A brief overview of the NMC’s fitness to practice investigation process and what nurses can expect if they are subject to a fitness to practice investigation. 

What the NMC means by Fitness to Practise

The Nursing & Midwifery Council (NMC) investigates allegations of ‘impaired fitness to practice’ and will instigate a fitness to practise investigation when there is evidence that its standards are not met.

When the NMC makes reference to “fitness to practise” it means that “a nurse, midwife or nursing associate must make sure that their skills, knowledge, education or behaviour don’t fall below these standards needed to deliver safe, effective and kind care.”

The NMC’s statutory powers are limited to:

  • allegations of fraudulent or incorrect entry of an individual nurse or midwife to their register;
  • allegations about the fitness to practise of nurses or midwives.

Whilst not exhaustive, fitness to practise allegations can relate to:

  • lack of competence;
  • insufficient knowledge of English;
  • criminal convictions and cautions;
  • health;
  • misconduct; and/or
  • determinations by other health organisations.

Overview of the NMC Fitness to Practise Investigation Process

Screening – The first stage in the fitness to practise process is called screening. This is where we look at the concern someone’s raised with us in more detail and decide on the next steps.

There are three stages of our screening decision.

  • Step one: Does the NMC have a written concern about a nurse, midwife or nursing associate on our register?
  • Step two: Is there evidence of a serious concern that could require it to take regulatory action to protect the public?
  • Step three: Is there clear evidence to show that the nurse, midwife or nursing associate is currently fit to practise?

The screening team carries out an initial risk assessment on each concern when they receive it. If they identify particular risks, such as a risk of harm to the public, the case may be referred to an interim order hearing. 


If we’ve decided that a concern needs further investigation, the screening team will pass it onto the investigation team.

The investigation team will then gather evidence like documents, witness statements and information from employers.

Case Examiners

At the end of the investigation, the team will put together a report for our case examiners to look at.  There are two case examiners per case. One will be a nurse, midwife or nursing associate, and one won’t.

It’s their job to consider the evidence and decide if there’s a case to answer.

When deciding if there’s a case to answer, case examiners need to look at whether there’s a real possibility that a Fitness to Practise Committee would decide from the evidence that:

  • the incident in the concern did happen, or that the issues (such as a health condition) are still present
  • the nurse, midwife or nursing associate’s fitness to practise is currently impaired.

They also decide what happens next to the case:

No case to answer – If the case examiners decide that there isn’t a case to answer, they can:

  • give advice (this is private and won’t be put on the public register), or
  • give a warning (this is public, put onto our register, and last for 12 months), or
  • take no action.

A case to answer – If case examiners decide there’s a case to answer, case examiners can:

  • recommend undertakings, or
  • decide that a case needs to be looked at by a fitness to practise panel at a meeting or hearing.


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NMC Sanctions

After a meeting or hearing, a panel will decide the outcome (also known as a “sanction”). Possible sanctions include:

  • No sanction
  • Caution order (similar to a warning)
  • Conditions of practice order – Nurse allowed to work, but there are restrictions to what they can do, including training requirements or supervision.
  • Suspension order – If a nurse, midwife or nursing associate receives a suspension, they can’t work during this period. Suspensions can last anywhere between one and 12 months.
  • Striking-off order – If the panel decides to strike the nurse, midwife or nursing associate off the register, they’re taken off the register and can’t work as a registered professional.

How long does NMC investigations take to conclude

This will depend on the complexity of the allegations and investigation and can take up to a year to complete, although it could take longer in certain cases. 

Why Legal Advice & Representation Matters

For nurses and midwives facing a NMC fitness to practice investigation, legal advice and representation is key to positive outcomes.

Generally speaking, there is clear evidence that legal advice and representation can significantly benefit health care professionals facing fitness to practise investigations.  With legal advice and representation, nurses and midwives will have a clear understanding of the fitness to practise process and what to expect, receive full support throughout the entire process, and benefit from a clear and robust defence strategy.

Nurses and midwives should consider the following when facing a NMC fitness to practise investigation without legal advice and support:

  1. Strengthen Practice – The NMC attaches substantial weight to “strengthen practice” (also referred to as insight and remediation) and robust evidence of this could lead to an early resolution to its investigation. A legal strategy will include advice and support with insight and remediation.
  2. Restoration – If you’re a nurse or midwife has been struck off, they won’t be able to apply to re-join the NMC register for five years.
  3. Public information – Certain NMC decisions and sanction are public and published on the NMC’s register and can last between one and five years. This public information can prove to be very detrimental to a nurse or midwife’s professional reputation, affecting their ability to work.
  4. Engaging with the NMC – At various stages in the NMC’s investigation, nurses and midwives will be asked for information and responses to inform the investigation. Wrong and poorly considered responses can prove detrimental instead of assisting the nurse or midwife.  Legal advice and representation will act for the nurse when engaging with the NMC and could lead to an early conclusion to the investigation.
  5. Restriction on practice – Nurses and midwives face the prospect of restrictions on their practice – that could last between one and three years. The prospect of practice restrictions – and other sanctions – could be substantially reduced with expert legal advice and representation on your side.

Here when you need us

Kings View has been advising and representing health care professionals for many years, and we know that despite their best efforts, some things do go wrong.  Through our experience, we know that the circumstances that lead to things going wrong are never straightforward.

Read more about Kings View’s fitness to practise case success.

Kings View are public access barristers, meaning that you can instruct us directly without having the additional expense of hiring a solicitor first (so we are generally at least one third cheaper).

Disclaimer: This article is for guidance purposes only. Kings View Chambers accepts no responsibility or liability whatsoever for any action taken, or not taken, in relation to this article. You should seek the appropriate legal advice having regard to your own particular circumstances.