Frequently asked questions

To practise safely in Australia, registered health practitioners must have effective English language skills. This includes being able to communicate effectively with patients/clients/consumers and their relatives and carers, collaborate with other healthcare professionals and keep clear and accurate health records. The National Boards set requirements for English language skills to make sure all registered health practitioners can provide safe care and communicate effectively in English.

There are three ELS registration standards, with the common ELS standard applying to all applicants for initial registration in Chinese medicine, chiropractic, dental, medical, medical radiation, occupational therapy, optometry, osteopathy, pharmacy, physiotherapy, podiatry and psychology.

The Nursing and Midwifery Board revised ELS standard applies to all applicants for initial registration as enrolled nurses, registered nurses and midwives. The Aboriginal and Torres Strait Islander Health Practice Board’s ELS standard applies to all applicants for initial registration as an Aboriginal and/or Torres Strait Islander Health Practitioner.

Yes. In order to be registered as a health practitioner in Australia, you must be able to meet the National Board’s ELS registration standard to demonstrate that your English language skills are at a level that will enable you to safely practise your profession. This is required under the National Law. National Boards’ English Language Skills registration standards help to ensure that everyone who registers as a health practitioner in Australia has these skills, regardless of their language background.

You need to meet this standard if you:

• are applying for registration as a health practitioner in Australia for the first time, or
• are applying for registration (including moving from non-practising to another registration type) and have not used English as your main language for more than five years, or
• hold limited registration on the basis that you were granted an exemption from the standard in the limited circumstances described under the ‘What are the possible exemptions to the standard’ section in the standard and are applying for a different type of registration.

There are four pathways that you can use to demonstrate to the Board that you are competent in the English language. The pathways are:

• the combined education pathway
• the school education pathway
• the advanced education pathway, and
• the test pathway.

Each of the pathways and their requirements are outlined in the English Language skills registration standard. Use our pathway selection tool to determine which pathway is most suitable for you.

The ELS transition arrangements policy provides some time-limited flexibility for certain applicants that may be impacted by the timing of the revised standards coming into effect. This includes a minor extension to the accepted test validity periods (for the test pathway) and the accepted time period since completion of study (for the advanced education pathway). Applicants seeking additional flexibility under the transition arrangements policy must submit an application within 30 days of the revised standard taking effect, by 18 April 2025.

The key changes to the ELS registration standard include:

• expanding the list of recognised countries
• removing South Africa from the recognised country list (in effect from 18 March 2026)
• reducing the writing component score for the approved English language tests from IELTS 7 to 6.5 (or equivalent)
• adding the Cambridge English language skills test
• widening grounds for extending the validity of English language test results to include continuously working in appropriate roles in recognised countries
• extending the timeframe for accepting English language test results from two sittings, from six months to 12 months 
• renaming the current ‘primary language pathway’ to the ‘school education pathway’ to clearly differentiate between the pathway and primary education, and
• strengthening and renaming of the current ‘extended education pathway’ to the ‘advanced education pathway’ to more clearly express the original intent of the pathway, clarify the minimum level of advanced education accepted and provide a more effective balance between public protection and flexibility for applicants through accepting breaks of up to two years during completion of study.

These changes are aimed at improving the effectiveness and flexibility of the standard, while maintaining public protection. A comprehensive scheduled review and two wide-ranging public consultations informed the changes in the revised ELS standards. They aim to provide more flexibility for applicants to meet the standard, while keeping the public safe.

More information about the review, including the consultations, a consultation report and submissions received, are available on the Past consultations page of the Ahpra website.

While the Nursing and Midwifery Board (NMBA) ELS registration standard aligns with the common ELS standard of most National Boards, the NMBA standard has elements tailored for registered nurses, enrolled nurses and midwives. The NMBA last updated their ELS standard in 2019 and initial testing with key stakeholders confirmed the pathways available via the current standard are working well.

However, to improve the effectiveness and flexibility of the standard, while maintaining public protection, the NMBA has also released an updated ELS registration standard, which includes the following changes:

• expanding the list of recognised countries
• removing South Africa from the recognised country list (in effect from 18 March 2026) 
• reducing the writing component score for the approved English language tests from IELTS 7 to 6.5 (or equivalent)
• adding the Cambridge English language skills test
• widening grounds for extending the validity of English language test results to include continuously working in appropriate roles in recognised countries
• extending the timeframe for accepting English language test results from two sittings, from six months to 12 months.

