How the Nursing and Midwifery Council deals with concerns about nurses, midwives and nursing associates: screening, investigation, case examiners, meetings and hearings, interim orders and sanctions. Built on the NMC's own Fitness to Practise Library, with the NMC's language kept intact: insight and strengthened practice, context, and what "case to answer" really means.
Choose your situation for what it means and where to focus.
Select your situation to see where to start.
NMC fitness to practise is the regulatory process the Nursing and Midwifery Council uses when concerns arise about whether a nurse, midwife or nursing associate's fitness to practise is currently impaired. Its purpose is public protection, not punishment.
The NMC describes being fit to practise as having the skills, knowledge, good health and good character to do the job safely and effectively. Its process is concerned with current risk. In its fitness to practise strategy, the NMC has said it may not need to take regulatory action for a clinical mistake, even where there was serious harm, if there is no longer a risk to patient safety and the professional has been open about what went wrong and can show they have learned from it.
Most referrals never reach a hearing. In 2024–2025, 72% of the NMC's decisions at screening were to close the case without further investigation. The NMC received an average of 546 new referrals a month over that year, against a register of more than 867,000 professionals.
Sources: NMC Annual Fitness to Practise Report 2024–2025; NMC news, 2025.
A concern is not a finding. An investigation is not a finding of impaired fitness to practise.
The NMC is the independent regulator of three professions. Healthcare assistants and support workers are not on its register and fall outside its fitness to practise remit.
Registered across the UK, in adult, children's, learning disabilities and mental health nursing, and as specialist community public health nurses.
Registered across the UK, with their own Standards of proficiency alongside the Code.
A distinct profession regulated in England only. A striking-off order prevents practice as a nursing associate in England.
Each layer of the NMC's framework has a different job. Knowing which one applies to a question saves a great deal of confusion.
Gives the NMC its authority, sets the grounds of impairment and the sanctions available, and creates the committees.
Govern the procedure: notice, evidence, hearings and meetings.
Set out what nurses, midwives and nursing associates must do. The yardstick for every concern.
The NMC's published guidance for its decision-makers, regularly updated, covering every stage and type of concern.
Make the decisions within their legal remit, independently of the staff who investigate.
Under the Order, fitness to practise can be impaired by reason of misconduct, lack of competence, a criminal conviction or caution, physical or mental health, not having the necessary knowledge of English, or a determination by another health or social care body.
The Code sets out the professional standards that nurses, midwives and nursing associates must uphold to remain registered. It has four themes and 25 standards. When a concern is raised, the first useful step is to identify exactly which standards are engaged. Read our full guide to the NMC Code.
Treating people as individuals and upholding their dignity; listening and responding to their preferences and concerns; making sure physical, social and psychological needs are assessed and met; acting in the person's best interests; respecting privacy and confidentiality.
Links to: confidentiality, professionalism
Practising in line with the best available evidence; communicating clearly; working cooperatively; sharing skills and knowledge; keeping clear and accurate records; delegating effectively; having an indemnity arrangement.
Links to: documentation, competence
Recognising and working within the limits of your competence; being open and candid when things go wrong; offering help in emergencies; acting without delay on risks to safety; raising concerns and protecting people from harm; advising on, prescribing, supplying, dispensing or administering medicines within your competence; reducing the potential for harm.
Links to: medication, competence
Upholding the reputation of the profession; upholding your position as a registered professional; fulfilling registration requirements; cooperating with investigations and audits; responding to complaints; providing leadership to make sure people's wellbeing is protected.
Links to: probity, misconduct
| Concern | Code theme usually engaged |
|---|---|
| Poor clinical practice | Practise effectively; Preserve safety |
| Documentation | Practise effectively (standard 10) |
| Patient safety and escalation | Preserve safety |
| Medicines | Preserve safety (standard 18) |
| Confidentiality | Prioritise people (standard 5) |
| Communication | Prioritise people; Practise effectively |
| Candour after an incident | Preserve safety (standard 14) |
| Dishonesty and probity | Promote professionalism and trust |
| Boundaries and social media | Promote professionalism and trust |
| Not cooperating with the NMC | Promote professionalism and trust (standard 23) |
This mapping helps explain the standards involved. It does not by itself establish misconduct or impairment.
The NMC's Fitness to Practise Library has dedicated guidance for different types of concern, and it is updated regularly. Each type is approached differently.
