t have a decision you can still stay but if you don’t submit in time then you’ll need to leave the country and apply from overseas.

What your Trust has to do

If your MTI sponsorship was provided by a Royal College rather than the hospital then that sponsorship needs switching. Even if you’re carrying on in the same hospital, that Trust need to take ownership of your visa and issue you a certificate of sponsorship.

Worth knowing: sponsoring you costs your Trust an Immigration Skills Charge of £1,320 for the first year and £660 for each further six months. There is no such charge on the MTI route, so a three-year sponsorship is roughly £3,960 the department has not previously had to budget for. It is not your bill, but it can slow an offer down if the budget holder has not planned for it.

What it costs

• Application fee: £324 per person for up to three years, or £628 per person for more than three years. The fee is the same inside or outside the UK.
• Immigration Health Surcharge: nothing. Health and Care Worker visa holders and their families are exempt.
• Maintenance: you need £1,270 held for 28 days in a row, unless your sponsor certifies maintenance on your Certificate of Sponsorship. Most Trusts do.
• Priority processing if you need it: £500 for a decision in five working days, or £1,000 for next working day. Availability varies, so check rather than assume.

The health surcharge exemption is a genuine saving. On the MTI route you were paying it at £1,035 a year. A doctor switching with a partner and two children for three years avoids somewhere around £11,000. Note it is an exemption, not a refund - you never pay it in the first place.

Your family

You can bring or keep your partner and children under 18. The restrictions you may have read about, where visa holders cannot bring dependants, apply to care workers and to roles below graduate level. They do not apply to doctors.

Everyone needs to make their own application and pay their own fee, and they can apply at the same time as you using your application number. Your dependants are exempt from the health surcharge too.

After you are approved

You will not get a card or a sticker in your passport. Your status is digital, held as an eVisa in your UKVI account.

Use the same UKVI account you set up for your MTI visa rather than creating a new one, because duplicates cause delays. Make sure the passport you actually travel on is the one linked to the account, and generate a share code when an employer, landlord or bank asks you to prove your status.

What about settling permanently?

Start with the hard part. None of your MTI time counts. Government Authorised Exchange is not a route to settlement, so your clock starts at zero on the day your Health and Care Worker visa begins.

The qualifying period is currently five years. The government has consulted on extending it to ten, and that consultation closed in February 2026 without an outcome being published yet. The Home Secretary has indicated that doctors and nurses could earn settlement at or sooner than five years, but nothing is settled.

Treat five years as the current position rather than a promise, and keep an eye on it. One rule to start tracking from day one either way: to settle, you cannot spend more than 180 days outside the UK in any rolling twelve months.

Should you switch?

MTI was built on the idea that you take your NHS experience home and use it there, and for a lot of doctors that is still the right call.

But plans change, and if you have been offered a post you want, switching is straightforward and well trodden. The main thing is to decide early enough to do it properly, because the timing is the part that goes wrong, not the application.