NMC Fitness to Practise: Complete Guide for Nurses, Midwives and Nursing Associates
How the Nursing and Midwifery Council handles concerns: the legal grounds, every stage from screening to a Fitness to Practise Committee hearing, the latest figures at each stage, the NMC's eight commitments on context, the rule changes in force from 1 October 2026, fairness and performance findings, and where to get support.
Reviewed October 2026 against the Nursing and Midwifery Order 2001, the NMC Fitness to Practise Rules as amended in 2026, the NMC fitness to practise library, NMC annual and monthly data, and PSA performance reviews
Short answer: NMC fitness to practise is the process the Nursing and Midwifery Council uses to decide whether a nurse, midwife or nursing associate can practise safely without restriction. In 2024-25 the NMC received 6,539 concerns about a register of 853,707 people, and most were closed after initial assessment. Serious cases go to case examiners, who decide whether there is a case to answer, and the most serious go to the Fitness to Practise Committee, which can caution, impose conditions, suspend or strike off. The NMC starts from the position that most people referred to it are normally safe to practise, and your insight and strengthened practice matter at every stage.
Key takeaways
- Employers made 30% of referrals in 2024-25 and the public 34%. Self-referrals were 8%.
- Case examiners referred 56% of the cases they decided to a hearing or meeting, so this stage matters most.
- The NMC takes account of context through eight published commitments, including your working environment and workplace culture.
- New rules from 1 October 2026 bring legally qualified chairs, stronger case management and online service of documents.
- Careline offers free, confidential, independent emotional support 24 hours a day on 0800 587 7396.
This guide covers the NMC only. For how all UK healthcare regulators compare, see our complete guide to fitness to practise in the UK. Doctors should see our GMC fitness to practise guide.
The legal grounds
Under article 22(1) of the Nursing and Midwifery Order 2001, an allegation must say that your fitness to practise is impaired because of one of these grounds, or that your register entry was wrongly made.
Strike-off is limited for three of these grounds. Under article 29(6), a striking-off order cannot be made for lack of competence, health or knowledge of English unless you have been continuously suspended or under conditions of practice for at least two years immediately before the decision. Misconduct and convictions have no such limit. Health concerns are explained in our guide to health and fitness to practise, and false declarations in our guide to failure to disclose.
Conduct outside work
The NMC can act on conduct in your private life, not only at work. Its guidance on sexual misconduct (FTP-2a-ii, updated 31 July 2026) covers behaviour at work and outside professional practice, and defines sexual misconduct as behaviour that "can be physical, verbal, visual or online". An independent review of how the NMC handled cases raised by a whistleblower, by Victoria Butler-Cole KC and David Hopkins (September 2025), found the NMC had at times taken too narrow a view of misconduct in private life, and recommended clearer guidance on matters such as sexual assault, domestic abuse and racism outside work. It found no evidence that this led to wrong outcomes in the private life cases it reviewed. Expect the NMC to treat serious private conduct as relevant to your registration.
The numbers: 2024-25 and the latest monthly data
The NMC regulates nurses and midwives across the UK, and nursing associates, a role in England. Its annual fitness to practise report covers April 2024 to March 2025. Its 2025-26 report had not yet been published when this guide was reviewed.
Who raised concerns
- Patients and the public 2,252 (34%)
- Employers 1,984 (30%)
- Other professionals on the register 652 (10%)
- Self-referrals 521 (8%)
- Opened by the NMC, other regulators, other and unknown sources 1,130 (17%)
The most common themes were patient care (19% of allegations), prescribing and medicines management (15%) and record keeping (13%). Records concerns are covered in our guide to records and probity.
What happened at each stage
| Stage | 2024-25 | What it shows |
|---|---|---|
| Concerns received | 6,539 | Up 13.2% from 5,774 |
| Closed after initial assessment | 5,074 | 72% of initial assessment outcomes |
| Interim orders imposed | 691 | 373 conditions (54%), 318 suspensions (46%) |
| Case examiner decisions | 1,171 | 658 referred to a hearing or meeting (56%) |
| Final panel decisions | 647 | 289 striking-off orders (45%) |
| Cases concluded within 15 months | 68.4% | Target 80%; 61% the year before |
Source: NMC Annual Fitness to Practise Report 2024-2025.
Case examiner outcomes
Final panel outcomes
The high strike-off share reflects how few cases reach a final panel, not how most nurses are treated: 289 strike-offs is about 1 in 3,000 of the register. What each outcome means, and how long it stays on the register, is in our guide to fitness to practise outcomes.
Source: NMC monthly performance updates, January and February 2026.
How an NMC case moves
- 1
Screening
The NMC checks whether it has a written concern about someone on its register and whether there is evidence of "an ongoing risk to public safety, public confidence or professional standards" that could require regulatory action. Concerns outside its remit, or that employers can resolve locally, are closed. The NMC's Employer Link Service works with employers on when to refer and how to handle concerns locally.
