FREE CHAPTER from ‘A Practical Guide to Proceedings Before the Nursing and Midwifery Council (NMC)’ by James Lloyd

07/04/2026

CHAPTER ONE – AN INTRODUCTION TO THE NURSING AND MIDWIFERY COUNCIL

  • The Nursing and Midwifery Council
    • The Nursing and Midwifery Council (NMC) is the statutory regulator for nurses, midwives and nursing associates in the United Kingdom. It is a creature of statute, entrusted by Parliament with responsibility for regulating professions whose work engages directly with patient safety, vulnerability and public confidence in healthcare services. The NMC’s overarching objective is the protection of the public. That is not a corporate slogan; it is the guiding principle which governs how the NMC exercises its functions, how panels approach the determination of allegations, and how decisions are scrutinised by the courts.
    • The NMC is not a professional body, a representative organisation or an advocate for registrants in any traditional sense. Nor is it an employment tribunal or a forum for resolving workplace disputes. Its function is to oversee the profession as a whole, to secure public safety and confidence. The distinction matters. Many of the tensions that arise when registrants encounter the NMC’s fitness to practise process stem from an understandable, but legally incorrect, assumption that the regulator is an extension of their employer, or a body designed to vindicate or punish. It is neither. It is a statutory creature responsible for controlling access to, and continued participation in, a regulated profession, in the public interest.
    • The NMC regulates the right to practise, not the right to be employed. The two often overlap in practice, particularly in the NHS, and a single set of facts can generate both employer action and regulatory action. They are nonetheless distinct jurisdictions, with different purposes, different tests and different outcomes.
    • For a reader approaching NMC proceedings for the first time, it is therefore useful to keep three propositions at the forefront of mind from the outset.
      • First, the framework is statutory. The NMC can act only where the statutory scheme permits it to act, and it must act in accordance with that scheme. The boundaries of the NMC’s powers have been set by Parliament, though operationally panels enjoy broad case management discretion: familiarity with the statutory scheme, fitness to practise rules and standards is essential.
      • Second, the framework is protective. Fitness to practise proceedings are not brought to punish, even though they often have severe and punitive consequences. They are brought to protect the public, to maintain confidence in the professions, and to uphold proper standards. These aims percolate through all decision making, particularly during the fitness to practise process.
      • Third, the framework is public law in character. The NMC, and the panels which exercise its adjudicatory functions, are subject to the supervisory jurisdiction of the High Court. Decisions must be lawful, fair, reasoned and proportionate.
  • Statutory footing and regulatory purpose
    • The NMC’s authority is conferred by the Nursing and Midwifery Order 2001 (the 2001 Order).[1] The 2001 Order establishes the NMC, creates and governs the register, and sets out the machinery through which regulation operates. It provides the framework for standard-setting, education and registration decisions, and fitness to practise. In that sense, it provides both the foundation and the boundary of the NMC’s jurisdiction. The 2001 Order also defines the regulator’s purpose. Articles 3(4) and 3(4A) state that the overarching objective of the NMC is the protection of the public, pursued through protecting, promoting and maintaining the health, safety and wellbeing of the public; promoting and maintaining public confidence in the professions regulated under the Order; and promoting and maintaining proper professional standards and conduct for registrants.
    • The statutory footing has two immediate consequences.
      • The NMC may act only within the powers conferred by Parliament. The NMC does not have a free-standing discretion to intervene whenever concerns are raised, however serious, emotive or politically charged. The statutory scheme defines the circumstances in which concerns may be investigated and, if appropriate, prosecuted. Where those gateways are not engaged, the NMC has no jurisdiction to proceed.
      • The NMC must exercise its powers for the purposes for which Parliament granted them. Regulatory power is not available as a means to resolve workplace disputes, to award compensation, to attribute blame for systemic service failure, or to “send a message” untethered to the statutory objectives. Where those objectives require intervention, the NMC is expected to act; where they do not, the statutory scheme provides no authority for intervention.
    • The NMC’s functions are not limited to fitness to practise. Its remit is concerned with entry into a regulated profession, continued inclusion on the register, and the maintenance of professional standards across a working life. The NMC’s regulatory duties therefore fall under three broad areas.
    • Standard-setting is one area. The NMC sets professional standards of conduct and performance for registrants, and educational standards for those seeking entry to the register. Those standards provide the normative yardstick against which allegations are assessed and suitability to practise assessed. They also influence the professional culture in which healthcare is delivered, by establishing what the regulator expects as a minimum. The NMC produces a wealth of guidance to registrants on professional conduct and the application of those standards. Registrants are expected to act in accordance with both the standards and the guidance, with the latter formally being instructive.
    • Registration control is the next. The register is not merely a list, but the legal instrument through which the state (by delegation) controls who may practise as a nurse, midwife or nursing associate. Entry decisions, restoration decisions and the maintenance of registration through revalidation are state-mandated controls of the utmost importance. Integrity of the register is a matter of public protection, and actions which undermine that integrity (for example, non-disclosure of criminal convictions or practising when registration has lapsed) are treated as among the most serious categories of misconduct.
