NMC Fitness to Practise

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1. What does the NMC mean by ‘fitness to practise‘?

The NMC defines fitness to practise as a nurse or midwife having the appropriate skills, knowledge, good health and good character to be able to perform their job safely and effectively.

The NMC publish their code of conduct, referred to as ‘The Code: Professional standards of practice and behaviour for nurses and midwives” which can be found on body’s website:

The code sets out the standards that patients and the public expect from nurses and midwives. The NMC regard a commitment to professional standards as being a fundamental aspect of the profession.



2. What are the core principles of the NMC’s code?

The NMC’s code sets out the following core principles:

  • Prioritise people – Ensuring that the care and safety of patients is every nurse or midwife’s main concern. This includes patient’s dignity being preserved and their needs being appropriately met;
  • Practise effectively – This involves working cooperatively and to the best of your ability and communicating effectively, including keeping clear and accurate records;
  • Preserve Safety –Ensuring that patient and public safety is protected, working within competency limits, exercising a ‘duty of candour’ which involves raising concerns where appropriate;
  • Promote professionalism and trust – Upholding the reputation of the profession and acting with honesty and integrity both in and out of the work environment.



3. What type of NMC fitness to practise concerns will the NMC investigate?

The NMC will investigate the following types of allegations, although this list is by no means exhaustive:

  • A criminal conviction/caution;
  • Misconduct;
  • Lack of competence;
  • Not having the necessary knowledge of English;
  • Allegations of dishonesty;
  • Substance misuse.



4. How does the NMC investigate fitness to practise complaints?

Screening team – The NMC’s screening team filter allegations where there is no credible evidence of the complaint, or the conduct referred is simply not serious enough to merit a full fitness to practise investigation.

The investigation – If the screening team deem it appropriate, they will refer the complaint to the Case Examiners. At this stage the NMC will write to the nurse or midwife providing details of the allegation and copies of any relevant documentation. The nurse or midwife then has the option to make written representations at this stage, usually within 28 days.

The NMC then conduct their investigation, gathering evidence. Once the investigation work has been completed, if the NMC consider there may be a case to answer, copies of the evidence are sent to the nurse or midwife, together with specific allegations. The registrant is then given another opportunity to put forward written representations about the allegations.

Case Examiners Decision – The Case Examiners will meet in private and examine the evidence, allegations and any response from the registrant. They will then decide if there is a case for the nurse or midwife to answer, regarding an allegation that their fitness to practise is impaired. The Case Examiners can decide to close an investigation, or they can refer the registrant to the NMC’s Conduct and Competence Committee or the NMC’s Health Committee.

Hearing – If a nurse or midwife is referred to the NMC’s Conduct and Competence Committee or Health Committee, there is in due course a formal hearing in London, for the Panel to hear the evidence from both sides and decide whether the allegations are proven. If the allegations are found proven, the Panel then decides if the facts amount to misconduct. If the Panel finds misconduct, they then have to decide is this amounts to the registrant’s fitness to practise being impaired, and if so they will impose an appropriate sanction.



5. How can our NMC lawyers help you?

Our NMC lawyers have a proven track record in preparing persuasive written representations to the NMC. It is essential that a careful strategic decision is made regarding when to provide written representations to the NMC, how much detail to go into and to ensure that the appropriate tone is struck.

Our NMC lawyers also have an excellent record for getting the best possible results for nurses and midwives before the NMC’s Conduct and Competence Committee.



6. What other options are there?

If a nurse or midwife has been referred to the NMC’s Conduct and Competence Committee, it may be possible, depending on the circumstances, to avoid the need for a full fitness to practise hearing. It may be possible to make an application for voluntary removal or for a consensual panel determination to be agreed with the NMC.

A consensual panel determination involves an agreement between the registrant and the NMC that the substance of the allegations is accepted, that impairment is conceded and what the sanction should be. A Panel will then meet to decide if they are agreeable to this outcome.

Our NMC lawyers can advise you on the likely prospects of an application for voluntary removal, or a consensual panel determination given your specific case and circumstances. We have experience in reaching these agreements with the NMC when it is genuinely in a nurse or midwife’s best interests.



NMC fitness to practise case studies

Below is a very brief sample of the types of NMC fitness to practise cases where our NMC lawyers have legally represented nurses and midwives before the NMC:

  • Complaint about a clinical incident in a nursing home. Our written representations persuaded Case Examiners to take no further action;
  • Successfully represented a nurse in an appeal, when the NMC had refused to allow the nurse to re-register, disclosing 3 sets of criminal convictions, including a short custodial sentence. The nurse protected their pin number and was able to resume practicing as a nurse;
  • Successfully agreed with the NMC a consensual panel disposal agreement of a conditions of practice order for a nurse who had allegations that she had failed to demonstrate appropriate knowledge and competency for a Band 5 nurse;
  • Assisted a nurse with a successful restoration application to the register;
  • Assisted a nurse with an NHS Trust Investigation into her record keeping skills and successfully protected her from a dismissal;



Testimonial from a nurse we represented

“Thank you for the exemplary service, advice and support and also your approachable friendly yet highly professional approach. I take this opportunity once again to thank you for all your efforts on my behalf, through what was for me a very stressful time. I was very appreciative of your advice, patience and kindness, shown to me and also with the professional quality and speed that you applied to progressing my requests. I would have no hesitation in recommending your services to anyone else needing legal assistance.”


Ask us a question

Do you have another question relating to NMC fitness to practise that hasn’t been covered in our guide? Feel free to ask Richard Nelson LLP’s NMC fitness to practise solicitors and we’ll endeavour to get back in touch with you as soon as possible.

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How to contact our NMC lawyers

When a nurse or midwife is facing an NMC fitness to practise investigation, it is best to obtain legal advice and representation as early as possible. It may be possible for our NMC lawyers to persuade the NMC to take no further action. However if this is not possible to achieve in your situation, we will instead aim to prepare the foundations for a robust defence to the allegations faced, or where necessary prepare powerful mitigation.



Further Reading


<< Back to Fitness to Practise


Other articles you may be interest in


The significance of Interim orders in Fitness to Practise Investigations


Guide to NMC Investigations


GMC Hearings: What to expect at the MPTS & how to prepare

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