Nurses, midwives and nursing associates
NMC fitness to practise: defence for nurses, midwives and nursing associates
The Nursing and Midwifery Council runs its fitness to practise cases under its own rules, with its own names for each step. It also sets its own time limits and its own sanctions. This page takes them stage by stage from the NMC's rules and guidance, then explains what to do on the day the letter arrives and how we act for you on fixed fees.
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Day one
When the NMC letter arrives
Do
- Note every date in the letter. A notice of allegation gives you 28 days from its date to send written representations. The Registrar may extend that only on request.
- Tell your indemnity provider, union or professional body straight away, even if you doubt the cover applies.
- Keep copies of the records, rotas, handover notes and emails connected with the concern, without altering anything.
- Write a private note of what you remember while it is fresh, and keep it to yourself.
- Speak to us before you reply to the NMC, agree undertakings or sign anything.
Do not
- Reply to the NMC straight away to explain yourself.
- Contact the patient, the family or the colleague who raised the concern.
- Change or add to clinical records after the event.
- Discuss the case with colleagues who may become witnesses.
- Post about it online, even in a closed group.
The stages
How an NMC case runs, in the NMC's own terms
Screening
The Registrar first decides whether the referral alleges impaired fitness to practise. The test sits in article 22(1)(a) of the Nursing and Midwifery Order 2001. If it does not, the Registrar tells the person who made the referral and does not refer it. If it does, rule 2A of the Fitness to Practise Rules 2004 requires the Registrar to refer it onward. It goes to the case examiners or, in some cases, straight to the Fitness to Practise Committee. Before deciding, the Registrar may investigate.
The NMC sets out its approach in its guidance on understanding fitness to practise. It starts from the basis that most people referred to it are normally safe. The guidance also commits the NMC to build a picture of your practising history and to consider the context in which the events happened.
Investigation and your response
Rule 6A requires the Registrar to send you a notice of the allegation. The notice comes with the documents relied on and tells you what the case examiners can do. It invites written representations within 28 days of the date of the notice, and it warns you that the NMC may show your representations to the person who made the referral. Rule 6B lets the Registrar investigate further, including obtaining records and statements. Your response at this stage is the material the case examiners will read, so it is where the work goes.
Case examiners
Under rule 6C, two case examiners decide whether there is a case to answer. One is a registered nurse, midwife or nursing associate, and one is lay. The NMC's guidance frames the test as a realistic possibility. Would the Fitness to Practise Committee find that the incidents happened or the issue is still present? Would it also find your fitness to practise currently impaired? The examiners do not decide whose account is true.
If they agree there is no case to answer they may close the case, give advice or issue a warning. If there is a case to answer, they must refer the case to the Fitness to Practise Committee or recommend undertakings. Under rule 6E you must confirm undertakings within 28 days. Undertakings are not available where there is a realistic prospect of a striking-off order. Our article on nurses, midwives and the NMC explains what persuades case examiners.
Interim orders
At any stage the NMC can ask the Fitness to Practise Committee for an interim order. Under article 31 of the Order the committee may suspend your registration or impose conditions for up to 18 months. The committee must be satisfied that the order is necessary to protect the public or otherwise in the public interest. It may also act where the order is in your own interests. It must review the order within six months and then before the end of each further six months. The NMC can ask the court to extend it by up to 12 months at a time. Our guide to interim orders explains how to prepare at short notice.
The Fitness to Practise Committee
Rule 11 requires at least 28 days' notice of a hearing. Less notice is possible where you consent or where the committee considers a shorter period is in the public interest. The committee may also decide some cases at a meeting on the papers. Where you admit the facts, the NMC may offer a consensual panel determination. You agree impairment and sanction, and a panel decides whether to accept the agreement.
If the committee finds your fitness to practise impaired, article 29(5) and the NMC's sanctions guidance give it five options. The lightest are no further action and a caution order of between one and five years. Next comes a conditions of practice order of up to three years. The most serious are a suspension order of up to one year and a striking-off order. A striking-off order for lack of competence or health is available only after two years of continuous suspension or conditions. The committee may add an interim order to cover the appeal period.
Appeal
Article 29(10) gives you 28 days to appeal to the High Court. The period begins with the date the NMC serves notice of the decision on you, while the NMC's own appeals guidance counts it from the day after the date on the decision letter. Treat the earlier date as your deadline. The order does not take effect until the appeal period ends or the court decides any appeal. Every final decision goes to the Professional Standards Authority for review. It has a further 40 days to appeal one it considers insufficient to protect the public. Appeals run through a regulated law firm we work with, and we stay involved.
