In short: The NMC's fitness to practise caseload has passed 7,000, its highest in recent years, driven by rising referrals, a register that has grown substantially, and capacity pressures. For individuals, the main effect is longer waits. That is stressful, but a longer case also gives you time to build genuine insight and remediation, which is exactly what strengthens your position by the time a decision is made.
If your case feels stuck in a queue, you are not imagining it. The NMC's fitness to practise caseload has reached a level not seen in recent years, and the practical consequence for many nurses, midwives and nursing associates is a longer, more uncertain wait. That uncertainty is one of the hardest parts of the whole experience.
This guide explains why the backlog has grown, what it realistically means for how long your case takes, and, most importantly, what you can do with that time so it works for you rather than against you. If you have only just been referred, our guide on what to do when you receive a letter from your regulator covers the immediate first steps.
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Why has the NMC caseload reached 7,000?
Because demand has risen faster than the NMC has been able to clear cases. The caseload passing 7,000 is its highest in recent years, and the NMC itself points to a combination of causes: a sustained rise in referrals, a register that has grown by around a fifth since 2020, and staffing and capacity pressures within its own processes. More registrants and more referrals, without a matching increase in throughput, produces a growing backlog. The figures below give a sense of the scale.
Over 7,000
The open fitness to practise caseload has passed 7,000, its highest level in recent years.
Sharp rise
New referrals have risen substantially, up around 40% compared with 2022 to 2023.
Grown by ~20%
The NMC register has grown by roughly a fifth since 2020, increasing overall volume.
It is worth saying clearly that a rising caseload is not unique to the NMC. Several UK healthcare regulators have reported similar increases in referrals, which reflects a wider trend rather than a single failing.
What does a bigger caseload mean for how long my case takes?
In practice, it means many cases take well over a year, and some considerably longer. The NMC works to a target of concluding cases within 15 months and has reported resolving around three quarters of cases within that window, which it has described as its fastest rate in several years. Even so, its overall performance against that target has come under pressure as demand has risen, and complex cases, particularly those involving parallel police investigations, can take longer still. The honest picture is that timescales vary widely, and while some cases move quickly, many do not.
Is the NMC meeting its regulatory standards?
Not fully, and the timeliness of cases is the central concern. The Professional Standards Authority, which oversees the NMC, assesses it against eighteen Standards of Good Regulation. In its most recent published review, covering 2025, the PSA found the NMC met nine of the eighteen Standards. The standard relating to how promptly and fairly cases are investigated has been a recurring problem, and the PSA has undertaken additional scrutiny of the NMC in recent years, including in the light of a 2024 independent culture review. This context matters, but for the individual it mostly translates back to the same practical issue: cases can take a long time.
What is the NMC doing about the backlog?
It has made the backlog a stated priority and reports progress at some stages of the process, alongside a frank acknowledgement that more needs to be done. The NMC has pointed to improvements such as a higher proportion of cases resolved within its target time, and to ongoing work on capacity and process efficiency. Whether these steps are enough to reverse the growth in caseload is something the PSA continues to monitor. For readers, the useful takeaway is not to rely on the process being quick, and to prepare on the assumption that you may be waiting a while.
Turn a long wait into strong evidence
A longer case is time you can use. Structured CPD aligned with CPD UK guidelines helps you build insight and remediation across the life of your case. Cover the key themes together and save.
What does a long wait mean for you?
Two things at once, and it helps to separate them. The first is emotional: a long, uncertain wait is genuinely stressful, and it is normal to feel anxious, low or frustrated while it hangs over you. Please do not carry that alone. Your union, such as the RCN or RCM, your defence organisation, occupational health, your GP and trusted colleagues are all there to support you, and using them is a sign of strength, not weakness. The second thing a long wait means is opportunity. However unwelcome the delay, the time it gives you is time you can put to good use, and doing so tends to reduce the feeling of powerlessness that makes waiting so hard.
How can you use the waiting time constructively?
By treating the wait as preparation rather than limbo. The steps below turn empty waiting time into a clear, evidenced timeline of insight and remediation, which is exactly what the NMC looks for when it does reach your case.
Get advice and stay engaged
Contact your union or defence organisation early, keep your contact details current with the NMC, and respond to correspondence promptly so nothing stalls.
Start your reflection early
Begin an honest written reflection now rather than at the last minute. Early reflection reads as far more genuine than something produced just before a hearing.
Build remediation evidence
Take relevant structured CPD and keep a dated record of your learning and change, so you can show a clear timeline across the life of the case.
Look after your wellbeing
Use your union, occupational health, your GP and trusted colleagues. Keeping your working and personal life as stable as possible protects you through a long process.
Keep practising well
Where you remain in practice, maintain and document a strong standard of care. A sustained period of safe, reflective practice is itself powerful evidence.
The difference this makes is stark when the two approaches are set side by side.
Waiting passively
Doing nothing until a hearing is scheduled, then trying to assemble reflection and evidence at speed, under pressure, with no timeline to show.
Using the time
Reflecting early, completing relevant CPD, and building a dated record of change, so that by the time your case is decided your remediation is already substantial.
Can you keep working while you wait?
In most cases, yes. A referral does not automatically stop you practising. You usually continue to work unless an interim order is imposed to restrict or suspend you while the case is ongoing, and that is a separate decision made only where it is considered necessary to protect the public or is otherwise in the public interest. Because interim orders turn on the specifics of a case, this is one of the first things to discuss with your union or defence organisation. If you are able to keep working, that period of safe practice is not just income and normality; it is also evidence.
How do insight and remediation help, especially over a long case?
They are the strongest cards you hold, and a long case gives you more time to play them well. The NMC's decisions turn heavily on whether a registrant has understood a concern and addressed it, so demonstrating insight, writing a strong reflective account, and evidencing genuine remediation can shape the outcome at every stage. A long wait, used well, means that by the time your case is considered you can show months of real, dated change rather than a last-minute effort. None of this guarantees a particular outcome, but of everything within your control, it is by far the most powerful.
Related courses
The structured CPD most useful during a long NMC case, each aligned with CPD UK guidelines and mapped to NMC standards:
