NMC: Insight into fitness to practise (January 2026)

Summary

Fitness to Practise is the process by which the Nursing and Midwifery Council (NMC) investigate concerns about the professionals on their Register and take action if it is required to protect the public. Fitness to Practise affects relatively few of our professionals but it can have significant consequences and is therefore subject to particular scrutiny.

This publication provides new insights about:

• Why some cases about similar concerns receive more serious sanctions than others.
• What types of behaviours constitute dishonesty.
• Why some concerns raised by employers concluded at the initial stages, indicating that some concerns can be safely and fairly resolved locally.

Content

What was found

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.