Conduct that falls seriously short of what is expected. The NMC's guidance recognises that not every breach of the Code is misconduct: the conduct must be serious. Misconduct can arise inside or outside clinical practice, and the question afterwards is whether it shows current impairment. Misconduct remediation
An unacceptably low standard of professional performance, judged on a fair sample of the professional's work. A single clinical incident is unlikely to show a general lack of competence unless it is exceptionally serious. These concerns are usually addressed through retraining, assessment and supervised practice, which is why conditions of practice are often suitable. Competence remediation
The NMC has specific guidance on dishonesty, including how charges are framed and the professional duty of candour. Dishonesty is treated seriously because honesty is central to trust in the professions, but the NMC's guidance also distinguishes the circumstances and seriousness of dishonest conduct. Probity remediation
Covers sexual conduct towards patients, colleagues and others, including abuse of the power imbalance inherent in professional relationships. These are among the most serious concerns the NMC considers and often raise public confidence issues that remediation alone cannot answer.
The NMC's guidance treats discriminatory behaviour and bullying of colleagues or patients as serious concerns because of their impact on people and on public confidence. It also recognises that professionals who experience discrimination or bullying may have that taken into account as context.
Convictions and cautions are a separate statutory ground. The NMC generally treats a conviction as proof of the facts of the offence, then considers what it means for current fitness to practise. Professionals must tell the NMC about relevant cautions and convictions.
A health condition only becomes a fitness to practise matter where it may affect the ability to practise safely and is not being managed safely. The approach is proportionate and focused on support, insight into the condition and safe practice.
Conduct outside work can be relevant where it raises questions about a professional's character, trustworthiness or the public's confidence in the professions. The NMC has specific, recently updated guidance on when it will and won't treat such conduct as a regulatory matter.
A distinct ground. Professionals must have the necessary knowledge of English to practise safely, and the NMC has a specific framework for these concerns.
Determinations by other health and social care regulators, and information from the Disclosure and Barring Service or Disclosure Scotland, can be relevant to NMC fitness to practise.
The NMC's process has five core stages. Agreed removal can be requested at almost any point, and interim orders can be sought whenever there is an immediate risk.
Referrals come from patients and families, colleagues, employers, other organisations and regulators, the police and courts, and professionals who self-refer. The NMC can also act on information from other sources, such as media reports, where regulatory action may be needed. Employers can call the NMC's employer helpline for advice before referring, and in many cases are advised a referral is not needed.
Screening is the first formal stage. The NMC looks at whether the information suggests a risk to public safety, to public confidence or to professional standards that could require regulatory action. It may make enquiries, for example with the employer, before deciding. Outcomes are closure, onward investigation, or an application for an interim order where there is an immediate risk. Most cases end here.
If there is a risk that needs managing while the case continues, the NMC can ask a panel to impose an interim conditions of practice order or an interim suspension order. The test is whether an order is necessary to protect the public, is otherwise in the public interest, or is in the professional's own interests.
The NMC typically asks for the full 18 months. Interim orders are reviewed regularly, at least every six months, and reviews are often held in private. The professional has the right to be heard before an order is imposed, and to ask for a review hearing if circumstances change. Extending an interim order beyond 18 months requires a court application.
Interim restriction≠Final sanction
An interim order is a temporary protective measure. It is not a finding that any allegation is proved.
These hearings can be arranged quickly. Contact your union (such as the RCN, RCM or Unison), your indemnity provider or a regulatory solicitor straight away.
Relevant, targeted learning and evidence of safe practice may also be relevant at interim order reviews.
If screening decides a concern needs further investigation, the investigation team gathers evidence and continually assesses the information it receives. The aim, in the NMC's words, is to gather enough information for decision-makers to make an appropriate decision.
You are told what the concerns are.
Records, statements, employer evidence, policies, training records, correspondence and, where needed, expert evidence.
To the concerns and the evidence, with any context and supporting material.
The NMC may seek more information as the picture develops.
The case passes to the case examiners.
Records, statements, documents.
Supervisor assessments, competency sign-offs.
Structured reflection showing application.
Courses, with scope and assessment results.
Changes in how you practise.
Audit, assessment, supervision reports.
Systems, culture, workload and circumstances.
From people aware of the concerns.
One of the most distinctive features of the NMC's approach is its guidance on context. Decision-makers are asked to consider the circumstances in which an incident happened, rather than treating an event in isolation. The NMC's guidance on context covers themes including:
At the end of an investigation, two case examiners, one a registered professional and one a lay person, decide whether there is a case to answer. The NMC's guidance (FTP-7, updated 25 March 2026) defines this precisely: whether there is a realistic possibility that the Fitness to Practise Committee would find the professional's fitness to practise currently impaired, based on the evidence gathered so far.
