Understanding NMC Sanctions

Guide to the possible NMC sanctions in a fitness to practise investigation.


A nurse or midwife undergoing an NMC investigation will face the possibility of different sanctions throughout the process. Richard Nelson LLP put this guide together to help you understand the sanctions that could be issued at each stage of the investigation and their practical implications for nurses and midwives.

The way that the nurse or midwife under investigation behaves throughout the process will have an impact on the sanctions that the NMC deems appropriate. Successful defence of your actions, a compelling presentation of mitigating factors and full cooperation with the NMC can all help to improve the professional’s situation.

We recommend seeking professional assistance if you are the subject of an NMC investigation, as an emotional response which is lacking in objectivity can make the situation worse.

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NMC Interim Orders Panel Powers

The NMC interim orders panel will determine whether or not interim sanctions are appropriate for the nurse or midwife under investigation. The purpose of interim orders is to protect the public and the professional from further harm while the investigation is ongoing. The panel may choose to impose no interim orders.

Conditions of practice order

An interim conditions of practice order allows the practitioner to continue to practise as long as they adhere to a set of conditions. The specifics vary. Some are designed to limit the amount of time a nurse or midwife can practise; others are designed to help the practitioner improve their skills. The conditions may be put in place to protect vulnerable members of the public or to protect the nurse or midwife from situations in which they would be at risk.

Interim suspension order

An interim suspension order prevents a nurse or midwife from practising for a period of time while the investigation is ongoing. It is a more severe sanction than the conditions of practice order, put in place when the NMC believes that the nurse or midwife’s continued practice poses a serious threat to the practitioner or the public.

Review and continued sanctions

The initial duration of an interim order is six months. The order will be reviewed at the end of six months and – if it is left in place – will be reviewed every three months after that. Orders may be changed or even removed at these review hearings should the NMC decide that the situation has changed. The nurse or midwife can also request an early review of the order if there has been a material change in their circumstances.

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Possible santions from an NMC Investigation

Further sanctions may be imposed at the conclusion of the NMC’s investigation. At this point, the Case Examiners have the option to issue advice, warnings and undertakings, or they can choose to refer the case to a fitness to practise committee. A fitness to practise referral will never be made in addition to another sanction. If their case is referred, the nurse or midwife must wait for the fitness to practise committee to agree on their final sanction.

No action
The NMC’s Case Examiners can decide that the registrant has no case to answer. They may offer advice to the nurse or midwife but there will be no permanent record of any findings against them.

A warning is given where the behaviour of the nurse or midwife is deemed unacceptable, but not severe or dangerous enough to warrant a more serious sanction. A nurse or midwife with a warning will be able to return to work without any restrictions. Their warning will be publically accessible and visible for 12 months.

Agreed undertakings
The Case Examiners and the nurse or midwife under investigation may agree on a plan to ensure that the practitioner and the public will not be put at risk in the future. Agreed undertakings are a joint initiative that could include a variety of different measures. Examples include requiring the registrant to undergo further training or to be treated for an illness. The case will not progress to the fitness to practise committee if the nurse or midwife accepts the undertakings and adheres to them in the future.

Fitness to practise committee referral
The Case Examiner refers the most serious cases to the NMC’s fitness to practise committee. The nurse or midwife will be summoned to a hearing with the committee in which they can be legally represented.

NMC Fitness To Practise Committee Sanctions

The committee will consider the evidence gathered in the investigation and listen to both parties to decide whether or not the allegations against the registrant are proven. They will then decide if any proven allegations means that the registrant’s fitness to practise is impaired. If they decide that the registrant’s fitness to practise is impaired, they will issue one of the following sanctions. If no impairment was found, they will take no action.

Once a sanction has been imposed on the registrant, their only way to appeal it is to go to the High Court.

Caution (for a period of one to five years)
The fitness to practise committee can issue a formal caution that will stay on NMC register for one to five years. A caution is similar to a warning: it is issued to recognise a fitness to practise breach where there is no ongoing risk to the public from the registrant’s unrestricted practice.

Conditions on registration (up to three years)
Conditions on registration restrict the nurse or midwife’s practice for up to three years. The practitioner must comply in order to continue to be registered. The fitness to practise committee will review the case at the time that the conditions are due to end to assess whether or not they need to continue.

Suspension from the register (up to 12 months)
In cases of severe fitness to practise breaches, the committee may decide that the nurse or midwife needs to be suspended from the NMC’s register for up to 12 months. A suspended registrant cannot work as a nurse or midwife for the duration of the suspension. Suspension orders are designed to prevent the registrant from harming the public, or to maintain public confidence in the profession.

Striking off order
The most severe sanction available to the NMC’s fitness to practise committee is a striking-off order. Once a nurse or midwife is struck off from the NMC’s register, they can no longer work as a nurse or midwife. The committee will only choose this option in the most serious of cases.

The public perception of the case can be a factor in making a striking off order, as the NMC always considers the public’s trust in the profession. Registrants may also make a striking off order more likely where they show no remorse or insight for their actions and are unwilling to accept any efforts to change their behaviour.

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