NMC fitness to practise timeliness improves as screening decisions reach record high

In July 2023, the rolling average for completing FtP cases within 15 months stood at 60.8 percent. By June 2025, this had risen to 70.4 percent. Meanwhile, in May alone, the NMC made 809 screening decisions – either closing cases or progressing them to investigation – a new monthly high.

To reduce the stress and uncertainty for people involved in the NMC’s FtP process, the regulator has focused its efforts on making quicker decisions, and resolving cases earlier. In the 12 months to June, the regulator reached an average of 928 decisions a month across the FtP process, meaning cases were either closed or progressed to an investigation. This is an increase on the average of 777 decisions in the previous 12-month period.

This progress reflects the momentum of the NMC’s turnaround, which includes a comprehensive Fitness to Practise Plan underpinned by major investment, and a three-year Culture Transformation Plan.
Other key achievements in the regulator’s latest data include:

• A drop in total caseload from 6,633 in December 2024 to 6,186 in June 2025;
• 65 percent of adjudication cases are now listed for hearing, compared to an average of 40 percent during 2024.

Driving change through external expertise

As part of its Fitness to Practise Plan, the NMC is continuing to embed external learning to help inform improvements in FtP – a key action in response to the Independent Culture Review, which the regulator commissioned and which published in July 2024.

A key contribution came from Anthony Omo, General Counsel and Director of Fitness to Practise at the General Medical Council, who undertook a secondment in late 2024. His insights – a summary which the regulator has now published - directly informed a number of successful changes, including:

• Updated screening guidance for more consistent, risk-based early decisions. This enables staff to identify concerns that require regulatory action quicker and progress these cases more swiftly, while closing cases that would be better resolved locally;
• A more structured approach to legal, clinical and safeguarding advice, with further developments ongoing.

Meeting ongoing pressures

While progress continues, the NMC is managing sustained demand, with monthly referrals now averaging 565, up from 513 in the previous year.

To manage these pressures and improve people’s experience, the NMC has launched new initiatives, such as:

• Updated, more flexible hearing cancellation guidance, allowing for more compassionate decisions in cases where professionals face significant health barriers (including lack of mental capacity) and are unlikely to work again or cannot meaningfully take part in the FtP process. This approach ensures professionals facing health barriers do not have to go through unnecessary proceedings
• New training and procedures, including mandatory workshops on fair, unbiased decision-making, and updated operating procedures to ensure greater consistency.

Over the coming year, the focus will be on accelerating progress at the investigation and adjudication stages, while developing new ways of working to make progress on the regulator’s new equality, diversity and inclusion targets.

Lesley Maslen, Executive Director of Professional Regulation, said:

“With a clear turnaround programme underway at the NMC, I welcome the recent progress in our fitness to practise performance. More efficient, timely decisions mean people spend less time in our processes, which can understandably be a distressing and uncertain experience.

“Thanks to the dedication of our teams, we are seeing steady improvements, including another record-breaking month in screening. But we know challenges remain – that is why we are sharpening our focus on tackling the pressure points we are seeing, including high volumes of referrals and challenges at the investigations stage.

“There is more to do before every person engaging with us feels a genuine shift in experience. We remain focused on strengthening the FtP process, which is a key part of transforming the NMC into the fair, effective and trusted regulator that professionals and the public deserve.”

Further information

• Careline: we offer an independent service run by specially trained counsellors, providing confidential emotional and practical support to professionals 24 hours a day, 365 days a year
• Referral: This is what we call a new concern submitted to us about a nursing or midwifery professional on our register 
• Screening: This is the initial assessment stage when we receive a new concern about a professional on our register and decide whether it should go to a full investigation 
• Investigations: If we have decided that a concern needs further investigation, the screening team will pass it onto the investigation team. The investigation team will then gather evidence and continually assess all the information they receive to decide what the next steps in the investigation should be. At the end of the investigation, the team will put together a report for our case examiners to look at 
• Case examiners: If a referral has been made about a professional and we have investigated the case, our case examiners will decide whether there is a ‘case to answer’ 
• Adjudications: cases are prepared for a final decision, which could be made in a meeting, hearing or by other means

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