    • Linked to, but distinct from those areas, is the the fitness to practise (FTP) process. This is the enforcement jurisdiction through which the regulator determines whether a registrant should remain on the register and, if so, whether their registration should be restricted. The FTP process is a further mechanism by which the regulator can declare and uphold proper professional standards.
  • Scope of regulation
    • The NMC regulates three professions: nurses, midwives and nursing associates. Only individuals whose names appear on the NMC register may practise in the protected roles conferred by registration. Regulation is therefore anchored in status: the holding of registration. That is why the NMC’s jurisdiction follows the registrant across settings and roles.
    • The scope of regulation is wide. It applies across all fields of nursing and midwifery and across all sectors in which nurses, midwives and nursing associates practise or hold themselves out as entitled to practise: the NHS, private healthcare, social care, education, agency work, consultancy, and independent practice. It applies irrespective of seniority or job title. A registrant in a senior management role is not insulated from regulation on the basis that they no longer provide direct clinical care. Professional trustworthiness is not a clinical-only concept. Integrity, safeguarding judgement, and the ability to act professionally are relevant across roles. The scope of regulation also stretches into the private lives of registrants where conduct outside the workplace has the propensity to bring the profession into disrepute.
    • The NMC regulates individuals, not institutions. Employers, trusts, care homes, commissioning bodies and NHS England are not regulated by the NMC as such. The NMC’s concern is the professional status of the individual registrant. That distinction is not pedantry. It explains why the NMC cannot determine employment disputes, award compensation, nor direct employers as to disciplinary outcomes. It also goes some way to explain conceptually why employer findings are not admissible in fitness to practise proceedings; they are not determinative of regulatory outcomes.
    • Protected titles are a familiar feature of statutory schemes and the NMC is no different. The titles “Registered Nurse”, “Midwife”, “Nursing Associate” and “Specialist Community Public Health Nurse” are protected in law and may only be used by those properly registered, with related criminal offences attaching to the misuse of these specific titles and functions. By contrast, “nurse” is not, in itself, a protected title, which means that in ordinary language the term is widely used while, as a matter of law, one could currently describe oneself and indeed practise as a “nurse” without registration, subject to the offence provisions in Article 44. This position has attracted criticism and ongoing policy attention, including the government’s announcement in July 2025 of an intention to strengthen nursing title protection by closing this loophole. Whether those proposals translate into legislation remains a matter of statutory change rather than regulatory discretion.
    • Internationally qualified applicants sit within the same public protection scheme. The register is a UK register, and admission to it requires the NMC to be satisfied that an applicant meets the relevant UK standards. The detail of how the NMC assesses international qualifications and competence is largely set out in the NMC’s published standards and registration guidance rather than in the 2001 Order itself, but the legal point remains: without registration there is no entitlement to practise in the protected roles.
    • Temporary or emergency registration powers are also part of the landscape and were used to great effect during the coronavirus period. Legislative mechanisms for temporary registration in emergencies involving loss of human life or human illness are reflected in consolidated legislative texts and the broader scheme of amendments: the register is a statutory tool capable of being adapted in exceptional circumstances to address public need while retaining a regulatory framework for standards and accountability.
  • The Register
    • The NMC maintains a single professional register, but that register is divided into distinct fields of practice. The structure reflects the reality that nursing and midwifery comprise distinct professional disciplines, each with their own education routes, standards of proficiency, and scopes of practice.
    • The legislative framework governing the register is set out in the 2001 Order (principally, Articles 5 and 6) together with its associated statutory instruments, and applies UK-wide. The 2001 Order requires the regulator to establish and maintain a register and to determine the standards of proficiency necessary for admission to the different parts of that register. It further provides that the register be divided into separate parts, each bearing a title which reflects the qualifications, education, or training required to entry the respective part. Registration on a particular part of the register entitles a practitioner to use the corresponding protected professional title.
    • Article 44 of the 2001 Order makes it a criminal offence for a person (with an intent to deceive) to: falsely represent themselves as being registered; claim registration in a part of the register to which they are not entitled; use a protected title unlawfully; or misrepresent their nursing or midwifery qualifications.
    • The division of the register flowing from the 2001 Order underpins all regulatory decision-making. In fitness to practise proceedings, panels must assess conduct, competence, and impairment by reference to the registrant’s registered field or fields. It is not appropriate to judge a mental health nurse by adult nursing standards, or vice versa, unless the registrant is dual-registered and the factual matrix properly engages both parts of the register.
    • The register is divided into the following fields and parts:

