Fitness to practise means being able to practise safely and effectively without restriction. In an NMC case, the key questions are whether the facts are proved, whether they amount to a ground such as misconduct or lack of competence, and whether your fitness to practise is currently impaired. The terms below explain each stage and outcome.
Key takeaways
- Impairment is about risk now, not only what happened in the past.
- Warnings and advice come from case examiners; cautions, conditions, suspension and striking-off come from panels.
- Insight and strengthened practice are the NMC's current terms for understanding and remediation.
- Interim orders are temporary and are not findings of fact.
NMC letters and decisions use a lot of specialist language. Understanding it makes the process less intimidating and helps you respond to what is actually being asked. Each term below links to a fuller guide where we have one.
For the process as a whole, start with the NMC Fitness to Practise process explained. For outcomes, see case examiner outcomes, interim orders, undertakings and sanctions.
People and bodies
- Nursing and Midwifery Council (NMC)
- The UK regulator for nurses and midwives, and for nursing associates in England. It keeps the register, sets standards and investigates concerns.
- Registrant
- A nurse, midwife or nursing associate on the NMC register.
- Case officer
- The NMC employee who manages your case during investigation and is your main point of contact.
- Case examiners
- Pairs of NMC decision-makers (one registrant, one lay) who decide on the papers whether there is a case to answer.
- Fitness to Practise Committee (FtPC)
- The NMC committee whose panels decide cases at hearings and meetings and impose sanctions.
- Panel
- Usually three independent members, at least one registrant and one lay member, who decide a case.
- Legal assessor
- A barrister or solicitor who advises a panel on the law but does not take part in the decision.
- Case presenter
- The lawyer who presents the NMC's case at a hearing.
Stages and decisions
- Referral
- A concern raised with the NMC about a registrant, by an employer, member of the public, the police, the registrant themselves or others.
- Self-referral
- Telling the NMC about a concern about yourself, required for charges, cautions, conditional discharges and convictions (other than protected ones).
- Screening
- The first stage, where the NMC decides whether a concern needs a full investigation.
- Investigation
- The stage where the NMC gathers evidence, such as records and witness statements.
- Case to answer
- The case examiners' decision that there is a realistic prospect a panel would find the facts proved, a statutory ground, and current impairment.
- Hearing
- A panel session, usually in public, where you can attend and give evidence.
- Meeting
- A panel decision made on the papers, without the parties attending.
- Determination
- The panel's written decision and reasons.
- Substantive order review
- A hearing or meeting, usually before a conditions or suspension order expires, to decide what happens next.
Legal tests and grounds
- Fitness to practise
- Being able to practise safely and effectively without restriction.
- Impairment
- Whether your fitness to practise is affected now, looking at risk to the public, public confidence and professional standards.
- Statutory grounds
- The legal categories a concern must fall into, such as misconduct, lack of competence, a criminal conviction or caution, physical or mental health, or not having the necessary knowledge of English.
- Misconduct
- Conduct that falls seriously short of what is expected of a registrant.
- Lack of competence
- A standard of professional performance that is unacceptably low, usually shown over a fair sample of work.
- Balance of probabilities
- The standard of proof at NMC hearings: more likely than not.
- Dishonesty
- Assessed using the Ivey v Genting test: what you knew or believed, and whether your conduct was dishonest by the standards of ordinary decent people.
- Duty of candour
- The professional duty to be open and honest with patients when something goes wrong.
Orders and outcomes
- Advice
- A case examiner outcome reminding you of your responsibilities. Not published.
- Warning
- A case examiner outcome where conduct fell significantly short of standards but there is no case to answer on current impairment. Published for 12 months.
- Undertakings
- Commitments you agree with the NMC, recommended by case examiners, to address the concerns without a hearing.
- Interim order
- A temporary order (conditions or suspension) while a case is ongoing. Up to 18 months, reviewed every six months. Not a finding of fact.
- Caution order
- A panel sanction lasting one to five years. You can practise without restriction.
- Conditions of practice order
- A panel sanction of up to three years setting requirements you must meet while practising.
- Suspension order
- A panel sanction of up to one year at first, during which you cannot practise.
- Striking-off order
- Removal from the register. You cannot apply for restoration for five years.
- Restoration
- Applying to return to the register after a striking-off order.
Evidence and reflection
- Insight
- Your understanding of what went wrong, why it mattered and how to prevent it happening again.
- Strengthened practice
- The NMC's term for steps taken to address a concern, often called remediation.
- Reflective statement
- A written account showing your understanding of the concern and what you have done about it.
- Testimonial
- A statement from someone who knows your practice and the concern, supporting your case.
- Bundle
- The collection of documents submitted as evidence.
Where can I learn more?
The NMC sets out its guidance in detail in its Fitness to Practise library; the sources listed below are good starting points. Our Navigating Your FtP Journey course explains each stage in plain English, and the stage-by-stage checklist helps you keep track.
Frequently asked questions
Impairment means your fitness to practise is affected now, because practising without restriction would pose a risk to the public, public confidence or professional standards.
Misconduct is conduct that falls seriously short of expected standards. Lack of competence is an unacceptably low standard of professional performance, usually over a fair sample of work.
It means the case examiners think there is a realistic prospect that a panel would find the facts proved, a statutory ground and current impairment.
It is the NMC's term for the steps you have taken to address a concern, often called remediation.
Sources and further reading
- NMC: Impairment (FtP library)nmc.org.uk
- NMC: How case examiners decide there is a case to answer (FtP library)nmc.org.uk
- NMC: Case examiners – available outcomes (FtP library)nmc.org.uk
- NMC: The sanctions available (FtP library)nmc.org.uk
- NMC: Interim ordersnmc.org.uk
- NMC: Has the concern been addressed? (FtP library)nmc.org.uk
