Supplementary Employment on the Health Care Worker Visa: The 2025 Rule Changes

The Health and Care Worker visa allows holders to take on supplementary employment — a second job up to 20 hours per week — in addition to their primary sponsored role. But the rules governing what roles qualify as supplementary employment changed significantly on July 22, 2025. Whether those changes affect you depends on your specific visa and occupation code.

What Supplementary Employment Is

Supplementary employment is additional work you do outside your primary sponsored role, at a different employer, within the 20-hour weekly limit. It must not interfere with your primary sponsored role, and crucially, it does not require a separate CoS or a new visa update — it is permitted automatically within the terms of your existing visa.

Common examples for healthcare workers: an NHS nurse picking up bank shifts at a care home, a hospital physiotherapist doing weekend sessions at a private sports clinic, or a registered nurse taking agency shifts at a different NHS Trust during their off days.

Until July 22, 2025, the rules on supplementary employment were relatively permissive. Health and Care Worker visa holders could work up to 20 additional hours per week in almost any shortage occupation, including care home roles — creating considerable earning flexibility.

What Changed on July 22, 2025

The Statement of Changes HC 997 introduced restrictions tied to the broader skill-level recalibration. The new supplementary employment rules state:

For visas issued after July 22, 2025: You can only undertake supplementary employment if the second role is either:

1. The exact same occupation code as your primary sponsored role, or
2. A role classified at RQF Level 6 (degree level) or above

For workers who have held continuous Skilled Worker or Health and Care Worker visas since before July 22, 2025: The old rules apply under grandfathering. These workers retain the right to undertake supplementary employment in any sponsorable RQF Level 3-5 role, preserving their previous flexibility.

What This Means for Registered Nurses (SOC 2231)

Registered nurses are sponsored under SOC 2231, which is classified at RQF Level 6. This is the key fact.

Under the new rules, a registered nurse can still take supplementary work as a care worker (SOC 6135, RQF Level 3) because their primary visa is at the higher RQF Level 6. The rules allow "downward flexibility" — you can work below your primary level as supplementary employment, provided your primary role qualifies at RQF 6+.

In practical terms: NHS nurses issued new Health and Care Worker visas after July 22, 2025 can still pick up bank shifts at care homes, work as healthcare assistants in other settings, or take on any other sponsored care role as supplementary work. The new restrictions do not eliminate this for nurses.

This is an important point that has caused significant confusion. Many nurses feared the July 2025 changes would prevent them from supplementing their income through care home or bank work. For nurses, the position is unchanged in practical effect.

What This Means for Care Workers (SOC 6135/6136)

For care workers who arrived in the UK before the overseas route closed and are still on a care worker visa:

Those with visas before July 22, 2025: Grandfathering preserves your old supplementary employment rights. You can still work supplementary hours in other RQF 3-5 roles within the sponsorable list.

Those who switched in-country to a care worker role after July 22, 2025: The new restrictions apply. Your primary care worker role is at RQF Level 3. Supplementary employment is therefore limited to roles in the same occupation code (care worker) or at RQF Level 6 or above. Since most care workers do not have degree-level qualifications in a separate field, this effectively restricts supplementary employment to additional care work within the same sector.

The Practical 20-Hour Limit

Regardless of the pre- or post-July 2025 rules, the 20-hour weekly limit applies universally. This is calculated per week and must not eat into your primary contracted hours.

There is no requirement to notify the Home Office or your primary employer when you take supplementary employment, as long as it fits within the 20-hour limit and meets the role requirements. However, some NHS employment contracts include clauses requiring you to declare secondary employment — check your primary employment contract for this requirement.

Supplementary Employment vs. a Full Employer Switch

These are distinct situations with different rules:

Supplementary employment: A second job within the 20-hour limit, at a qualifying role, requiring no CoS or visa update. Flexible and straightforward.

Switching primary employer: Moving your main sponsored role to a new employer. Requires a new CoS from the new employer and a visa update application. The new employer becomes your primary sponsor.

Some workers confuse supplementary employment with employer switching. If you want to move to a completely different NHS Trust as your main employer, that's a switch — not supplementary employment — and requires the full CoS and visa update process.

International Context: Supplementary Income Planning

For internationally recruited nurses managing financial commitments in their home countries — remittances to family in the Philippines, Nigeria, India, or elsewhere — supplementary income through bank shifts or care home work has been an important part of financial planning. The July 2025 changes do not eliminate this for registered nurses, as explained above.

What the changes do restrict is the ability of care workers on post-July 2025 visas to freely pick up supplementary income in entirely unrelated sectors. If you are a care worker looking to maximize earnings through supplementary work, your options are now limited primarily to additional care work within the same sector.

For registered nurses, this particular concern doesn't apply. Your RQF Level 6 primary role gives you the broadest supplementary employment flexibility under the new framework.

The UK Health & Care Worker Visa Guide covers the supplementary employment rules in detail, including a comparison of the pre- and post-July 2025 positions, how to determine whether your specific secondary role qualifies, and how to declare secondary employment correctly in your primary employment contract.