Changing Employer on a Health Care Worker Visa: How the CoS Process Works

One of the most persistent myths in UK healthcare immigration communities is that you are permanently tied to your first NHS employer and cannot leave without losing your visa. This is false. The Health and Care Worker visa has no cooling-off period — you can resign and move to a different employer at any time, provided you follow the correct process for obtaining a new Certificate of Sponsorship before taking up the new role as your primary position.

This matters enormously. Workers who believe they cannot leave often remain in poor working conditions, accepting exploitation or inadequate terms, because they fear their visa will be cancelled. Understanding the real rules gives you negotiating power and genuine employment freedom.

The Legal Reality

Your visa is linked to a specific employer — the one named on your current Certificate of Sponsorship (CoS). If you want to work for a different employer as your primary role, they must issue you a new CoS and you must submit a visa update application to the Home Office. This is a legal and routine process.

There is no minimum service period before you can switch. You could start a new NHS Trust role in your third month in the UK if you had a legitimate reason to change and a new employer willing to sponsor you.

Why You Might Want to Switch Employers

Common legitimate reasons:

• Your current Trust's working environment does not match what was described during recruitment
• A different Trust offers a higher AfC band or specialist development opportunity
• You want to relocate to a different region
• Your sponsor is under Home Office investigation or their licence has been suspended
• You received a better offer at a private hospital or independent healthcare provider
• The Trust failed to honor commitments made during the recruitment process

None of these reasons require permission from your current employer. You can resign and move.

The Process: Step by Step

Step 1: Secure a job offer from the new employer. Apply through NHS Jobs or the new employer's recruitment portal. Go through the normal interview and offer process. When you receive an offer, the new employer will typically ask about your current visa status.

Step 2: New employer issues a CoS. The new employer generates a fresh Certificate of Sponsorship through the Home Office Sponsor Management System. This new CoS specifies your new role, the new employer's sponsor licence number, your new salary, and your proposed start date.

Step 3: Submit a visa update application. Before starting the new role as your primary employment, you must submit a visa update application to the Home Office. This is done online through the UK Visas and Immigration system. You will need:

• Your new CoS reference number
• Your current BRP or digital immigration status
• Details of your new role and employer
• The reduced Health and Care Worker visa fee (£628 for a visa over three years, or the proportional shorter visa if your remaining time is limited)

Step 4: Await the decision. Standard processing for health and care worker visa updates typically takes around three weeks. During this processing period, you have specific work rights (see below).

Step 5: Notify the Home Office of the change. Once your new visa is issued, your new employer will update your record in the Sponsor Management System. Your current employer's sponsorship of you ends when you resign.

Working During the Transition Period

Here is a common point of confusion. If you submit your visa update application before starting the new role, but the Home Office hasn't yet issued your updated visa, can you start working?

The rules allow for a specific transitional working arrangement:

• Once you have submitted a valid new visa application (with a new CoS), you can work up to 20 hours per week for the new employer as supplementary employment while awaiting the decision
• You can continue working your current primary role until your notice period ends
• You cannot work more than 20 hours per week for the new employer in this transitional period, as the primary visa is still tied to your previous employer

This means there may be a period where you work your current primary role while simultaneously doing limited hours for the new employer — for example, bank shifts or ward cover — while the visa update is processed. Once the new visa is issued, you transition fully to the new employer as your primary position.

Practical Considerations Before You Switch

Check for repayment clause obligations. Review your current employment contract before resigning. If you have a repayment clause, calculate your liability based on how long you have been employed:

• Under 12 months: potentially 100% of itemized eligible costs
• 13-24 months: up to 50%
• 25-36 months: up to 25%
• Over 36 months: nothing

If you are under 12 months with your current employer and the repayment clause is legitimate and itemized, factor this cost into your decision. It doesn't prevent you from leaving — but it creates a financial obligation.

Give proper notice. Your employment contract will specify a notice period, typically one to three months for NHS roles. You must work this notice period (or negotiate a shorter one with mutual agreement). If you leave without serving notice, you breach the employment contract and may face additional complications.

Confirm the new employer's sponsor licence status. Before resigning from your current role, verify that your new employer's sponsor licence is active on the Home Office register. Do not resign from a valid sponsoring employer before confirming the new employer can legally issue you a CoS.

Care about timing relative to your visa expiry. If your current visa is due to expire within several months, factor this into your switching timeline. The new CoS and visa update should be processed well before your current visa's expiry date.

If You Are Switching to Escape Exploitation

If the reason for switching is that your current employer is exploiting you — not paying the salary on your CoS, withholding your documents, charging illegal fees, or threatening you with visa cancellation if you attempt to leave — the process is the same legally, but you have additional protections.

Employer threats that your visa will be cancelled if you leave are false. You retain the right to resign and switch employers regardless of what your employer says. Their ability to revoke your visa does not exist — only the Home Office can curtail your leave, and the Home Office does not act on employer complaints against workers who exercise their legal right to change jobs.

If you are documenting exploitation, do so before and during your resignation process. Keep records of all communications.

The UK Health & Care Worker Visa Guide includes a full employer-switching checklist — including how to read your repayment clause, a notice period calculator, a script for approaching new NHS employers as an existing visa holder, and what to include in your visa update application.