Continuing rise in new concerns

NMC have seen a 13% increase in the new concerns they received in the last year. The number of professionals on their Register increased by 3%. Members of the public continue to be the biggest source of concerns, but referrals from employers are increasing and returning to pre-pandemic levels. The number of Fitness to Practise concerns received each year involves less than 1% of the professionals on their Register.

Concerns raised by employers

Between 01 April 2024 and 31 March 2025, 15% of concerns which were closed after an initial assessment and did not progress beyond screening for regulatory investigation were raised by employers.

The NMC want to work more closely with employers to support the right decisions about the concerns they can manage locally, and when a fair and appropriate referral is required. Making unnecessary Fitness to Practise referrals causes additional stress and worry for those involved. It also causes delays in the progression of other Fitness to Practise cases. The analysis of a sample of employers’ concerns found that just over half of employers in the sample had not used the employer advice line before making the referral, and that employers had been unable to complete local investigations for a quarter of the concerns because professionals had not engaged with the process.

Outcomes at hearing stage

Factors which result in the most serious sanctions include conduct which puts people risk of harm, a lack of insight into failings, a pattern of misconduct over time, and abuse of a position of trust. Dishonesty is one of the concerns most likely to result in a more serious sanction. The analysis reveals the types of behaviours that constitute dishonesty and some of the reasons expressed by professionals for this behaviour.

A culture of learning

It is important that professionals experience working environments and workplace cultures that enable them to speak up and report mistakes so that learning can be shared. This also prevents repetition of that mistake and enables the nurse, midwife or nursing associate to rectify errors immediately without fear of blame, bullying or harassment.

Key findings and areas for improvement

Response to whistleblowing disclosures

The NMC has been working to respond to serious concerns raised in whistleblowing disclosures. It has commissioned three independent reviews, two of which had not been published by the time we completed our review. The published ICR made numerous critical findings about the NMC’s organisational culture, and the NMC accepted all its recommendations. We note that the concerns are serious, and we had regard to the findings of the published ICR where relevant, alongside the other evidence available to us. We will consider the findings of the other two reviews when they are available.

Equality, Diversity and Inclusion (EDI) 

The whistleblowing concerns included concerns about discrimination and the organisational culture of the NMC. We saw that the NMC has processes in place to promote EDI, but given the findings of the ICR, we could not be assured that these processes were working effectively. The NMC has acknowledged that it needs to develop its capability in EDI, and has begun work on a range of improvement actions. We saw that the NMC’s standards and guidance promote non-discriminatory, respectful, compassionate, and kind care. However, we were not assured that the NMC has effectively embedded EDI into its work. Therefore Standard 3 was not met.

Education quality assurance

We noted some serious concerns about the NMC’s work to assure the quality of education and training. Having identified issues about a training provider’s compliance, the NMC carried out a mandatory self-reporting exercise where it required all training providers to send information about compliance with its standards. In our view, the need for such an exercise illustrated a failure of the NMC’s routine monitoring. The NMC had also carried out an internal review of its education quality assurance work, which identified a number of serious risks, and limitations on the NMC’s ability to mitigate them. The NMC started work on an improvement plan, but this was still in development by the end of our review period. Therefore Standard 9 was not met.

Accuracy of the register

Around 350 graduates from a university training course were added to the NMC’s register when they had not completed the required practice hours. When it became aware of the issue, the NMC contacted the affected graduates to request information about further practice learning they may have undertaken; most but not all had responded by the end of the review period. A number of other people may have joined the register fraudulently in relation to instances of large-scale fraudulent applications. The NMC is investigating these matters and has taken steps to improve its fraud prevention processes. However, maintaining an accurate register is a core function of a regulator, and a large number of people were added to the NMC’s register without meeting its requirements. Therefore Standard 10 was not met.

Fitness to Practise

The NMC is still taking too long to deal with fitness to practise cases. It has been working to an action plan to clear its backlog but had made only limited progress during the review period, partly because it had received more referrals than expected. Therefore Standard 15 was not met. Concerns about the NMC’s safeguarding capability were identified through the whistleblowing disclosures. Safeguarding is identified as the NMC’s highest strategic risk, and it has taken action to improve its ability to detect and address cases. However, an internal audit identified that there had been cases where the NMC had not taken action that was necessary from a safeguarding perspective. Even a small number of safeguarding failings could amount to a serious risk to the public. Therefore Standard 17 was not met. The evidence we saw from our audit of a sample of cases did not give us serious concerns about the NMC’s routine decision-making. One of the independent reviews into whistleblowing disclosures will be reviewing a sample of fitness to practise cases, and we will consider the outcomes of the review when available.

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