Regulatory Law
Nurses & Midwives

We handle cases where nurses and midwives are being investigated by their regulatory body, the Nursing and Midwifery Council (NMC).

The Regulatory Process

In the United Kingdom, nurses and midwives are regulated by the Nursing and Midwifery Council (NMC), which also regulates nursing associates in England. The NMC is responsible for maintaining the professional register, setting standards of professional conduct and investigating concerns about a registrant’s fitness to practise. The regulatory framework is governed principally by the Nursing and Midwifery Order 2001 and the associated Fitness to Practise Rules. Where a concern is raised, the NMC will initially assess whether the matter falls within its jurisdiction and whether there is sufficient evidence to justify investigation. If the matter proceeds, evidence will be gathered from relevant sources, including employment records, clinical records, witness statements and expert opinions where appropriate. The nurse or midwife will normally be notified of the allegations and given an opportunity to respond.

Following the investigation, the matter is considered by two NMC Case Examiners, one being a registered professional and the other a lay member. The Case Examiners determine whether there is a realistic prospect of the Fitness to Practise Committee finding that the alleged facts are proved, that a relevant statutory ground is established and that the nurse or midwife’s fitness to practise is currently impaired. Where there is no case to answer, the Case Examiners may close the case without further action, provide private advice or issue a public warning, which normally remains on the register for 12 months. Where there is a case to answer, they may recommend undertakings to be agreed with the registrant or refer the matter to the Fitness to Practise Committee for a formal hearing or meeting. Undertakings are voluntary agreements intended to address identified concerns about professional practice.

Where necessary to protect members of the public, otherwise in the public interest, or in the interests of the nurse or midwife, the Fitness to Practise Committee may also impose an interim order suspending registration or imposing temporary conditions of practice while an investigation or disciplinary proceedings continue. Such orders may initially remain in force for up to 18 months, subject to statutory review and extension procedures. Interim orders must normally be reviewed every six months. However, where new evidence relevant to the interim order becomes available after it was made, including evidence arising from a material change of circumstances, the order must be reviewed without waiting for the next scheduled review. Where proceedings have not concluded within the initial period, the NMC may apply to the relevant court for extensions of up to 12 months at a time.

Formal hearings are conducted by independent panels of the NMC’s Fitness to Practise Committee, comprising professional and lay members. At the hearing, the nurse or midwife is entitled to attend, be legally represented, make representations, call witnesses and submit evidence in their defence. The panel will determine whether the factual allegations have been proved on the balance of probabilities, whether a relevant statutory ground of impairment is established and whether the nurse or midwife’s fitness to practise is currently impaired.

From 1 October 2026, revised NMC Fitness to Practise Rules introduced strengthened case management powers, greater flexibility concerning evidence, representations and procedural communications, and the power to appoint Legally Qualified Chairs to practice committee panels. These changes also permit the use of agreed digital communication arrangements and provide additional flexibility concerning special measures for witnesses. Legally Qualified Chairs are being introduced progressively and will not necessarily preside over every hearing.

If the Fitness to Practise Committee determines that the nurse or midwife’s fitness to practise is impaired, it may decide that no further action is necessary or impose a sanction. Available sanctions include a caution order lasting between one and five years, conditions of practice for up to three years, suspension from the register for up to 12 months, or a striking-off order removing the nurse or midwife from the register. Conditions of practice and suspension orders are subject to statutory review arrangements and may be extended, varied or replaced where appropriate. A caution order is distinct from a warning issued by Case Examiners where there is no case to answer.

Where impairment arises solely from adverse physical or mental health, lack of competence, insufficient knowledge of English, or a combination of those grounds, a striking-off order cannot be imposed unless the nurse or midwife has been continuously subject to substantive suspension or conditions of practice for at least two years immediately preceding the decision. Time spent under an interim order does not count towards this two-year period.

Striking off prevents the nurse or midwife from practising in their regulated profession unless and until their registration is restored. A registrant who has been struck off cannot apply for restoration until at least five years have elapsed from the date the striking-off order took effect. Restoration is not automatic, and the Fitness to Practise Committee must be satisfied that the applicant is fit to practise before directing restoration. Only one application for restoration may be made within any 12-month period. Following a second or subsequent unsuccessful restoration application, the Committee may suspend indefinitely the registrant’s right to make further applications, subject to the statutory appeal and review provisions.

A nurse or midwife may appeal against an appealable decision of the Fitness to Practise Committee to the Court of Session where their registered address is in Scotland, the High Court of Justice in Northern Ireland where their registered address is in Northern Ireland, or otherwise to the High Court in England and Wales. Such appeals must be brought within 28 days of notification of the decision being served. Interim orders may also be challenged before the relevant court in accordance with the applicable statutory procedures.

In addition, the Professional Standards Authority (PSA) has the power to refer certain decisions of the NMC’s Fitness to Practise Committee to the relevant court where it considers that the outcome is insufficient to protect the public. Consequently, even where a nurse or midwife receives a relatively lenient sanction, the decision may subsequently be challenged and a more severe outcome may result.

Internal Disciplinary Proceedings

We also assist and represent nurses and midwives where they are the subject of internal disciplinary proceedings by their employer.

What To Do If Regulatory Proceedings Are Commenced Against You

Should internal disciplinary proceedings or NMC regulatory proceedings be commenced against you, then please either telephone us on 0333 301 0700, or complete our questionnaire.