Case examiners do not decide whether allegations are proved, whether an incident happened, or whether the professional is fit to practise. Those questions belong to the Fitness to Practise Committee. A case to answer decision is a filter, not a verdict.
Case examiners can also ask for further investigation before deciding, and can recommend that an interim order be considered.
Source: NMC FtP Library, Examining cases (FTP-7).
Cases referred by the case examiners go to a panel of the Fitness to Practise Committee. A case may be decided at a meeting, considered on the papers without the parties attending, or at a hearing, where evidence is heard, witnesses may give evidence and the professional can attend, be represented and make submissions. The panel considers the evidence and decides whether the concerns are proved.
Where facts and outcome are not in dispute, the NMC can resolve a case through a consensual panel determination, in which the professional and the NMC agree a proposed outcome for a panel to approve. A professional can also apply for agreed removal from the register.
If facts are proved, the panel decides whether they amount to a statutory ground, such as misconduct, and then whether the professional's fitness to practise is currently impaired. This is the forward-looking step. A serious past event may not mean current impairment if the risk has been addressed; a lesser event may if it has not.
At this stage the panel considers the risk of repetition, insight, strengthened practice, current practice, and whether a finding is needed to protect the public, maintain public confidence and uphold professional standards.
The NMC's guidance on insight and strengthened practice (FTP-16, updated 25 March 2026) is clear that insight is crucially important, because a professional must recognise a problem before they can take effective steps to address it. Decision-makers look at the quality and nature of insight, not just whether some is present.
According to the NMC, a professional who shows insight will usually be able to:
Recognition → Understanding → Responsibility → Impact → Learning → Changed behaviour → Prevention
The NMC's guidance lists factors including whether the professional cooperated with local investigations, accepted the concerns when first raised, drew failings to their employer's attention or self-referred, accepts the key points of the concern, has done so since the early stages, understands the harm or risk and the effect on public confidence, and takes responsibility without blaming others. It stresses these are not exhaustive and not a test in themselves.
Yes, potentially. The NMC's guidance says that denying some or all of the facts is not necessarily a bar to demonstrating insight. A professional can dispute what happened while showing they understand why the conduct alleged would be a serious departure from standards.
Illustration only, not a template: "I do not accept that the incident happened as described. However, I understand why the practice described would create a serious risk to patient safety, and I have reviewed how I document and escalate to make sure it could not happen."
Timing matters too: late acceptance after compelling evidence emerges is viewed differently. Take advice before making statements about disputed facts.
"Strengthened practice" is the NMC's term for the steps a professional takes to improve their practice after a concern. Its guidance frames the assessment around three questions. They are central but, as the NMC notes, not a rigid legal test.
Clinical and competence concerns usually can. Some, such as serious dishonesty or sexual misconduct, are harder to address.
What has actually been done, and what evidence shows it?
Is there reassurance that the risk has gone, now and in future?
The NMC's guidance says steps taken should be:
Directly linked to the nature of the concerns.
Verifiable. For a course: scope, topics and results of any assessment.
Showing that past failings have been objectively understood and tackled.
Scale matters. A single clinical incident in an otherwise unblemished career needs less reassurance than repeated errors that continued after the professional knew about the problem.
Not all evidence carries equal weight. The NMC's guidance on insight and strengthened practice is unusually specific about what makes evidence count. Choose an evidence type to see what the guidance says adds or reduces weight.
| Evidence | Carries more weight when |
|---|---|
| Training course | Relevant, comprehensive, with a practical element and formal assessment, results available |
| Reflection | It shows how learning was applied in practice |
| Action plan | Problem, action, deadline, completion and evidence |
| Supervised practice | Targeted at the specific concerns |
| Employment | In a similar role, with the employer aware of the concerns |
| Testimonials | From a manager or supervisor, aware of the allegations, signed, dated, on letterhead |
Based on the NMC's guidance on assessing evidence.
Select an evidence type.
Standard 14 of the Code requires professionals to be open and candid with people in their care when something goes wrong. The NMC's guidance says apologising should be encouraged, and that an apology can be evidence of insight and of meeting the duty of candour.
It also recognises that some professionals are discouraged from apologising by employers or workplace culture, and that cultural differences or English as a second language can affect how insight and apologies are expressed. Apologising to a patient is not an admission of legal liability.
An apology alone does not resolve the underlying concern.
Before a hearing, cases can end with closure, advice, a warning or undertakings. If a Fitness to Practise Committee panel finds fitness to practise impaired, it considers sanctions in order, from the least restrictive. The NMC states that sanctions protect the public, maintain confidence and uphold standards, and are not intended as punishment.