- 2
Interim order, if needed
If there may be a risk while the case continues, the NMC can ask a panel for interim conditions or suspension. In 2024-25, 65.8% were imposed within 28 days of the concern, against a target of 80%. See our guide to interim and substantive suspension.
- 3
Investigation
The NMC gathers statements, records, clinical advice and, where relevant, health or language assessments. Our guide to the investigation stage explains what happens.
- 4
Case examiners
Two case examiners, one a nurse or midwife and one lay, decide whether there is a case to answer. Under the rules in force from 1 October 2026, you must be given 28 days to comment on the information first, and the Registrar can extend that period. Our guide to writing your response covers what to say.
- 5
Fitness to Practise Committee
A panel decides the facts, impairment and sanction, at a meeting on the papers or a hearing. Some cases can be resolved by agreement, for example through a consensual panel determination or, in some cases, agreed removal from the register. Hearing days are covered in our guide to fitness to practise hearings.
Case examiners can close a case with advice, a warning or undertakings instead of a hearing. When to accept these is explained in our guide to warnings and undertakings.
What happens to you at each stage
| Stage | What usually happens | What you can do |
|---|---|---|
| Screening | The NMC checks the concern against its screening questions. Many are closed or passed back to the employer to resolve locally. | If contacted, take advice from your union or indemnity provider before replying. |
| Interim order | If there may be a risk while the case continues, a panel can impose interim conditions or suspension, shown on the register while in force. | Attend the hearing, comply strictly with any order, and ask for a review if things change. |
| Investigation | The NMC gathers statements, records and clinical advice, and may assess your health or English language. | Gather evidence of context: staffing, workload, training and support at the time. |
| Case examiners | The information is sent to you with 28 days to comment before two case examiners, one registrant and one lay, decide. | Send a full response covering insight and strengthened practice. Ask for an extension if you need it. |
| Fitness to Practise Committee | A meeting on the papers or a hearing decides facts, impairment and sanction. | Engage, attend, and consider whether the case can be resolved by agreement. |
A warning from the case examiners is published for 12 months. The test for a warning and how to respond to undertakings are in our guide to warnings and undertakings.
The sanctions a panel can impose
Under article 29(5) of the Nursing and Midwifery Order, if a panel finds your fitness to practise impaired it can impose:
Caution order
Shown on the register for between one and five years. It does not restrict practice.
Conditions
For up to three years, such as supervision, training or limits on certain work.
Suspension
For up to one year, usually with a review before it ends.
Striking-off
No application to return for five years (article 33).
After a suspension or striking-off order, the panel can also make an interim order of up to 18 months to cover the appeal period. What each outcome means day to day is in our guide to fitness to practise outcomes.
Tsolo v Nursing and Midwifery Council [2025] EWHC 2324 (Admin)
What happened. An agency nurse faced concerns about a night shift in a care home in 2019. While her case was ongoing she was under an interim suspension and then interim conditions. The panel found she had worked as a nurse while suspended, breached her conditions, and was dishonest when she told an interim order panel she was complying. After the panel refused a further adjournment and partly proceeded in her absence, she was struck off.
The outcome. The High Court dismissed her appeal on 12 September 2025. It said she "simply proceeded on the basis that she was going to be granted another adjournment" and that "that was the wrong approach" (para 37), and described the dishonesty findings as "extremely serious" (para 99).
The lesson: an interim order must be followed to the letter, and breaching it, or being dishonest about it, can lead to striking-off on its own. Engage with the process: do not assume a hearing will be adjourned.
Nurrish v Nursing and Midwifery Council [2026] EWHC 2 (Admin)
What happened. A nurse who had admitted dishonest misconduct, in difficult personal circumstances, was suspended for 12 months. At the review hearing, a new panel decided she had been deliberately dishonest in her oral evidence and struck her off.
The outcome. On 2 January 2026 the High Court allowed her appeal. It noted that "it was not put to the Appellant directly that she was at risk of the panel concluding that she was lying" (para 67), and held that "the panel's finding that the Appellant had been deliberately dishonest was wrong and cannot stand" (para 80). The case was sent to a new panel.
The lesson: at a review, panels must give you a fair chance to answer any suggestion that you are being dishonest, and consider innocent explanations such as anxiety or confusion. Being well prepared for a review hearing matters as much as the first hearing.
The NMC's eight commitments on context
The NMC's guidance on taking account of context (FTP-12, updated May 2025) sets out eight commitments for every decision. The first is to "approach cases on the basis that most people referred to us are normally safe".
Start from the position that most people referred are normally safe to practise.
Build a full and accurate picture of your history in practice.
