If an NMC Fitness to Practise Committee panel finds your fitness to practise currently impaired, it can take no further action or impose a caution order (one to five years), a conditions of practice order (up to three years), a suspension order (up to one year at first) or a striking-off order. It must choose the least restrictive sanction that protects the public.
Key takeaways
- Five outcomes: no further action, caution, conditions, suspension, striking-off.
- Warnings and advice are case examiner outcomes, not panel sanctions.
- Panels start with the least restrictive option and move up only if needed.
- Striking-off is not available for health or lack of competence cases until two continuous years of suspension or conditions.
Headlines about nurses being struck off describe a minority of cases. Understanding the full range of outcomes, and how panels choose between them, takes some of the fear out of the process and shows where your own evidence can make a difference.
What sanctions can an NMC panel impose?
An NMC Fitness to Practise Committee panel that finds impairment has five options, listed here from least to most restrictive.
- No further actionRare where impairment is found.
- Caution order1 to 5 years. You can practise without restriction.
- Conditions of practice orderUp to 3 years. You practise within set conditions.
- Suspension orderUp to 1 year at first. You cannot practise.
- Striking-off orderRemoved from the register. You cannot apply to return for 5 years.
- No further action: the panel decides no sanction is needed despite impairment. This is uncommon.
- Caution order: you can practise without restriction, but the caution appears on the register for between one and five years.
- Conditions of practice order: you practise subject to conditions, such as supervision or training, for up to three years. It must be reviewed before it expires.
- Suspension order: you cannot practise for a set period of up to one year at first. It is normally reviewed before it expires.
- Striking-off order: you are removed from the register and cannot apply for restoration until five years have passed.
Is a warning an NMC sanction?
No. This is a common mix-up. Advice and warnings are outcomes available to case examiners at an earlier stage, without a hearing. A warning is published on the register for 12 months. Panel sanctions are only those listed above.
See NMC case examiners: possible outcomes for advice, warnings and undertakings.
How does a panel choose a sanction?
The panel starts by considering the least restrictive option and only moves up if that would not be enough to protect the public, maintain public confidence and uphold professional standards. The sanction must be proportionate. Panels weigh aggravating factors, which make a case more serious, against mitigating factors, which reduce seriousness.
- Aggravating factors can include harm to patients, abuse of trust, dishonesty, a pattern of behaviour, or lack of insight.
- Mitigating factors can include early admissions, genuine insight, evidence of strengthened practice, a previously good record and positive testimonials.
Panels must impose the least restrictive sanction that still protects the public.
Can I be struck off for a first offence?
Yes, if the conduct is serious enough. Striking-off is reserved for cases where the concerns are fundamentally incompatible with remaining on the register, such as some cases of serious dishonesty, abuse or deliberate harm. It is not available where impairment is based only on health, lack of competence or insufficient English until you have been under a suspension or conditions order for a continuous period of at least two years.
What happens when a suspension or conditions order ends?
Both orders are normally reviewed before they expire. At review, the panel can let the order lapse, extend it, change it, or replace it with a different sanction. You will need to show that you have addressed the concerns, so the work continues after the hearing.
Read returning to nursing after suspension and finding a job with conditions of practice.
Can I appeal an NMC sanction?
Yes. You can appeal a substantive sanction to the High Court (or the Court of Session in Scotland). There are strict time limits, so take legal advice quickly if you are considering an appeal. The panel may also impose an interim order to cover the appeal period.
How can I influence the outcome?
Sanction decisions repeatedly refer to whether the registrant has shown genuine understanding and taken real steps to address the concern. That work happens in the months before the hearing, not on the day.
Prepare with Attending a Fitness to Practise Hearing and build your evidence of insight with Reflection Writing for FtP. Facing a dishonesty allegation? Dishonesty Explored covers how the NMC approaches it.
Frequently asked questions
After finding impairment, a panel can take no further action or impose a caution order, a conditions of practice order, a suspension order or a striking-off order.
Up to one year in the first instance. It is normally reviewed before it expires and can be extended.
A caution order lets you practise without restriction but is recorded on the register for between one and five years.
You cannot apply for restoration until five years after the striking-off order. You then have to show you are fit to practise.
No. A warning is a case examiner outcome published for 12 months. A caution order is a panel sanction lasting one to five years.
Sources and further reading
- NMC: The sanctions available (FtP library)nmc.org.uk
- NMC: Sanctions we can imposenmc.org.uk
- NMC: What sanctions are and when we might use them (FtP library)nmc.org.uk
- NMC: Striking-off order (FtP library)nmc.org.uk
- NMC: Conditions of practice order (FtP library)nmc.org.uk
- NMC: Case examiners – available outcomes (FtP library)nmc.org.uk