Rare, and only where no further action is needed to protect the public.
The professional is cautioned but can practise without restriction. Visible on the register for its duration.
Restricts practice, for example to certain settings, or directs retraining. Used where concerns are capable of being addressed through retraining or assessment. Must be reviewed before it expires.
Prevents practice for a specified period. Usually reviewed before it ends, when the panel considers what has changed.
The professional cannot work as a nurse or midwife in the UK, or as a nursing associate in England. An application for restoration cannot be made until five years after striking off, and restoration is not automatic.
A current sanction is visible when someone searches the professional's name on the NMC register. Professionals can appeal a final decision to the court. See FTP outcomes and sanctions to compare the NMC with other regulators.
Medication errors, including administration, checking, documentation and escalation, are among the most common clinical referrals. An error is not automatically misconduct: the NMC considers systems, context and response. Strong remediation typically combines learning, supervised practice, competency reassessment and audit.
Medication remediationStandard 10 requires clear and accurate records, completed at the time or as soon as possible after an event. Corrections must be transparent. Altering records after a concern arises can create a new and serious probity concern.
Documentation remediationStandard 5 covers privacy and confidentiality, including social media and professional communication. Deliberately accessing records without a work reason is treated very differently from accidental disclosure.
Confidentiality remediationProfessional boundaries with patients and families, online and offline, fall under standard 20. The NMC's guidance on sexual misconduct and on conduct outside practice is particularly relevant here.
Professionalism remediationRecognising risk, escalating without delay, raising concerns and reporting incidents all fall within Preserve safety. The NMC's context guidance is especially relevant where workplace culture or systems contributed.
Performance remediation| Employer process | NMC fitness to practise | |
|---|---|---|
| Relationship | Employment | Professional registration |
| Framework | Employer policies, capability and disciplinary procedures | Nursing and Midwifery Order 2001, Rules, Code |
| Question | Should employment continue, and on what terms? | Is fitness to practise currently impaired? |
| Outcome | Employment outcome | Registration outcome |
Different purposes and standards of proof. A conviction is generally treated as proof of the facts; an acquittal does not automatically end NMC interest. You must tell the NMC about relevant charges, cautions and convictions.
Findings by other health and social care regulators, and information from the DBS or Disclosure Scotland, may be relevant to NMC fitness to practise.
Revalidation CPD shows ongoing learning. Remediation needs relevance, reflection, application and evidence. A CPD certificate alone is not strengthened practice.
| Reflection | Insight | Remediation | Strengthened practice |
|---|---|---|---|
| Learning from what happened | Understanding what went wrong, why and its impact | The steps taken to address it | The NMC's term for the resulting improvement in practice |
| A process | A quality decision-makers assess | Actions | Evidenced change |
Choose learning that directly matches the concern. Completing a course can provide evidence of learning, but course completion alone does not establish insight, competence, strengthened practice or any particular NMC outcome.
Structured CPD · 1.5 CPD ptsStructured CPD · 1.5 CPD ptsStructured CPD · 1.5 CPD ptsStructured CPD · 2 CPD ptsStructured CPD · 2 CPD ptsStructured CPD · 2 CPD ptsStructured CPD · 1.5 CPD ptsStructured CPD · 1.5 CPD ptsStructured CPD · 3 CPD ptsDepending on the concern, Probity, Confidentiality or Dealing with a Complaint or Investigation may also be relevant. See all NMC remediation courses.
General educational guidance. The right approach depends on your stage and circumstances.
Carefully, and note every deadline.
What is alleged, and what is not.
Screening, investigation, case examiners or committee.
Which standards are engaged.
Records, context, witnesses.
Securely. Never alter them.
Your union, indemnity provider or a solicitor.
From the root cause.
Relevant, measurable, effective.
Supervision, audit, feedback.
What you do now, safely.
Over time, not just before a decision.
A simplified educational model. Actual routes vary with the circumstances and the NMC's rules.
| NMC fitness to practise | Remediation |
|---|---|
| A regulatory process | An improvement process |
| Assesses the concern | Addresses learning and behaviour |
| Considers evidence | Creates evidence |
| Determines regulatory action | Demonstrates change |
I completed a course, so the concern is resolved.No. A course shows learning; strengthened practice needs evidence of application.
I wrote a reflection, so I have shown insight.Not necessarily. Quality and application matter.
I disagree with the allegation, so I can't show insight.Not necessarily. The NMC says denial is not automatically a bar.