Adult nursing

  • Adult nursing is the field concerned with the care of adults with physical health needs. It encompasses acute, chronic, and long-term conditions and is practised across hospital, community, and specialist services.
  • Registrants in this field are trained primarily in physical assessment, clinical reasoning, medicines management, and the delivery of evidence-based care for physical illness and injury. Their competence is assessed by reference to adult nursing standards and proficiencies, not by reference to other nursing disciplines.
  • On the register, these practitioners are recorded as Registered Nurse (Adult).

Mental health nursing

  • Mental health nursing is a distinct field focused on the care of people experiencing mental illness, psychological distress, and associated behavioural or emotional difficulties. Practice is centred on therapeutic engagement, risk assessment, safeguarding, recovery-oriented care, and the management of complex legal frameworks relating to mental health, capacity, and consent.
  • Mental health nurses work in inpatient, community, crisis, and forensic settings. The standards by which their practice is judged reflect the particular legal and ethical demands of mental health care, rather than the delivery of physical healthcare alone.
  • On the register, these practitioners are recorded as Registered Nurse (Mental Health).

Learning disability nursing

  • Learning disability nursing is a separate field dedicated to supporting people with learning disabilities. The emphasis is on promoting health, independence, inclusion, and quality of life, frequently in community-based settings rather than acute hospitals.
  • Training and practice focus on communication, behavioural support, advocacy, safeguarding, and addressing health inequalities. Learning disability nurses often play a coordinating role, ensuring that individuals can access services and that reasonable adjustments are made to meet their needs.
  • On the register, these practitioners are recorded as Registered Nurse (Learning Disabilities).

Children’s nursing

  • Children’s nursing is the field concerned with the physical healthcare of infants, children, and young people. It includes neonatal care, acute paediatrics, community children’s nursing, and specialist paediatric services.
  • Children’s nurses are trained in child-specific physiology, development, safeguarding, and family-centred care. The legal and ethical context of practice differs materially from adult nursing, particularly in relation to consent, parental responsibility, and safeguarding duties.
  • On the register, these practitioners are recorded as Registered Nurse (Children).

Midwifery

  • Midwifery is regulated by the NMC but is a distinct profession rather than a branch of nursing. Midwives provide care to women and babies during pregnancy, labour, birth, and the postnatal period, and have a clearly defined scope of autonomous practice.
  • Midwifery has its own education standards, proficiencies, and protected title. While some individuals hold both nursing and midwifery registration, midwifery registration is distinct.
  • On the register, these practitioners are recorded as Midwife.

Nursing associates

  • Nursing associates are a separately regulated role, introduced to support the nursing workforce and to bridge the gap between healthcare support workers and registered nurses. They are subject to distinct professional standards.
  • Nursing associates are not entered into one of the four nursing fields. Their scope of practice, level of autonomy, and educational preparation are distinct, and they must practise within the limits of their role.
  • On the register, these practitioners are recorded as Nursing Associate.
  • Scope of practice
    • Some practitioners hold registration in more than one part of the register, for example in both adult and mental health nursing, or as both a nurse and a midwife. In such cases, the registrant is entitled to use each protected title corresponding to their registration and is expected to maintain competence within each field.
    • Where a registrant holds only a single field of registration, they are not considered entitled to practise outside that field simply by virtue of being a registered nurse. This distinction is frequently central to disputes about scope of practice, employer expectations, and allegations of lack of competence.
  • Touchpoints of regulatory engagement
    • Most registrants will have limited direct interaction with the NMC over the course of their career. The common points at which regulatory engagement becomes direct and consequential can be outlined thus:

Entry (or return) to the register

  • This includes initial registration, admission of internationally qualified applicants, and restoration following removal or lapse. These decisions determine whether an individual is legally entitled to practise under the protected professional titles and therefore engage the NMC’s public protection function at its earliest point.
  • Registration is the legal gateway to authorised practice and the basis on which the public can assume a minimum level of competence, integrity and accountability.
  • Entry (or re-entry) to the register is not simply an administrative exercise. The registration process requires the NMC to be satisfied that an applicant meets threshold requirements. The NMC’s function is therefore protective. The public interest does not engage only when something goes wrong in practice, but persists from the moment the public is exposed to risk through professional practice. Nurses, midwives and nursing associates interact daily with the public in circumstances of the utmost vulnerability, have access to controlled medications, are required to make clinical decisions, are privy to sensitive information, and exercise positions of trust. Their actions and decisions are capable of fatal and life-changing consequence. The statutory scheme mandates that access to such an important position of responsibility be granted only to those who demonstrably meet baseline standards.
  • The protective obligation manifests in three ways:
    • Threshold suitability. The NMC must be satisfied that the applicant meets the requirements of education and training and any other prerequisites, including those relating to health and character. Threshold decisions can become contested where there is previous misconduct, adverse health history, adverse findings by another regulator, or criminal history.
    • Lawful practice. Registration is more than an endorsement of competence; it confers a legal entitlement. That is why removal from the register has immediate practical effect. It deprives a person of the legal ability to practise in the protected roles. This is true whether removal occurs by disciplinary sanction, by lapse, or by failure to revalidate.
    • Continuing accountability. Registration is not a one-time affair. It is a continuing status subject to continuing standards. Once a practitioner is registered, they remain accountable to the NMC for the duration of that registration, wherever and however they practise.
  • Registration decisions are capable of challenge, and the scheme provides routes of appeal and oversight in particular contexts. The broader legal point is that these are public law decisions; decisions taken under statutory power with significant consequences. They must therefore be taken lawfully, fairly and rationally.
  • Registration also interacts with other statutory schemes, particularly criminal records disclosure and safeguarding regimes. Disclosure and Barring Service (DBS) information may affect both the NMC’s assessment of suitability and an employer’s ability to deploy an individual in regulated activity. The DBS regime contains statutory duties to refer information in defined circumstances. The existence of these duties, and the consequences of DBS barring decisions, can be practically decisive for a registrant’s ability to work with vulnerable groups, even where the NMC has not taken action or has not yet concluded action. The statutory regimes are distinct, but the same facts often engage both.

Revalidation

  • Registration is a continuing status which must be maintained through regular revalidation. Revalidation is one of the principal points at which the NMC’s regulatory relationship with registrants is experienced by the profession as a whole.
  • Revalidation requires registrants, at prescribed intervals, to demonstrate continued engagement with practice and with professional standards. It typically includes requirements relating to practice hours, continuing professional development (CPD), reflective accounts, professional discussion and confirmation. Conceptually, revalidation is not a re-examination of competence, but a supervised review of reflection, accountability, continued learning and engagement with standards.
  • Failure to revalidate has automatic consequences. If a registrant does not successfully revalidate, they are removed from the register. The removal is regulatory rather than disciplinary, but it has the same practical effect: the registrant may not lawfully practise in the protected roles.

Raising concerns

  • Concerns may be referred by employers, colleagues, service users, other regulators or the police. Registrants may also (and are in certain circumstances required to) self-refer. The NMC’s guidance reflects an expectation that employers will ordinarily act first to address concerns about practice, unless the risk is so serious that immediate regulatory action is required. Referrals should explain the steps taken locally and why they were insufficient. Members of the public are similarly encouraged to raise concerns with employers in the first instance where appropriate. This is not a jurisdictional rule. It is a practical and policy approach to proportionality and regulatory resource.
  • The nature of concerns capable of engaging the regulator is wide. The critical question is not whether the conduct occurred in the workplace, but whether it engages one or more statutory grounds and, if so, whether it raises an issue of fitness to practise.

Interim action

  • In cases where there is an alleged immediate risk to public safety or to public confidence, the NMC may seek interim conditions of practice or interim suspension while an investigation or hearing is ongoing. Interim orders are protective rather than punitive. Their justification lies in risk management rather than findings of misconduct.

The fitness to practise (FTP) process

  • Once concerns pass the statutory threshold, the registrant may become subject to investigation and, in appropriate cases, formal adjudication. This is the point at which regulatory engagement becomes overtly legal.
  • Allegations are formulated by reference to statutory grounds, evidence is gathered and tested, and the registrant’s fitness to practise is assessed by an independent tribunal. The detail of the FTP process forms the majority of the content of this book.