Give careful weight to evidence of discrimination, victimisation, bullying or harassment.
Where system or process failures created the risk, focus on actions that fix them.
Where you had to use professional judgement, respond in proportion to the situation you faced.
Consider the steps you have taken where a concern came from a knowledge gap or personal circumstances.
Look at whether group norms or workplace culture shaped your conduct before acting.
Where culture contributed, prioritise steps that reduce the chance of it happening again.
Paraphrased from NMC guidance FTP-12. Read the full wording in the NMC fitness to practise library.
Context does not excuse serious misconduct, but it shapes how the NMC reads the evidence. When you respond, it helps to explain the working conditions at the time, with evidence, alongside your own insight and the steps you have taken to strengthen your practice.
What changed on 1 October 2026
Amendments to the NMC Fitness to Practise Rules came into force on 1 October 2026, after a consultation that received 7,786 responses.
| Change | What it means for you |
|---|---|
| Legally qualified chairs | Panel chairs can now also give the legal advice, replacing the separate legal assessor in those hearings. The NMC is introducing them in phases. |
| Case management directions | Panels or chairs can set binding directions before a hearing. If a party does not comply without good reason, the panel can draw adverse inferences or refuse to admit evidence. |
| Agreeing the issues early | Parties are expected to identify the key issues and disputed facts, and agree what evidence is needed, before the hearing. |
| Online service | If you agree, documents can be served through an online account, and count as served on the day they are placed there. |
| Notice periods | Hearing notices are generally sent 28 days ahead. Preliminary meetings need 14 days' notice, which can be shortened with your consent or in the public interest. |
| Time to respond | You get 28 days to respond before case examiners decide, with a clearer power for the Registrar to extend it. |
Respondents to the consultation warned of risks for people without representation, people whose first language is not English, and those who need extra support. If that applies to you, tell the NMC early and ask what adjustments are available.
Performance, culture and fairness
The NMC has been under sustained scrutiny, and it is fair to know what independent reviews found.
PSA review 2025
The Professional Standards Authority's review of 2025, published on 28 May 2026, found the NMC met 9 of its 18 standards, including none of the fitness to practise standards on timeliness, decision quality and keeping parties updated (standards 15, 16 and 18). It said screening timeliness had improved significantly, but it had "not seen evidence of substantial and sustained improvement" overall.
Independent culture review 2024
A review led by Nazir Afzal, published on 9 July 2024, found experiences of racism, discrimination and bullying within the NMC and linked its regulatory performance to its culture. The NMC apologised, accepted the recommendations and set up a safeguarding hub to advise fitness to practise staff.
On fairness, the NMC's Ambitious for Change research found that men and Black professionals are more likely to progress through its fitness to practise stages, and some employers refer a higher proportion of men and Black professionals than their share of the register. A University of Greenwich review of 288 cases closed between 2019 and 2023, published in 2025, found disparities in how some cases involving Black and male professionals were handled that "might be attributable to bias", including closer scrutiny of evidence and inconsistent interim conditions, but no evidence of bias in final decision outcomes. The NMC has committed to revise its guidance, use case clinics for sensitive cases and roll out unconscious bias training.
By UK nation, concerns broadly matched the register: England accounted for 80% of concerns and 77% of the register, Scotland 9% of both, and Wales 5% of both.
If you believe discrimination, bullying or a poor working culture played a part in your referral, say so with evidence: commitment 3 requires the NMC to give it careful weight.
The concerns that most often reach the NMC
Patient care
The most common allegation theme in 2024-25 (19%). Context such as staffing and support is part of the picture, under the NMC's context commitments.
Medicines management
15% of allegations, including administration errors and controlled drugs. Report errors promptly and reflect on them.
Record keeping
13% of allegations. Altering records afterwards turns a care concern into a dishonesty case. See our guide to records and probity.
Dishonesty
Including timesheets, working while on sick leave, and false statements to employers or the NMC. See our guide to dishonesty allegations.
Interim order breaches
Working in breach of interim conditions or suspension is treated as extremely serious, as Tsolo shows.
Conduct outside work
Including sexual misconduct, online behaviour and convictions. See our guides to professional boundaries and self-referral.
