How does a case get to a hearing?
Most concerns about nurses, midwives and nursing associates never reach a hearing. Many are closed at screening or after investigation. When the NMC has investigated, two case examiners, one a registered professional and one a lay person, decide whether there is a case to answer. That means deciding whether a panel could realistically find the facts proved and your fitness to practise currently impaired.
| Case examiners' decision | Possible outcomes |
|---|---|
| No case to answer | No action, advice (private), or a warning (public, shown on the register for 12 months). The case closes. |
| Case to answer | Undertakings may be agreed, or the case is referred to the Fitness to Practise Committee for a meeting or hearing. |
Separately, if there is an immediate risk while the case is ongoing, the NMC can ask a panel to consider an interim order, which can suspend you or put conditions on your practice until the case ends. An interim order hearing is not a final decision about the allegations.
What is the difference between an NMC meeting and a hearing?
When a case is referred to the Fitness to Practise Committee, it is decided either at a meeting or a hearing. The NMC asks which you prefer.
| Meeting | Hearing | |
|---|---|---|
| How it works | The panel decides on the papers | Live evidence and submissions |
| Do you attend? | No, but you can send written information in advance | You can attend, with or without a representative, or send a representative |
| Witnesses | None attend | Witnesses may give evidence and be questioned |
| Length | Usually much shorter | Often several days |
| If you do not respond | A meeting is usually held, unless the panel decides a hearing is needed | You can ask for a hearing instead of a meeting |
Sometimes a case is resolved without a contested hearing. In a consensual panel determination, you and the NMC agree on impairment and a proposed sanction, which requires you to admit the facts and accept impairment. A panel still makes its own decision and does not have to accept the agreement. Your representative can advise whether this route is suitable.
Who will be at an NMC hearing?
- The panel: three people, a chair, a registered nurse, midwife or nursing associate, and a lay member. At least one is on the same part of the register as you.
- The legal assessor: an independent lawyer who advises the panel on the law and procedure but takes no part in the decision. They may explain procedure to you if you are not represented.
- The hearings coordinator: organises the hearing and helps the panel draft its written decision, without influencing the outcome.
- The NMC case presenter: sets out the NMC's case and the concerns about your practice.
- You, and your representative if you have one. Many registrants are represented by their trade union or defence organisation.
- Witnesses: called by either side, for example colleagues, the person who made the referral, or your employer.
- Observers and journalists, unless the hearing or part of it is held in private.
You may also be able to bring a relative or colleague for support. Ask your representative or the NMC about this in advance.
What are the stages of an NMC hearing?
A substantive hearing follows three main stages. The panel makes a decision at each one before moving to the next, and gives reasons.
- Stage 1: Facts: The panel decides which of the allegations are proved. You may admit some or all of them. For disputed facts, witnesses give evidence under oath or affirmation and can be questioned by both sides and by the panel. The NMC must prove the facts, and the panel decides on the balance of probabilities.
- Stage 2: Grounds and current impairment: If facts are proved, the panel decides whether they amount to a ground such as misconduct or lack of competence, and then whether your fitness to practise is impaired today. This is where insight, strengthened practice, risk of repetition and the public interest are considered. Evidence such as reflective statements, training records and references is particularly relevant here.
- Stage 3: Sanction: If impairment is found, the panel decides what sanction is needed. It starts with the least restrictive option and must explain why it chose that sanction and rejected the others.
At each stage, both sides can make submissions, and the legal assessor gives the panel advice on the law, which is shared openly so that you or your representative can comment on it. If you are not represented, the chair and the legal assessor should explain what is happening and when you can speak. It is fine to ask for something to be repeated or explained.
What sanctions can an NMC panel give?
Sanctions are meant to protect the public, maintain confidence in the professions and uphold standards. They are not meant to punish. The panel works up from the least severe option.
| Outcome | What it means | Length |
|---|---|---|
| No further action | No sanction is imposed | Not applicable |
| Caution order | You can practise without restriction, but the caution appears on the register | One to five years |
| Conditions of practice order | You can practise, subject to specific conditions, such as supervision or retraining | Up to three years, reviewed before it expires |
| Suspension order | You cannot practise for a set period | Up to 12 months |
| Striking-off order | Your name is removed from the register | No fixed period |
Sanctions are visible when someone searches the register. Review hearings and restoration have their own rules, so check the NMC's guidance or ask your representative how they apply to you.
Are NMC hearings public, and are they held online?
Hearings are usually held in public, but a panel can hold all or part of a hearing in private. Cases that focus on a registrant's health are always held in private. Personal matters, such as health or family details, may also be heard in private where appropriate.
Hearings can be held in person or virtually. Physical hearings are normally held at NMC hearing centres in London and Edinburgh, and in Northern Ireland and Wales, depending on where the registrant lives. Virtual hearings use video conferencing. If you attend from home, you will need a reliable connection, suitable equipment and a private space.
Hearings normally start in the morning and run through the working day, with regular breaks. You can ask for a break if you need one, and you can tell the NMC about any reasonable adjustments you need.
How should I prepare for an NMC hearing?
- Read every document you receive carefully and keep to deadlines.
- Work with your representative on which facts you admit, and why.
- Write a reflective statement in your own words that shows understanding of the concerns and what you have changed.
- Gather evidence of strengthened practice: relevant training with assessment, supervision records, appraisals and audits.
- Ask for references from managers or supervisors who know the full allegations. They should be signed, dated and include contact details.
- Look after your health. Use your GP, occupational health or employee assistance services, and accept support from people you trust.
Amara, a band 5 nurse, faced a hearing about record keeping on a busy ward. With her union representative she admitted most of the facts early. In the months before the hearing she completed assessed record-keeping training, asked her ward manager for monthly audits of her notes, and wrote a reflective statement in plain English about what she had learnt. Her manager provided a reference written with full knowledge of the allegations. Her representative presented this evidence at the impairment stage. Each case is decided on its own facts, but this is the kind of evidence panels are able to weigh.
What happens after the hearing, and can I appeal?
At the end, the panel goes into private session to decide, and its decision and reasons are then announced and sent to you in writing. Decisions from public hearings are usually published.
If you disagree with the outcome, you can appeal to the courts within 28 days of the date of the letter telling you the decision. In England and Wales this is the High Court, in Northern Ireland the High Court of Justice in Northern Ireland, and in Scotland the Court of Session. You may be placed on an interim order while the appeal is decided. Take legal advice before deciding to appeal.
Further support
For a clear overview of the whole process, Fitness to Practise Explained: GMC, NMC and HCPC Processes covers each stage from referral to hearing and the possible outcomes. Insight and Remediation: Building Your Evidence focuses on the impairment stage, explaining what insight means and how to evidence change. The NMC Code for New UK Nurses is a useful refresher if your case involves standards you want to revisit. These courses support your own learning and do not replace advice from your representative.
Frequently asked questions
How long does an NMC hearing last?
It depends on the case. Meetings, decided on the papers, are usually much shorter than hearings. Hearings with disputed facts and several witnesses can last several days or longer. Your notice of hearing will state the expected length. Ask your representative or the NMC if you need to plan time off work or childcare.
Do I have to attend my NMC hearing?
You do not have to attend, but it is usually in your interest to take part. You can attend with or without a representative, or your representative can attend for you. If you do not engage, the panel may proceed in your absence. Speak to your union or defence organisation about the best approach for your case.
What are the three stages of an NMC hearing?
First, the panel decides whether the facts are proved. Second, it decides whether those facts amount to misconduct or another ground, and whether your fitness to practise is currently impaired. Third, if impaired, it decides on a sanction, starting with the least restrictive. The panel gives reasons at each stage.
Can I be struck off at my first NMC hearing?
A striking-off order is the most serious sanction and is reserved for the most serious cases. Panels must consider less severe options first and explain why they are not enough. The outcome depends on the facts, the seriousness of the concerns, and evidence of insight and strengthened practice. Your representative can advise on the risks in your case.
Are NMC hearings public?
Most hearings are public, so observers and journalists can attend, and decisions are usually published. A panel can hold all or part of a hearing in private, and cases that focus on a registrant's health are always held in private. You or your representative can ask for private sessions for sensitive matters.
What is an NMC interim order?
An interim order is a temporary measure while a case is ongoing. A panel can impose interim conditions or an interim suspension if it decides there is a risk that needs managing before the case is concluded. It is not a finding that the allegations are true. Seek representation for any interim order hearing.
Related courses
Fitness to Practise Explained: GMC, NMC and HCPC Processes
This course explains, step by step, how fitness to practise concerns are handled by the UK health regulators, from the first referral to a final…
Insight and Remediation: Building Your Evidence
This course explains what UK healthcare regulators mean by insight and remediation, how they are assessed at each stage of a fitness to practise…
The NMC Code for New UK Nurses
This course explains the NMC Code and shows how to apply it in everyday UK nursing and midwifery practice. It works through each of the four themes…
Sources and further reading
- Meetings and hearings, and people who attend a hearing. Nursing and Midwifery Council.
- Case examiners and their decisions. Nursing and Midwifery Council.
- Available sanction orders. Nursing and Midwifery Council.
- Consensual panel determination. Nursing and Midwifery Council.
- Appealing a fitness to practise outcome. Nursing and Midwifery Council.
- Our framework for delivering fitness to practise hearings and meetings. Nursing and Midwifery Council.
- NMC hearings: what to expect. Royal College of Nursing.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
More guides
What Does 'Insight' Mean in a Fitness to Practise Case?
What insight means in a fitness to practise case, how the NMC and GMC assess it, how to show it in a reflective statement, and what weakens it. Plain UK guide.
MPTS Tribunals Explained: The Process and Possible Outcomes for Doctors
MPTS tribunal process explained for doctors: who decides, the three stages of a hearing, possible outcomes and sanctions, review hearings and appeals.
HCPC Fitness to Practise: A Guide for Physiotherapists, Paramedics and AHPs
HCPC fitness to practise process explained for physiotherapists, paramedics and AHPs: triage, investigation, the ICP, hearings and sanctions.