The Nursing and Midwifery Council (NMC) regulates nurses and midwives across the UK, and nursing associates in England. It maintains the register of professionals eligible to practise and it investigates concerns about nurses, midwives and nursing associates - assessing whether an individual's 'fitness to practise' is impaired, and making sure registrants meet the requirements of the NMC Code and relevant standards.

The NMC can consider concerns from a range of sources including patients, members of the public, the police and employers.

The NMC will investigate various concerns including:

• misconduct
• lack of competence
• not having the necessary knowledge of English
• criminal behaviour
• serious ill health
• determinations and sanctions by other health and social care organisations.

The NMC's Advice and information for employers of nurses and midwives provides more information about fitness to practise and the types of concerns that may be investigated.

Although the NMC recognises that it can be very distressing for a person to be subject to fitness to practise proceedings, it has an obligation investigate any complaints it receives in line with its fitness to practise process. 

Support from the RCN

It's important you contact us as soon as you are contacted by the NMC. 

As long as you were in the correct category of RCN membership at the time of the incident leading to the referral, you’ll be referred to our Legal Department where a member of the screening team will be assigned to your case. 

We’ll send you a client care letter and 'On the Case' leaflet, which clearly set out what you can expect from us and what you need to do.

The role of the RCN’s Legal Department is to provide you with advice and representation and present the case in a way that will bring about the best practicable outcome for you.

Your case may progress in one of several different ways. You’ll be informed at each stage who your legal representative is, who can answer any questions you may have about the process.

It’s helpful to engage with the NMC's process. The NMC’s step by step guide on the fitness to practise process provides more information about what to expect.

Although you can’t be investigated by the NMC for fitness to practise concerns if you are no longer registered, you can still be investigated if the process started before your registration lapsed. 

If you were not in RCN membership at the time of the incident that led to the referral, please read our advice on legal support for matters which occurred outside membership. 

NMC investigations and your employment

The NMC has information on how it carries out its investigations which outlines what you can expect.

If you’re subject to any disciplinary investigation by your employer alongside the NMC proceedings, please see our guidance on investigations and get in touch with us for further support. See more in 'Telling your employer' below.

NMC hearings 

The NMC's guidance can help you understand what to expect if you are attending a hearing before a Fitness to Practice Panel (FtP) or Interim Orders Committee (IOC) (see 'interim orders' below). 

If your hearing is held remotely, our guidance on virtual hearings may be helpful.

NMC Careline

The NMC Fitness to Practise Careline is available, free of charge, to anyone who needs emotional support and practical advice while going through the fitness to practise process. 

Retaining and renewing your registration while your case is ongoing

In order to retain your registration with the NMC and stay on the NMC register, you need to pay your fee every year. Every three years you also need to renew your registration by revalidating (see below).

While the investigation continues you should ensure that you remain registered with the NMC, if possible. If your registration payment/renewal is due during the investigation, you should pay/renew it in the usual way. 

If you do not retain/renew your registration and there is an active NMC investigation in place, your registration will not be allowed to lapse but the NMC register will show that your registration has passed its expiry date. You're not allowed to practice as a nurse, midwife or nursing associate while your registration is expired. If you do, the NMC will take this matter very seriously and will want to know more. As you will be unable to practise, your employer could conduct an investigation too, or decide to suspend or take disciplinary action against you. Contact us if your employer takes any of these actions.     

Please note that you will not be permitted to retain/renew your registration if you are subject to an interim or substantive suspension order.

Once the proceedings have concluded, if you wish to continue nursing and your registration has lapsed, you will need to apply for readmission and pay the registration fee.  It can take approximately two to six weeks to obtain readmission to the register. Find out more in our guide on NMC readmission.

Revalidation while your case is ongoing

You can revalidate as normal while your case is ongoing as long as your registration is not subject to an interim or substantive suspension order at the time the revalidation is due.

If you are unable to revalidate due to suspension of your registration, your registration will lapse at the end of the case (provided a striking off order has not been imposed). You will need to submit an application for readmission to the register, together with confirmation that you have complied with your revalidation requirements. You will not need a confirmer because your referees for the readmission process will be sufficient.

The NMC prefers revalidation to be up to date, so would prefer that the tasks required for revalidation are completed within the year prior to your readmission application.