The information you provide in your application for registration about your English language skills will be checked by Ahpra. However, it is up to you to ensure that you maintain your level of English language proficiency once you are registered, even if you frequently communicate with patients in a language other than English.

The National Boards and Ahpra may reassess your English language skills if a concern is raised, for example, if a complaint is made about you.

The English language skills registration standard applies to all applicants who are applying for registration as a health practitioner in Australia. This means that all new applicants for registration must meet the standard, regardless of their language background or visa status. The standard aligns closely with the Department of Home Affairs (DoHA) English language requirements for skilled migration visas.

National Boards accept a number of English language tests, and these tests are also used by DoHA to assess English language skills. If you sat one of these tests as part of your application for a skilled migration visa in the past two years and you met the requirements and achieved the minimum score specified in the National Boards’ ELS standard, you can use those results and do not need to sit another test.

Full-time education or workload demonstrates your exposure to and use of English in the education or working environment. The definition of full-time equivalent is:

• For the purposes of education - the successful completion (no failed courses or subjects) of a course load which meets the education provider’s definition of full-time enrolment and does not include any recognised prior learning.
  • Example one – accepted
    If you are enrolled in a full-time four-year undergraduate degree, you would be expected to complete the degree in four years, as set by the relevant educational institution. This can include a combination of part-time courses, which together make up a full-time course load.
    • i.e., two part-time courses taken at the same time, each consisting of a 50 per cent course load, that together meet the full-time load requirement.
  • Example two – not accepted
    If you have completed a concurrent, accelerated or fast track course(s) and/or additional education taken during semester breaks, this cannot be counted for more than one full-time equivalent course load. This means that if you studied two programs in a year concurrently, one at half full-time equivalent and the other at three quarters full-time equivalent, you could only count a maximum of one full-time equivalent year. Where a course is delivered in a shorter time such as an accelerated or fast-tracked course (for example a four-year course delivered over three years) only the duration of the delivery of the course is to be counted (i.e. the three-year course delivery period in this example).
• For the purposes of work - it means the equivalent to working full-time hours typically ranging from 35 to 38 hours per week.

‘Recognised countries’ in the ELS standard means one of the following countries or territories:

^*In the revised ELS standard, South Africa has been removed as a recognised country however there will be a 12-month transition period for removing South Africa as a recognised country. South Africa will no longer be considered a recognised country from 18 March 2026.

Other recognised countries may be approved by the National Boards from time to time and published on the Boards’ website. National Boards reserve the right at any time to revoke their approval of a recognised country.

The list of recognised countries was expanded as part of the recent review of English Language Skills Registration Standards. Limited feedback on countries missing from the proposed list of countries was received during the consultation process and there was no supporting evidence provided in responses to support including the countries that were suggested. You can read more about the consultation responses in the public consultation report available on the Ahpra website.

To add new countries to the recognised countries list, we need objective evidence that shows that adding the country is a safe thing to do. We also need to be able to show that the evidence can be consistently applied to applications for registration. This is to make sure we are protecting the public by only allowing people with a safe level of English to be registered and practise in Australia.

In most of the countries that stakeholders suggested in the review of the ELS standards, English is not the only main language.

National Boards will continue to monitor research which would support National Boards reconsidering the list.

Transition arrangements for South Africa

In the most recent review, National Boards consulted on whether South Africa should be removed from the recognised country list, bringing it into line with the Department of Home Affairs (DoHA). After careful consideration of the available evidence and stakeholder feedback, National Boards decided that South Africa should be removed from the list of recognised countries which aligns the list with DoHA visa requirements at the time of the review.

The current review found that qualifications across the professions are offered in South Africa at multiple institutions. In some cases, they have different entry requirements and many of these are substantially below the equivalent Australian entry level ELS requirements. It was also found that some institutions have no English minimum requirements for entry.

There will be a 12-month transition period for removing South Africa as a recognised country. Applicants relying on their education or work experience in South Africa as a recognised country must submit their application for registration before 18 March 2026. Applicants who are unable to submit an application by this time may need to complete an English test to meet the revised ELS standard.