NMC: Fitness to practise concerns

The Nursing and Midwifery Council (NMC) regulates nurses and midwives across the UK, and nursing associates in England. It investigates concerns about the nursing profession, assessing whether an individual's 'fitness to practise' is impaired, and makes 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 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 hear from the NMC. 

As long as you were in 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 which clearly sets out what you can expect from us and what you need to do.

The role of the RCN’s legal team 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. 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

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, please see guidance on investigations and get in touch for further support. You have an obligation under section 23 of the NMC Code to co-operate with all investigations and audits and to tell your employer about any caution or charge, conditional discharge in relation to or have been found guilty of a criminal offence. In addition, you must tell employers about any practice restrictions or conditions placed on you by the NMC or other relevant body.

NMC hearings 

The NMC's guidance can help you understand what to expect if you are attending a hearing. 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. 

As part of their 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.

There is no obligation to refer yourself to the NMC unless you:

• have received a caution, charge, conviction or conditional discharge for a criminal offence
• are, or have been disciplined by any regulatory or licensing organisation (including organisations that don't work in health and care).

Not telling the NMC about the circumstances above may be a breach of the NMC Code and could result in the NMC taking regulatory action. 

If your employer tells you or tries to encourage you to ‘self-refer’ to the NMC, its your choice. We do not usually encourage self-referral because:

• your employer might not make that referral and consequently you experience an avoidable NMC investigation
• the NMC will not criticise you for failing to self-refer (unless there is a specific obligation under the NMC Code)
• though the NMC may give you some credit for self-referring, they may only give this limited weight.

It's important that you contact us to seek advice if you're thinking of self-referring for any reason. We can consider the individual facts of your case and help you make an informed decision.

We have guidance on informing the NMC about cautions, convictions and penalty notices.

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

NMC investigations can be lengthy and you may find that you have restrictions placed upon your practice whilst under investigation. This 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.

If you have concerns about the fitness to practise of a colleague you should raise your concerns internally, following your employers 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 - 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.