23.3 tell any employers you work for if you have had your practice restricted or had any other conditions imposed on you by us [the NMC] or any other relevant body.”

1. In most circumstances you will be required by your contract, local policy or application form (if applying for a nursing post) to disclose if you are currently or have previously been under investigation by the NMC or another body or employer.
2. If there is no local requirement as set out in point 1 above, you are required under the Code to disclose any restriction on your practice and a failure to do so could lead to a charge of dishonesty by the NMC.
3. If there is no local requirement and no restriction on your registration, there is no positive duty to disclose the NMC proceedings to your employer.

We strongly advise that you disclose to your employer (or potential employer) any NMC referral, investigation or proceedings as soon as you become aware of them.

The is because:

1. It is likely that as part of an NMC investigation, the NMC will contact your employer for information. It is preferable that you have already informed your employer about what has happened in such circumstances.
2. Failure to disclose when there is a requirement to do so could result in charges of dishonesty being brought against you by the NMC.
3. It is likely that a reference will be required from your employer at some stage in the proceedings. Failure to disclose what has happened early on in the case may discourage your employer from offering support to you. It is helpful if your employer can say in a letter that you were open and honest about the NMC proceedings from the beginning.
4. If you do have a positive duty to disclose NMC proceedings to your employer, failure to do so may result in the RCN withdrawing support from your case.

Finally, please note the following paragraph in the NMC Code:

“When telling your employers, this includes telling: 

A case does not always reach a final hearing or meeting. It can be closed at an earlier stage.

If a case does reach a final hearing and a registrant’s fitness to practise is found to be impaired, the following sanctions are available to a panel:

No further action	Having made a finding of impairment, the panel may decide to take no further action. This happens in very rare cases.
Caution order	This order can be imposed for a period of between one and five years. It does not restrict the registrant’s ability to practise, but is recorded on the register and published on the NMC website. It is disclosed to anyone enquiring about the registrant’s fitness to practise history. It is generally imposed to mark that the behaviour was unacceptable and should not happen again.
Conditions of practice order	This order requires the registrant to comply with conditions for a period of up to three years. It is usually reviewed by a panel at a hearing or a meeting before it expires. At any review, the panel can revoke the order or any condition of it; vary the conditions; or impose any other sanction option (however, please see below for restrictions on striking-off orders).
Suspension order	This order can be imposed for a period of up to one year, during which time a registrant may not practise as a nurse, midwife or nursing associate. It is usually reviewed by a panel at a hearing or a meeting before it expires. At any review, the panel can revoke the order or replace it with any other sanction option.
Striking-off order	This order results in the removal of a registrant’s name from the register. They may not apply for restoration until a period of five years has elapsed. The factors taken into account by the panel deciding on the restoration application are set out on the NMC website. A striking-off order is not available to any panel in cases where fitness to practise is impaired by health, lack of competence or not having the necessary knowledge of English, unless the registrant has been subject to either a suspension order or a conditions of practice order for a continuous period of no less than two years.

The NMC must consider public interest when making decisions. It takes into account promoting and maintaining public confidence in nurses, midwives and nursing associates. It considers whether the facts of the case show that the public might be deterred from using the services of nurses or midwives in general; and/or it needs to publicly declare to all nurses or midwives the importance of the professional standards involved.

This means that even if there are no current practice concerns regarding the registrant, the hearing panel may still consider it appropriate to 'mark' the conduct with a finding of impairment and a sanction.

Once the NMC has commenced a fitness to practise case, you cannot cancel your registration until the case closes.

However, there are a limited number of ways to come off the register at certain stages of the proceedings.

Agreed removal

An application can be made to have your name removed from the register if you do not wish to practise in the future. It is known as agreed removal (‘AR’). Agreed removal is not guaranteed and is a decision for the Assistant Registrar at the NMC. You can find out more information about this on the NMC website.
 
An AR application is likely to be accepted if:  

• the regulatory concerns are not so serious that the Fitness to Practise Committee is unlikely to make a striking-off order; and  
• the nurse, midwife or nursing associate provides evidence that they do not intend to continue practising.  

While AR is unlikely to be successful in the most serious misconduct cases (including cases where a nurse’s conduct is considered to be incompatible with remaining on the Register and likely to result in a striking-off order) we can still consider submitting an application and reviewing our position from there if it is not successful.  
 