The Code your case is measured against
Every NMC case is judged against The Code, built around four themes: prioritise people, practise effectively, preserve safety, and promote professionalism and trust. The NMC plans to consult on a new Code and revalidation model from September to December 2026, with proposals including explicit expectations to challenge racism and discrimination, guidance on digital tools and AI, and clearer expectations on conduct outside professional practice. Until a new Code is published, the current Code applies. You also revalidate against the Code every three years.
| Area | Where the Code covers it | Our guide |
|---|---|---|
| Honesty and integrity | Section 20, uphold the reputation of your profession | Probity in healthcare |
| Openness after mistakes | Section 14, be open and candid | Duty of candour |
| Records | Section 10, keep clear and accurate records | Records and probity |
| Boundaries | 20.5 and 20.6 | Professional boundaries |
| Gifts and finances | 21.1 to 21.3 | Conflicts of interest |
| Telling the NMC | 23.2, cautions and charges; 23.3, restrictions on your practice | Self-referral |
Support during an NMC case
Careline, 24 hours a day
Free, confidential emotional support from CiC, an independent provider. It is "completely independent from the NMC" and will not tell the NMC you have called. Anyone involved in a fitness to practise case can use it, and you do not need to be in crisis. Freephone 0800 587 7396.
Your union or professional body
Contact your union, professional body or indemnity provider as soon as you hear from the NMC, and before you reply. If you are not represented, tell the NMC, so it can explain the process and any adjustments.
If your health is part of the picture, see our guide to health and fitness to practise. If you are struggling, you can contact Samaritans at any time on 116 123.
If you have just heard from the NMC
- Note every deadline, including the 28 days to respond before case examiners decide.
- Get advice from your union or indemnity provider before replying.
- Tell your employer where you are required to, and keep to any interim order.
- Do not change any records connected to the concern.
- Gather context evidence: staffing, workload, training and support at the time.
- Start reflecting and learning now. Our guide to reflective accounts explains how.
Real NMC panel and court decisions are summarised in our fitness to practise case studies. If you are struck off, you cannot apply to return for five years, as explained in our guide to how long remediation takes.
Frequently asked questions
How many nurses are struck off by the NMC each year?
In 2024-25, NMC panels made 289 striking-off orders out of 647 final decisions, on a register of 853,707 professionals.
How long does an NMC investigation take?
The NMC aims to conclude 80% of cases within 15 months. In January 2026, 74% were resolved within 15 months on a rolling average.
Who refers nurses to the NMC?
In 2024-25, 34% of concerns came from patients and the public, 30% from employers, 10% from other registered professionals and 8% were self-referrals.
What does the NMC look at first?
At screening it checks whether there is a written concern about someone on the register and whether there is evidence of an ongoing risk to public safety, public confidence or professional standards that could need regulatory action.
Does the NMC consider the pressures I was working under?
Yes. Its guidance on context sets eight commitments, including taking account of system failures, workplace culture and evidence of discrimination or bullying.
What changed in NMC hearings in October 2026?
New rules from 1 October 2026 introduced legally qualified chairs, binding case management directions, online service of documents with your agreement, and clearer notice periods.
Is there free support for nurses under NMC investigation?
Yes. Careline offers free, confidential and independent emotional support 24 hours a day on 0800 587 7396.
What sanctions can the NMC impose?
A caution order for one to five years, conditions for up to three years, suspension for up to one year, or a striking-off order.
How long is an NMC warning published?
A warning given by case examiners is published for 12 months.
What happens if I breach an NMC interim order?
It is treated as extremely serious. In Tsolo v NMC (2025), working while suspended, breaching conditions and being dishonest about it contributed to striking-off.
Can I keep working during an NMC investigation?
Yes, unless a panel imposes an interim suspension, or conditions that restrict where or how you work.
Can the NMC act on something I did outside work?
Yes. The NMC can consider conduct in your private life, including online, where it raises questions about public protection or your ability to uphold professional standards.
Can I return to the register after being struck off?
You cannot apply for restoration until five years after the striking-off order took effect, and you must show you are fit to practise.
Primary sources
21 official documents, laws and judgments
- NMC: Annual Fitness to Practise Report 2024-2025
- NMC: Latest data show cases resolved at fastest rate in over five years (February 2026)
- NMC: Fitness to practise performance update (January 2026)
- Nursing and Midwifery Order 2001, article 22
- NMC (Fees) (Practice Committee) (Fitness to Practise) (Amendment) Rules Order of Council 2026
- NMC: Fitness to practise rules changes for a faster, fairer process (April 2026)
- NMC: Screening decisions (SCR-1)
- NMC: Taking account of context (FTP-12)
- NMC: Case examiners
- NMC: The Code
- NMC: Consultation on a new Code and revalidation process (July 2026)
- NMC: Careline emotional support
- NMC: Ambitious for Change, phase 3
- NMC: Independent culture review (July 2024)
- PSA: Review of the NMC's performance (May 2026)
- Tsolo v Nursing and Midwifery Council [2025] EWHC 2324 (Admin)
- Nurrish v Nursing and Midwifery Council [2026] EWHC 2 (Admin)
- Nursing and Midwifery Order 2001, article 29
- NMC: Sexual misconduct (FTP-2a-ii)
- Independent review of the NMC's handling of cases raised by a whistleblower (September 2025)
- Nursing and Midwifery Order 2001, article 33 (restoration)
