The Nursing and Midwifery Council regulates nurses, midwives and nursing associates across the UK. NMC fitness to practise guidance sits in an online library of more than forty guides. If you face a concern, you are better served by reading the relevant parts of it than by relying on accounts of the GMC process. That process differs in important ways. This article picks out what matters most at each stage.
The starting assumption
The NMC's guidance on taking account of context opens with a principle worth quoting back to the NMC when you respond. It will approach cases on the basis that most people referred to it are normally safe. The same guidance commits the NMC to build an accurate picture of your practising history. It also commits the NMC to concentrate on underlying issues where system and process failures caused the risks. And it commits the NMC to consider whether group norms or workplace culture influenced what happened. If your concern arose on an understaffed shift, in a unit with known problems or under a local practice you were trained to follow, those principles give you a framework for saying so with evidence.
Screening, investigation and case examiners
A concern passes through screening and, if it goes further, an investigation. The case examiners then make the decision that shapes most cases. Their guidance, updated on 1 October 2026, sets the test they apply. They ask whether there is a realistic possibility that the Fitness to Practise Committee would make two findings on the evidence gathered so far. The first is that the incidents happened or that the issue is still present. The second is that your fitness to practise is currently impaired. Case examiners do not decide whose account is true. Instead, they weigh what is in front of them, including anything you have told the NMC and any evidence you have provided.
The outcomes available to them are these. If there is no case to answer, they can close the case, give advice or issue a warning. If there is a case to answer, they can recommend undertakings agreed with you or refer the case to the Fitness to Practise Committee. They can also ask for further investigation before deciding.
Two things follow for your response. The word currently matters, because the question is about impairment now. So evidence of what you have done since the incident, from training to supervised practice to reflection, belongs in front of the case examiners. The case examiners also consider each incident separately. A response that deals with the strongest allegation and ignores the weaker ones therefore leaves the rest unanswered.
The sanctions and their lengths
If a panel finds your fitness to practise impaired, the NMC's guidance sets out four orders.
- A caution order runs for between one and five years. It is the least restrictive order, and the register records it.
- A conditions of practice order lasts up to three years. The conditions must be relevant, proportionate, workable and measurable.
- A suspension order lasts up to one year, and a panel usually reviews it before it expires.
- A striking-off order removes you from the register.
One point in the caution guidance is easy to miss. No review of a caution takes place. So the NMC warns its own panels that a caution of more than three years may run longer than a more restrictive order. That would happen without the chance to show a review panel that you are no longer impaired. If a panel is considering a long caution, that is a point to raise in submissions on sanction.
Resolving a case by agreement
The NMC offers a consensual panel determination. In it, you admit the factual allegations and agree with the NMC on impairment and on what the sanction should be. A panel then considers the provisional agreement, usually at a meeting, and makes its own decision. This can shorten a case a great deal. It also means admitting the facts and impairment on the record. So take advice on the wording of any agreement before you sign it.
Appeals and their deadline
You can appeal a final substantive order to the High Court in England and Wales, the High Court in Northern Ireland or the Court of Session in Scotland. You have 28 days, counted from the day after the date on the letter telling you the outcome. The only exception is where the court finds exceptional circumstances to extend the time. A High Court appeal runs through a regulated law firm Eloquia works with, because conducting litigation is a reserved legal activity. The Professional Standards Authority reviews every final decision. It has a further 40 days, starting on the last day of your appeal period, to appeal a decision it considers insufficient to protect the public.
Eloquia acts for nurses, midwives and nursing associates before the NMC on our NMC page, part of our track for other healthcare professionals. We quote a fixed fee for each stage before it starts, stated plus VAT. That fee includes a specialist barrister whom we involve from the outset. We quote expert fees separately, and our fees and funding page explains how staged payment works.
Where to put your effort
From my years in practice and on the bench, the stage that repays preparation is almost always the earliest one you can still influence. In an NMC case that is the response to the investigation and the material the case examiners will read. Gather your training records and references from colleagues who have seen your practice since the incident. Add a short, specific reflection on what you would do differently. Then present them early, and in a form a case examiner can read in one sitting.