If you were to pursue AR you would need to complete an application form and gather the following:  

1. Evidence of your decision to leave nursing
   Any documents or evidence to confirm when you last worked as a nurse (for instance a letter from your former employer confirming your last working day etc); any evidence that you have allowed your PIN to lapse or when you last renewed your PIN (which we can obtain from the NMC website); any evidence of drawing on your pension, if applicable; and any evidence of you pursuing work outside of nursing, if available or suitable.  
   
   
2. Health documents
   It would assist to provide a letter and/or medical evidence confirming your current health; treatment plan; and prognosis, if your health is relevant to your decision.
    
3. Reflective statement
   We would require a document setting out your reflection on the concerns as well as details of you leaving nursing including: confirmation of your decision to leave nursing; when you last worked as a nurse; when your NMC PIN lapsed; the reasons for your decision; what you do now and your future plans.  

More advice can be provided on the above should you choose to pursue this option. Please get in touch with your RCN legal representative to discuss this further. 

Striking-off order

A striking-off order is one of the sanctions available to the panel at the final Fitness to Practise Panel hearing. It results in the removal of the registrant’s name from the register, preventing them from working as a registered nurse, midwife or nursing associate.

It is possible to agree to a striking-off order by way of consensual panel determination (CPD).  

The purpose of CPD is to agree on the sanction of a case in advance, thereby avoiding the need for a lengthy hearing. It is only available in the following circumstances:

1. When a registrant admits the charges against them
2. When a registrant admits that their fitness to practise is impaired
3. Where the registrant and the NMC can agree on the appropriate sanction in the circumstances of a case.     

The CPD agreement must be approved by an NMC panel. If the panel rejects the agreement, the case will be adjourned and a full hearing will be required.

While there are other sanctions that can be agreed by CPD, a striking-off order is a way of coming off the register in serious cases when a registrant does not wish to continue nursing. It would only be available in cases where the panel determines that the behaviour is fundamentally incompatible with being a registered professional.

A registrant whose name has been struck off the register cannot apply for restoration to the register until a period of five years has elapsed since the striking-off order was made. An application for restoration would only be granted if a panel is satisfied that the applicant meets the requirements for admission to the register and, in addition, is a fit and proper person to practise as a nurse, midwife or nursing associate.

'Cease to engage'

You are under no obligation to respond to the NMC and you can simply cease to engage with the proceedings. The proceedings will nevertheless continue to a conclusion.

There are various stages at which the case could be closed. If, however, the case reaches a hearing and the sanctions stage is reached, a striking-off order is one of the possible outcomes (see above regarding striking-off orders). If the sanction is a conditions of practice order or a suspension order instead, it may need to be reviewed at a later date. If you continue not to engage at any of the reviews, eventually a reviewing panel is likely to impose a striking-off order on your registration.

If you were to cease to engage, the RCN would stop acting for you and we would tell the NMC to direct correspondence to you.

Allowing the registration to lapse or cancelling the registration at a review hearing

If the sanction stage is reached at a Fitness to Practice Panel hearing, the panel may impose a number of alternative sanctions. If a conditions of practice order or a suspension order is imposed, the panel may require it to be reviewed at a future date by a review panel, to consider whether a registrant’s fitness to practise remains impaired.  

An application can be made to a reviewing panel to find impairment but to allow the order to lapse. If the registrant is not intending to return to nursing and has not been able to remediate any concerns, such an application can be made on the basis that the registrant is not returning to nursing. This allows a registrant to leave the register without a striking-off order against their name.

If a registrant has not retained/renewed their registration in the past year when the order expires, the registration will lapse automatically. No further steps would need to be taken to remove their name from the register. However, the registrant would need to sign a declaration promising not to apply to return to the register within the next five years.

If the registrant has retained/renewed their registration in the last year, once the order expires, the panel would expect a registrant to cancel their registration. A registrant would need to sign a declaration stating that they will cancel their registration and that they would not apply to return to the register for at least five years.

Please note that the success of such an application will always depend on the circumstances of each case and success is not guaranteed, so it's important to seek advice from your RCN legal representative about your options.

It may be worth considering whether you need to adjust your online social media settings.

NMC hearings are generally held in public and occasionally, members of local press outlets report on the hearings. There have been cases in which the press has obtained the charges and details of the case from the NMC website and obtained members’ photos from social media sites like Facebook or LinkedIn. These was used to create an online article. While this is rare; it is possible.