How we help
What you can expect from Eloquia
Saqib Khan leads your case from the first letter. A specialist barrister works alongside him from the outset, rather than appearing only once the NMC lists a hearing. We put the most effort in early, because the stage you can still influence is the one that repays preparation. We pair a clear account of the events, set against the records, with evidence of what you have done since. That gives the decision maker a reason to close the case or to choose the least restrictive outcome.
Before each stage starts, we confirm in writing what it covers and what it costs. You then decide whether to go ahead. You deal with the same people throughout. Where a hearing follows, we prepare the evidence, the witness statements and any expert report. We also prepare you to give evidence, and we present your case.
You may also face a police investigation, an inquest or a disciplinary process at work. If so, we run every track as one strategy, so that nothing said in one forum harms you in another.
Fees
The same fixed fee approach as for doctors
We quote a fixed fee for each stage before it starts, in the same way as we do for doctors. Every fee we quote is plus VAT. You pay stage by stage, so you never pay in advance for a hearing that may not happen. We do not act on conditional fee agreements. Our fee menu for GMC cases shows how we price the stages of a doctor's case. We price the stages of your case on the same basis. Has your indemnity provider, union or defence organisation declined to help? Read our page on cover refused or limited.
Each fee is plus VAT and includes a specialist barrister. We involve the barrister from the outset to give you additional support and advice. Fees do not include additional expenses such as expert fees, which we quote separately.
Read at source
The rules and guidance this page draws on
Sources
- Nursing and Midwifery Order 2001, article 29 (orders and appeals)
- NMC: Understanding fitness to practise
- Nursing and Midwifery Order 2001, article 31 (interim orders)
- NMC: How case examiners decide there is a case to answer
- Nursing and Midwifery Council (Fitness to Practise) Rules 2004, consolidated text effective 1 October 2026
- NMC: Sanctions (fitness to practise library)
- NMC: Consensual panel determination
- The Code, NMC (paragraph 23.2, telling the NMC about a caution or charge)
- NMC: Appeals against panel decisions
Questions and answers
Questions nurses and midwives ask
How long do I have to respond to an NMC notice of allegation?
Rule 6A of the NMC's Fitness to Practise Rules gives you 28 days from the date of the notice to send written representations. The Registrar may extend the period on request. Bear in mind that the NMC may show your representations to the person who raised the concern. What you send is the material the case examiners read, so take advice before you reply. Use the time to gather records, references and evidence of what you have done since.
What can NMC case examiners decide?
Where they agree there is no case to answer, they can close the case, give advice or issue a warning. Where there is a case to answer, they must either refer you to the Fitness to Practise Committee or recommend undertakings. You confirm undertakings within 28 days. Undertakings are not available where there is a realistic prospect of a striking-off order. Our article on nurses, midwives and the NMC explains the test they apply.
How long can an NMC interim order last?
Up to 18 months under article 31 of the Nursing and Midwifery Order 2001. The Fitness to Practise Committee decides whether to impose one. It may do so only where the order is necessary to protect the public or otherwise in the public interest. An order in your own interests is the third ground. The committee must review it within six months, then before the end of each further six months. The NMC can also ask the court to extend it by up to 12 months at a time.
What sanctions can the NMC impose?
If the Fitness to Practise Committee finds your fitness to practise impaired, it has five options. It can take no further action or impose a caution order of between one and five years. A conditions of practice order can last up to three years and a suspension order up to one year. The fifth option is a striking-off order. A caution order has no review. For that reason the NMC warns its own panels that a caution of more than three years can outlast a more restrictive order.
How long do I have to appeal an NMC decision?
Article 29(10) of the Order gives you 28 days, beginning with the date the NMC serves notice of the decision on you. The NMC's guidance counts from the day after the date on the letter. Treat the earlier date as the deadline. Your appeal goes to the High Court in England and Wales. The order does not take effect until the period ends or the court decides the appeal. The Professional Standards Authority has a further 40 days to appeal a decision it considers too lenient.
Does Eloquia act for nurses on fixed fees?
Yes. We quote a fixed fee for each stage before it starts, and every fee is plus VAT. Each fee includes a specialist barrister from the outset. We quote expert fees separately. You pay stage by stage, and our fees and funding page explains how staged payment works.
More answers sit on our questions and answers page, and our glossary explains the terms regulators use.
Read more
Guides on this subject
Other professions
Nurses, midwives and the NMC: what a fitness to practise case involves
How NMC fitness to practise works for nurses and midwives, how its case examiners decide and what each sanction means.
The GMC process
Insight and remediation: what tribunals look for and how to evidence it
How the GMC and the MPTS define insight and remediation, and how to build evidence of both from the start.
The GMC process
Interim orders tribunals: what they decide, how often they suspend and how to prepare
The section 41A test an interim orders tribunal applies, what it decides, the 2025 figures and how to prepare.
Arrange a confidential conversation
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