NMC self-referral: what you need to know

The Nursing and Midwifery Council (NMC) regulates nurses and midwives across the UK, and nursing associates in England, maintaining the register of professionals eligible to practise.

It investigates any referrals or concerns, assessing whether an individual's fitness to practise (FtP) is impaired, and making sure registrants meet the requirements of the NMC Code and relevant standards.

Misconduct, criminal behaviour or serious ill-health are possible reasons someone might be referred to the NMC. In most cases, an employer will refer an employee to the regulator, but referrals can come from anyone including the public, patients and police. You can also self-refer.

What's self-referral?

Self-referral is when a nurse, nursing associate or midwife informs the NMC of a serious professional or personal issue that means they may be unable to continue in their role without restriction.

As a registrant, you’re accountable for your own acts and omissions, so self-referral means asking yourself if your FtP might be impaired.

Why self-refer?

As outlined in the code, there are some circumstances where you’re under professional duty to refer yourself to the NMC.

For example, if you’ve been charged with a criminal offence, accepted a police caution, or if you’ve been diagnosed with a health condition that affects your ability to practise safely. In these circumstances, it’s a further breach of the code to fail to make a self-referral.

Is a new health condition a grey area in self-referral?

An employer will usually make referrals, especially if you’re in discussion with them already about your health condition or if they believe your diagnosis might mean you’re unable to perform your duties safely.

For example, if you’ve been diagnosed with a neurological condition affecting limb function and/or brain memory. In which case, you won’t need to self-refer.

If your employer has a concern and they’re advising you to self-refer, it might be best if they make the referral.

You cannot withdraw a referral, so it’s an important decision

If your employer is helping you manage your health condition and there are no concerns about your nursing practise, the NMC wouldn't expect you to make a referral in these circumstances.

The NMC doesn’t need to know about every health condition or medical diagnosis. They only need to know if it’s impacting on your ability to practise safely.

What else should I be aware of when self-referring?

If you do self-refer, you’re initially responsible for providing evidence, reports, reflections and any other documents the NMC might ask for. Once the process is in place, you cannot withdraw your referral, so it’s an important decision.

As an NMC registrant, you’re accountable for your own acts and omissions. Be honest with yourself and reflect on whether something is impeding your FtP.

If your concern falls outside the limited occasions where making a self-referral is mandatory, think carefully about whether self-referral is appropriate.

If your employer refers you, they’re responsible for gathering evidence and paperwork and are best placed to liaise directly with the NMC.

If your employer tells you to make a referral (for example, following an incident at work), you might ask them to make the referral but confirm that you’ll engage with the regulator in relation to any ongoing investigation.

This will save you from having to effectively provide evidence against yourself and gives you time to seek proper support in relation to any responses to the NMC. You can tell your employer this. Self-referral isn’t necessary; you just have to engage in the process.

So, my employer will refer me?

If your employer has any concerns that need to be referred – for example any clinical or attitudinal concerns, or an illness that’s affecting your work – they should put in the referral to the NMC.

Under the Code, you're under a duty to comply with any investigations and requests from the NMC, but the important point to note is the gathering of evidence, documents and anything else to do with the case isn’t solely your responsibility. 

You shouldn't be the main contact for the NMC in your own case where there has been an incident at work. 

I’m feeling pressure from my employer to self-refer, what should I do?

If you’re an employee, you shouldn’t feel under any pressure from an employer to self-refer. If there are concerns or if there’s something you’ve disclosed that needs further investigation, your employer should make the referral.

If your employer hasn’t made a referral, but they’re asking you to, you should suggest they refer you and, if necessary, seek our advice.  You shouldn’t be criticised for this if you’re still willing to engage in the process.

Will I be more likely to have to self-refer if I’m agency staff or not directly employed by an employer?

Not necessarily. Agency and temporary staff are managed through NHS Professionals and any concerns regarding the conduct of an agency or bank flexible worker must be raised via their formal procedure for raising concerns. This procedure is completed online.

• Read next: What happens at an NMC hearing 

Raising a concern through this process will place an automatic restriction on the flexible worker’s profile. They will not be able to undertake any further shifts at the trust until an investigation has taken place and a request for the sanction to be lifted made. Referrals can be made by agencies or the workplace itself.

What happens when you self-refer?

When a self-referral is made, the NMC makes enquiries to decide whether it amounts to an allegation of impaired fitness to practise.

They begin a two-stage screening process, checking whether they’ve received a concern in writing about someone on the register and whether there’s evidence suggesting that there’s an ongoing risk to public safety, public confidence or professional standards that could require them to take regulatory action.

You’ll be invited to make a response to the regulatory concerns whether you self-referred, or a third party made the referral.

What can I expect from the RCN if I self-refer?

We have a handy decision-maker tool to help check if you need to self-refer. It suggests all types of scenarios to enable you to make an informed decision. You can access this by navigating to the self-referral to the NMC section of our website. 

If you’ve already made a referral, it’s important if you’re an RCN member to contact us as soon as you’re able, so we can support you with what to expect and to represent you in relation to any ongoing FtP process.

Will a self-referral lead to a FtP hearing?

Not in all cases.

The NMC says if there’s clear evidence a registrant has reflected appropriately on the issues raised in the concern, or, where appropriate, provided evidence of relevant retraining, it may decide the case doesn’t need to be referred to the FtP committee.

There are various stages of the process where a case might conclude without the need for a final hearing.