My employer says I'm good, so the NMC must accept it.No. Evidence is weighed, including whether the employer knew the concerns.
My reference proves competence.Not automatically. References without informed comment on practice carry little weight.
It happened years ago, so it can't matter.Not necessarily. The question is current impairment.
The investigation means I'm impaired.No. Investigation gathers evidence; it decides nothing.
A warning is the same as suspension.No. A warning follows a no-case-to-answer decision and does not restrict practice.
The NMC's process for deciding whether a nurse, midwife or nursing associate's fitness to practise is currently impaired, and whether regulatory action is needed to protect the public, maintain confidence and uphold standards.
Nurses and midwives across the UK, and nursing associates in England. It does not regulate healthcare assistants.
Concerns about misconduct, lack of competence, criminal convictions or cautions, health, knowledge of English, or determinations by other bodies, including conduct outside work in some cases.
The concern goes to screening, where the NMC decides whether it needs regulatory action. In 2024–25, 72% of screening decisions closed the case.
The first stage, which assesses whether the information suggests a risk to public safety, public confidence or professional standards requiring regulatory action.
The NMC gathers records, statements, employer evidence and sometimes expert evidence, and invites your response, before passing the case to the case examiners.
Whether there is a realistic possibility that the Fitness to Practise Committee would find your fitness to practise currently impaired on the evidence gathered. It is not a finding.
Two decision-makers, one a registered professional and one a lay person, who decide whether there is a case to answer at the end of an investigation.
Yes. Most are closed at screening, and case examiners can close cases, give advice, issue warnings or recommend undertakings.
A formal response case examiners can give where there is no case to answer but the conduct fell below standards. It does not restrict practice.
Agreed commitments, such as training or supervision, that case examiners can recommend where there is a case to answer, allowing the case to be resolved without a hearing.
A temporary conditions or suspension order imposed while a case continues, where necessary to protect the public. It can last up to 18 months, is reviewed regularly, and is not a finding.
A panel hears evidence, decides whether facts are proved, whether they amount to a statutory ground, whether fitness to practise is currently impaired and, if so, what sanction is needed.
The NMC committee whose panels decide referred cases at meetings or hearings, independently of the staff who investigate.
The ability to look at what happened objectively, recognise what went wrong, accept your role, appreciate what should have been done differently and understand how to act differently in future.
The NMC's term for the steps taken to improve practice after a concern. It asks whether the concern can be addressed, has been addressed and is highly unlikely to be repeated.
Potentially. NMC guidance says denial of facts is not necessarily a bar to insight, if you show you understand why the alleged conduct would be serious. Take advice first.
Relevant courses with assessment results, reflection showing application, completed action plans, targeted supervised practice, relevant employment with an informed employer, and testimonials from managers aware of the concerns.
No. A course shows learning. Insight and strengthened practice need understanding and evidence of applied change.
CPD is ongoing learning, including for revalidation. Remediation addresses a specific concern and needs relevance, reflection, application and evidence.
A caution order, conditions of practice order, suspension order or striking-off order, considered in that order after a finding of impairment.
A sanction lasting one to five years that allows practice without restriction but appears on the register for its duration.
Restrictions or directions for up to three years, such as working only in certain settings or retraining, used where concerns can be addressed through retraining or assessment.
An order preventing practice for a specified period of up to one year, usually reviewed before it ends.
Removal from the register. The person cannot practise and cannot apply for restoration until five years have passed.
Yes. They have different purposes and can run in parallel.
The professional standards nurses, midwives and nursing associates must uphold, organised into four themes and 25 standards.
Its guidance asks decision-makers to consider circumstances such as practising history, system failures, workplace culture and discrimination experienced. Context can explain a concern; it does not automatically excuse it.
Yes, where the conduct raises questions about character, trustworthiness or public confidence in the professions.
Read the correspondence carefully, note deadlines, identify the stage and concerns, preserve records and contact your union or indemnity provider before responding.
This guide is based on the NMC's published material. IRR Practice is independent; naming the NMC does not imply endorsement.
Content governance. Last reviewed September 2026. NMC rules, guidance and standards change, and the FtP Library is updated regularly. This page is general educational information, not legal advice, representation or a guarantee of any outcome. For an active case, take independent advice.
Understanding the concern is only the beginning. Build relevant knowledge, reflection, insight and evidence of strengthened practice through remediation matched to the professional issue.
The Code, revalidation, interim orders, reflective accounts and more.
Writes for IRR Practice on professional standards, fitness to practise, insight, reflection and remediation for UK healthcare professionals.
Last reviewed: September 2026