Blog: Why insight matters – and how it strengthens nursing and midwifery practice

At the NMC, our vision is for safe and effective nursing and midwifery practice across the UK.

A big part of achieving this is making sure we listen, learn and act based on evidence. The insight we gather from our regulatory work – both data and the experiences of professionals on our Register and the public – helps us regulate with purpose, influence practice and support improvement across the health and care system.

Improving our Fitness to Practise process

Everyone wants a Fitness to Practise process that’s faster, fairer and more compassionate.

Since launching our Fitness to Practise Plan in April 2024, we’ve been making steady progress towards making quicker, fairer decisions and creating a process that is more supportive to everyone involved.

Our newest annual Fitness to Practise insight publication, published today, shares what we’re learning. It shows:

• why some concerns lead to more serious outcomes
• what dishonest behaviour looks like and why it happens
• why some employer referrals don’t need a formal investigation.

We know that registrants who take part in local investigations and feel supported to engage in our process are more likely to receive lighter outcomes or early closure.

That’s why we’ve introduced a new Professional Support and Engagement Team to offer needs-led support to vulnerable nurses, midwives or nursing associates who become involved in a Fitness to Practise case. We’re also trialling a bespoke pathway to better support health-related cases, such as for people with conditions like dementia, and we’re making improvements to how we first contact registrants when a referral is made about them – recognising how difficult that moment can be.

Our insight also reinforces the importance of an open workplace culture. Dishonesty – which is sometimes driven by fear or pressure – is often linked to the most serious sanctions. When registrants feel safe to speak up, learning happens locally, and problems are far less likely to reach the NMC.

We’re seeing an increase in referrals from employers, but many don’t need to be made. In a sample of 166 cases we reviewed, 15% related to isolated incidents — mainly medication errors — and 70% of these came from independent care homes. These are concerns that can often be addressed through support and training. Our employer advice line – run by our UK-wide Employer Link Service – can help managers decide whether a referral is needed, reducing unnecessary stress and helping us to focus on the cases that really require our involvement.

Understanding what our insights are telling us gives us confidence that the changes we’re making to Fitness to Practise are meaningful. It also helps us plan future improvements based on clear evidence and help us track the difference we are making.

Why insight matters to employers, partners and the public

Insight has value far beyond the NMC. It keeps public protection and professional standards grounded in reality — not assumption — and helps us evolve regulation in a way that supports safe and effective practice.

• For employers, it highlights common concerns and trends, helping them strengthen training, supervision and staffing before issues escalate.
• For policy-makers and system leaders, it shines a light on wider structural challenges, including workforce pressures and inequalities.
• For the public, it builds trust by showing how we are learning and improving.

Turning insight into action

Publishing insight is important, but action matters even more. One of the clearest lessons from this year’s findings is that not every concern needs to be referred to the NMC. Supporting employers and the public to make appropriate referrals — and to resolve issues locally where it’s safe to do so — is a vital focus for us in the months ahead.

Insight is a central part of our commitment to building a new NMC. But so is collaboration. By working with employers, providers and partners across the system, we can use this insight to improve, learn and build trust in our professions and in regulation.

These insights help all of us stay focused on what protects the public: fair decisions, strong workplace cultures, and employers getting the right support at the right time.

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