FAQs - Consultation on supporting improvements to our fitness to practise process

We are the independent regulator of more than 853,000 nurses and midwives in the UK and nursing associates in England. Our role is to protect the public and maintain confidence in the nursing and midwifery professions. We do this by setting and upholding standards of proficiency.

Our role and remit are set out in the Nursing and Midwifery Order: The Nursing and Midwifery Order 2001. This is the legislation that governs our work.

The way we work as a regulator is governed by legislation made by UK parliament and rules made by our Council and approved by the Privy Council.

We are proposing some improvements to our Fitness to Practise rules now, ahead of more wide-ranging reforms proposed by UK government, who we will be working with over the next few years to modernise our legal framework.

We are proposing to:

1. Use legally qualified chairs to provide legal direction and advice instead of legal assessors in some hearings.
2. Give panels stronger case management powers to make binding directions before hearings.
3. Allow information to be sent through a secure online account or portal (with agreement).
4. Make deadlines and notice periods more flexible in certain circumstances.
5. Improve support and adopting a needs-led approach for vulnerable witnesses.

The consultation is open for 12 weeks from 3 November 2025 to 26 January 2026.

When the consultation closes, we will publish an analysis of the responses in spring 2026. This will include our Equality Impact Assessment.

Our Council will consider all the feedback before a decision is taken on the next steps.

We welcome all responses via our survey. You can find the survey on our consultation webpage 

You can respond as an individual or on behalf of an organisation or a group. We encourage everyone to share their thoughts.

Taking part in the consultation survey is optional. You can skip any section of the consultation not relevant to you. The exception is the 'About you' questions where we use this information to understand we have heard from a diverse and broad range of people. This includes an option for people to prefer not to say.

The survey takes around 15 minutes to complete.

If you have any questions or need the survey in a different format, email consultations@nmc-uk.org

The consultation is open to everyone.

All data shared (with the exception of the name of your organisation if you are not responding as an individual) will be aggregated and anonymised.

Your personal data will be collected and stored in line with our privacy policy.

A nurse, midwife or nursing associate is fit to practise if they have the skills, knowledge, good health and character to deliver safe, effective and kind care for their patients and people who need or use health and social care services.

If we find that someone registered with us presents a risk to people who use healthcare services, the public, their colleagues or themselves, we can restrict their practice or remove their right to work as a nurse, midwife or nursing associate.

We are working towards making our Fitness to Practise process faster and fairer for everyone involved. Since we launched our Fitness to Practise plan in 2024, we have made gradual and meaningful improvements.  

We have made positive changes across safeguarding, at screening with high numbers of decisions being made each month and in our approach to adjudications.

We have also begun to make the process more compassionate including the introduction of a bespoke pathway for health cases to support professionals with illnesses including dementia and substance misuse issues.

However, we are still facing challenges – Fitness to Practise remains very expensive to run and too many people are still delayed in our process for too long.

The changes we are proposing through this consultation will support us to continue to improve the process for everyone involved.

We are proposing to:

1. Use legally qualified chairs to provide legal direction and advice instead of legal assessors in some hearings.
   
   
2. Give panels stronger case management powers to make binding directions before hearings.
   
   
3. Allow information to be sent through a secure online account or portal (with agreement).
   
   
4. Make deadlines and notice periods more flexible in certain circumstances.
   
   
5. Improve support and adopting a needs-led approach for vulnerable witnesses
   
   

These changes would help us to:

• reduce the age of our caseload
  
  
• remove unnecessary process delays
  
  
• free up capacity at the adjudication stage of our process
  
  
• improve the efficiency of hearings
  
  
• be more person-focused by recognising and putting people’s needs at the centre of what can be a distressing process.

For registrants whose case reaches a hearing, the changes we are making would mean hearings take less time, conclude more quickly and there will be more options for how information is shared to support everyone involved to participate.

For vulnerable witnesses, we would be able to provide more needs-led support.

The way we work as a regulator is governed by legislation made by UK parliament and rules made by our Council and approved by the Privy Council.

We are proposing some improvements to our rules now, ahead of more wide-ranging reforms proposed by UK government, who we will be working with over the next few years to modernise our legal framework.

We are in the early stages of planning how implementation might take place if we proceed with these changes, after the consultation has closed.

From the changes that we are proposing, we expect to see eventual cost savings from a more efficient case management process, and in particular from the introduction of legally qualified chairs. This should produce significant savings on the current spend on legal assessors which is currently over £4m a year.

We are carrying out engagement on our proposals and seeking feedback through meetings with our partners and stakeholders. We are completing an assessment of the impacts of the proposed changes so that we don’t create unfair barriers.

We want to introduce improvements while not compromising on quality or fairness. We will:

• Continue to apply the law and our rules fairly
  
  
• Allow enough time for people to respond
  
  
• Keep using legal expertise in hearings
  
  
• Make reasonable adjustments for anyone who needs them

We also ensure that all our decision makers and colleagues working with registrants or people involved in fitness to practise are supported with ongoing training. For 2025, this has included training on being trauma informed and unconscious bias.

It means doing what is best for public safety and maintaining high confidence in nursing and midwifery.