Striking-off order

Reference: SAN-3f

Last Updated 28/07/2017


A striking-off order results in the removal of the nurse or midwife’s name from the register, thus preventing them from working as a registered nurse or midwife. They may not apply for restoration until a period of five years has elapsed since the striking-off order was made. An application for restoration will not be granted unless a panel of the Fitness to Practise Committee is satisfied that the applicant meets the requirements for admission to the register and in addition, is a fit and proper person to practise as a nurse or midwife. Key considerations are:

  • can public confidence in the professions and the NMC be maintained if the nurse or midwife is not removed from the register?
  • is striking-off the only sanction which will be sufficient to protect the public interest?
  • is the seriousness of the case incompatible with ongoing registration (see above for the factors to take into account when considering seriousness)?

This sanction is likely to be appropriate when the behaviour is fundamentally incompatible with being a registered professional, which may involve any of the following factors.

  • A serious departure from the relevant professional standards as set out in key standards, guidance and advice.
  • Doing harm to others or behaving in such a way that could foreseeably result in harm to others, particularly patients or other people the nurse or midwife comes into contact with in a professional capacity. Harm is relevant to this question whether it was caused deliberately, recklessly, negligently or through incompetence, particularly where there is a continuing risk to patients. Harm may include physical, emotional and financial harm. The seriousness of the harm should always be considered.
  • Abuse of position, abuse of trust, or violation of the rights of patients, particularly in relation to vulnerable patients.
  • Any serious misconduct of a sexual nature, including involvement in child pornography.
  • Any violent conduct, whether towards members of the public or patients, where the conduct is such that the public interest can only be satisfied by removal.
  • Dishonesty, especially where persistent or covered up (consider the guidance on the seriousness of dishonesty).
  • Persistent lack of insight into seriousness of actions or consequences.
  • Convictions or cautions involving any of the conduct or behaviour in the above examples.

The courts have supported decisions to strike off healthcare professionals where there has been lack of probity, honesty or trustworthiness, notwithstanding that in other regards there were no concerns around the professional’s clinical skills or any risk of harm to the public.1 Striking-off orders have been upheld on the basis that they have been justified for reasons of maintaining trust and confidence in the professions.

A striking-off order is not available where fitness to practise is impaired on the basis of health, lack of competence or not having the necessary knowledge of English, until the nurse or midwife has been subject to either a suspension order or a conditions of practice order for a continuous period of no less than two years. The two-year period can be made up of a combination of periods of suspension and conditions, provided that there is a continuous period during which the nurse or midwife’s practice has been subject to restriction under a substantive order.

1 For example, Parkinson v NMC [2010] EWHC 1898 (Admin), Mvenge v GMC [2010] EWHC 3529 (Admin), Ige v Nursing and Midwifery Council [2011] EWHC 3721 (Admin)