You may therefore consider it wise to review your social media privacy settings and/or replace any photos of yourself that might be on Facebook/LinkedIn etc with the default images on those sites. It may also be sensible to double check whether photos of you are accessible to the public via a web search such as Google/Yahoo search.

We do not have expertise on how to adjust privacy settings or replace photos, so if you need help with this, we suggest you contact the provider/social media platform directly.

Please see our guidance NMC: Self-referrals for more information and guidance on what to do next. Please note: to access this page, you'll need to log-in to the website using your membership details if you haven't done so already.

The NMC also has further information on making a self-referral, including when you don't need to.

NMC investigations can be lengthy and you may have restrictions placed on your practice whilst under investigation by way of an interim order. These can include limits on where you can work or the type of work you can do.

You may have concerns about maintaining your registration through Continuing Professional Development (CPD) and accessing other learning; the latter can be harder if you're not working under a contract of employment as this is often a condition of acceptance onto courses. Continue with your CPD, your reflection on what has happened, and any learning that is relevant to your situation.

Securing any voluntary and paid work (within any restrictions on practice set by the NMC) can be helpful with your case as you may be able to obtain references to present to the NMC panel.

Additionally you may have questions about disclosing your situation to prospective employers and our guidance applying for a job following dismissal includes further information on restrictions and the type of work you can do.

Changing employers

Many employment application forms ask the applicant whether they have ever been referred to the NMC. It is important to be honest. The NMC Code also states you must declare to an employer or new employer, any restriction on your practice imposed by the NMC.

Once you've been referred, we usually advise that you tell a new employer because this will help to bring about a trust relationship. The NMC is likely to get in touch with the new employer at some point anyway.

There's no obligation to tell a new employer that a previous employer intends to refer you to the NMC. It is your choice whether to share this information but it may be advisable not to, as it may not happen.  Please also see the section on 'self-referral' above. 

Working in an unregistered support role

There is nothing to prevent nurses or midwives working in support roles although it's important to consider issues like:

• accountability (professional and legal)
• employment liability (vicarious)
• revalidation.

You can find more information in our guidance on revalidation and applying for a job following dismissal. We also have guidance on readmission to the register and practising whilst lapsed.

We recognise that being referred to the NMC can be distressing and isolating. It can also lead to issues with finances, relationships and maintaining professional registration. 

Our member support services can provide further help and support for you during this difficult time. Members often reflect on how isolated they felt during the investigation. You may be prohibited from speaking to colleagues or just lose touch. Some members turn to family and friends for support, but they may not always understand what you're going through.

Counselling service

If you're feeling stressed, disappointed or upset at any point, our counselling service may be able to help. We offer short term, telephone-based counselling as part of your membership and we understand the impact that a referral to the NMC can have on all areas of your life.

To make an appointment, please contact us.

Financial wellbeing

If your financial situation changes because of a referral to the NMC, an assessment from the RCN's financial wellbeing service can help you maximise your income and check your eligibility for benefits.

Our welfare service can also offer further advice and assistance including managing rent arrears and challenging benefit decisions. If you require help from the welfare service please contact us.

Careers service

Peer support service

 

If you're an RCN member and worried about your immigration status due to a referral to the NMC, please contact us to be put in touch with our Immigration Advice Service.

As part of an investigation the NMC will want to speak to other people who may be able to help. If you're contacted by the NMC to be a witness, you'll be asked to provide an account of what is being investigated by the NMC or to provide documentation or other information that may help.  You could be contacted by an investigator from the NMC or a legal firm acting on its behalf. 

Our guidance for witnesses outlines the support the RCN can offer you.

As a witness, you can also get support from the NMC's witness liaison team and use its resources for witnesses.

If you have concerns about the fitness to practise of a colleague you should raise your concerns internally, following your employer's policy. After raising your concerns, you or your employer may decide to raise these concerns externally.

At all stages, ensure that you keep records of your concerns and any steps you have taken to resolve them as you may need to refer to them later.

Please see our raising concerns guidance and refer to the NMC guidance for employers on managing concerns.

If you have been struck off the NMC register, you can apply for restoration after five years. This is not the same as readmission; restoration only happens if you have been removed or struck off by a Fitness to Practise Panel. Please contact us for advice.