If you have received a letter from the Nursing and Midwifery Council, take a breath. A referral is the start of a process, not a verdict, and many concerns close before a hearing. This guide walks through every stage in plain English, with links to a fuller article on each.
What is NMC Fitness to Practise?
Fitness to Practise (FtP) is the NMC's process for deciding whether a nurse, midwife or nursing associate can practise safely and effectively without restriction. When a concern is raised, the NMC assesses whether your fitness to practise may be currently impaired and whether action is needed to protect the public.
Concerns can come from employers, patients and families, the police, colleagues, or registrants themselves (a self-referral). The NMC regulates nurses and midwives across the UK and nursing associates in England. Other regulators, such as the HCPC and GMC, have their own processes.
What are the stages of an NMC Fitness to Practise investigation?
There are four main stages: screening, investigation, a case examiner decision and, if referred, a hearing or meeting. An interim order can be made at any point if there is an immediate risk. Many cases close at screening or with the case examiners.
Screening
The NMC checks whether the concern is one it needs to investigate. Many concerns close here. You may be asked for information: engage calmly and take advice before responding in detail. Start with your first five steps after a referral.
Investigation
A case officer gathers evidence such as statements, records and employer information. This is usually the longest stage. It is also the time to start building evidence of insight and strengthened practice.
Case examiners
Two case examiners (one registrant, one lay) review the evidence and your written response, which you have 28 days to send. If there is no case to answer, they can close the case, give advice, or issue a warning. If there is a case to answer, they can recommend undertakings or refer the case to a panel. Case examiner outcomes explained.
Hearing or meeting
A Fitness to Practise Committee panel decides the facts, then whether your fitness to practise is currently impaired, then any sanction. What happens at a hearing.
Outcome, reviews and returning
Conditions of practice and suspension orders are normally reviewed before they expire, which is another opportunity to show progress. See returning to nursing after suspension.
How long does an NMC investigation take?
There is no fixed length. Some concerns close at screening within weeks or months; investigated cases commonly take many months; cases that reach a hearing can take well over a year. The NMC reports its timeliness in each annual Fitness to Practise report.
Delay usually comes from gathering evidence, waiting for employer or police processes, and giving you fair time to respond. The wait is hard, but it is also the time you need to build evidence properly. Read more: How long does an NMC investigation take?
What is an NMC interim order?
An interim order is a temporary conditions of practice or suspension order made while a case is ongoing. A panel can only make one if it is necessary to protect the public, otherwise in the public interest, or in your own interests. It is not a finding that the allegations are true.
Interim orders can last up to 18 months and are reviewed at least every six months. Beyond 18 months, the NMC must apply to the High Court (or the Court of Session in Scotland), which can extend the order for up to 12 months at a time. Full detail: NMC interim orders explained.
What can NMC case examiners decide?
If there is no case to answer, case examiners can close the case, give advice, or issue a warning that is published on the register for 12 months. If there is a case to answer, they can recommend undertakings or refer the case to the Fitness to Practise Committee.
Note that warnings are a case examiner outcome, not a panel sanction. Undertakings are commitments you agree to, such as training or supervision, that resolve the case without a hearing: see NMC undertakings explained.
What happens at an NMC hearing?
A panel of usually three independent members, at least one registrant and one lay member, decides the case in three stages: whether the facts are proved, whether they amount to misconduct (or another ground) and your fitness to practise is currently impaired, and if so what sanction is needed. A legal assessor advises the panel.
Hearings are usually public, although health matters are generally heard in private, and they can be held in person or virtually. Some cases are decided at a meeting, on the papers. Prepare with Attending a Fitness to Practise Hearing and read about character references and testimonials.
What sanctions can the NMC impose?
If a panel finds your fitness to practise 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 option that protects the public.
After a striking-off order you cannot apply for restoration for five years. More in NMC sanctions explained.
Can you keep working during an NMC investigation?
Usually, yes. A referral alone does not restrict your practice. Only an interim order, or another restriction, limits what you can do while the case is open.
Your employer can still make its own decisions under its policies, and you must tell employers about any restriction. Full detail: Can I keep working during an NMC investigation? and telling your employer about an NMC referral.
Insight and strengthened practice: the part you control
Insight is your understanding of what went wrong, why it mattered and how to prevent it happening again. Strengthened practice (often called remediation) is the evidence that you have acted on it. Decision-makers assess whether your insight is enough to address the specific concern.
- Targeted CPD that relates to the specific concern, with a note of what you learned.
- Reflective writing that is honest, specific and anchored to the NMC Code.
- A reflective log maintained over months, not written in a panic the week before.
- Changed practice you can point to, supported by supervision records and testimonials.
Start here: How to demonstrate insight and strengthened practice and How to structure an NMC reflective statement. If honesty is part of the concern, read duty of candour vs dishonesty.
The NMC Fitness to Practise process in numbers
Sources: NMC Annual Fitness to Practise Report 2024–2025 (referrals, concluded cases; the NMC's open caseload was 6,357 at year end); NMC FtP library: duration of interim orders; NMC FtP library: case examiner outcomes.
Key terms
The words you will see most often in NMC letters. Our Fitness to Practise glossary defines many more.
- Impairment Whether your fitness to practise is affected now, considering risk to the public, public confidence and professional standards.
- Case to answer The case examiners' view that a panel could realistically find the facts proved and your fitness to practise currently impaired.
- Misconduct Conduct that falls seriously short of what is expected of a registrant.
- Undertakings Commitments you agree with the NMC to address the concerns without a hearing.
- Insight Your understanding of what went wrong, why it mattered and how to prevent it happening again.
- Strengthened practice The NMC's term for the steps you take to address a concern, often called remediation.
You don't have to do this alone
Speak to your union (for example the RCN or Unison) or professional indemnity provider as early as you can, and consider legal advice for serious allegations and interim order hearings (see Do I need a solicitor?). The personal work of reflection and rebuilding is yours, and it helps to walk it with someone who has been where you are. Our 1:1 mentorship is delivered by people with lived experience of the FtP process, in confidence. For peer support and advocacy, we work with NMCWatch. When you are ready to move forward, our CV writing service helps you tell your story to employers, and finding a job with conditions of practice covers disclosure. If the process is affecting your wellbeing, read looking after your mental health.
Not sure where to start? Book a free introduction call with Cathryn. No obligation, just a conversation about your situation.
Last reviewed: , against NMC guidance published on nmc.org.uk, including the FtP library and the NMC Code. Written by the Fit 2 Practise team.
Fit 2 Practise is independent and not affiliated with the Nursing and Midwifery Council. This guide is general information, not legal advice. If you are facing an NMC investigation, speak to your union (for example the RCN or Unison), your professional indemnity provider or a regulatory solicitor.