Review and restoration

  • Final orders may impose conditions, suspend registration or remove a registrant from the register entirely. Many orders are subject to review at defined intervals, and all orders short of strike-off are reviewed before expiration.
  • A registrant’s ability to return to unrestricted practice commonly depends on evidence of insight, remediation and effective management of risk.
  • These touchstones frequently coincide with other statutory or legal processes arising from the same underlying events. Safeguarding regimes may be engaged where concerns relate to abuse or neglect, including section 42 Care Act enquiries. The DBS regime may be engaged where a person is removed from regulated activity because they have caused harm or pose a risk of harm. Coronial proceedings may arise where a death has occurred. Civil proceedings may also be pursued, including claims in negligence arising out of alleged clinical failings. Criminal investigations or prosecutions may proceed in parallel, and the outcome of criminal proceedings may itself constitute a statutory ground for regulatory action. Employer processes frequently run alongside all of these, applying different tests and serving different purposes.
  • Parallel processes are common, given that serious incidents seldom trigger only one protective regime. There is often pressure to await the outcome of other proceedings before progressing with regulatory proceedings. Often that is appropriate. Sometimes it is not. The NMC’s protective function can require action even where other processes are ongoing, particularly where risk is immediate. Interim orders are often the mechanism used to address risk pending the conclusion of other proceedings.
  • In practice, one of the most important skills for lawyers undertaking NMC work is the ability to disentangle overlapping regimes and parallel proceedings. This requires identifying which questions properly belong to which process, managing the flow of evidence and disclosure between them, and ensuring that engagement with one process does not prejudice the investigation, process or a registrant’s position in another.
  • Material generated in one forum, including employer investigations, safeguarding enquiries, inquests, civil proceedings or criminal cases, may later be relied upon in fitness to practise proceedings. Such material must be approached with careful attention to relevance, fairness and statutory purpose, recognising that findings made for one legal purpose are not determinative of regulatory outcomes. 
  • Relationship with NHS bodies
    • Many referrals originate from NHS employers, and the NMC’s work frequently intersects with NHS governance. The relationship is close in practice but distinct in law.
    • Employer disciplinary and capability processes are directed at employment. Their purpose is to manage workforce standards, protect patients within the employer’s service, address contractual obligations, and employer reputation. Employers can impose conditions of employment, redeploy staff, suspend staff, or dismiss staff. These powers are managerial. They are not regulatory.
    • FTP proceedings are directed at public-facing values and registration. Their purpose is to determine whether a message needs to be sent to the public and profession as a whole, and whether a registrant remains fit to practise and therefore entitled to remain on the register (restricted or otherwise).
    • The NMC itself recognises that employers are often best placed to act first in relation to practice concerns and expects employers to provide details of the steps taken to address concerns before referral, unless the risk is so serious that immediate regulatory action is required. That approach is rooted in proportionality and in the practical reality that employers can intervene quickly and can directly manage risk in the workplace.
    • The overlap between employer processes and regulation, however, generates recurrent forensic issues. Registrants and witnesses alike often demonstrate a temptation to treat NMC proceedings as an appeal against an employer’s decision. Such an approach is erroneous. The NMC does not determine whether an employer acted fairly or whether dismissal was lawful. Those are employment law questions. The NMC determines, based upon its own independent assessment of the facts, whether the registrant’s fitness to practise is impaired.
  • Procedural rules
    • The 2001 Order establishes the statutory foundation for the NMC’s regulatory functions, but those functions are given procedural effect through a series of distinct statutory instruments, each directed to a specific regulatory task.
    • Registration, readmission and registration appeals are governed separately by the Nursing and Midwifery Council (Education, Registration and Registration Appeals) Rules 2004 (the Registration rules). These rules regulate entry to the register, renewal, lapse, readmission and appeals against registration decisions. Education and training are regulated through the same rules, together with standards issued by the NMC under the 2001 Order.
    • FTP proceedings are governed principally by the Nursing and Midwifery Council (Fitness to Practise) Rules 2004 (the FTP rules). The FTP rules regulate the investigation and adjudication of allegations, the imposition of interim measures, the conduct of substantive hearings, the review of orders and the disposal of cases. Proceedings under the FTP rules are concerned with past conduct only insofar as it informs the present question of impairment and the need for protective regulatory intervention. Adjudication under the FTP rules is carried out by one of two Practise Committees.[2]
      • The Investigating Committee exercises a gatekeeping role at the pre-hearing stage, determining whether allegations should be referred for adjudication or disposed of by other statutory means.
      • The Fitness to Practise Committee determines whether a registrant’s fitness to practise is impaired by reason of any of the grounds set out in Article 22 of the 2001 Order. The Fitness to Practise Committee was previously divided between, but now sits as a combination of:[3]
        • The Conduct and Competence Committee, panels of which determine cases where impairment is alleged by reason of misconduct, lack of competence, conviction or caution, or adverse determinations by other regulators.
        • The Health Committee, panels of which which have exclusive jurisdiction where impairment is alleged by reason of physical or mental health.
      • The makeup and rules of appointment to those committees are governed by the Nursing and Midwifery Council (Practice Committees) (Constitution) Rules 2008 (the Constitution rules).
    • Supervisory jurisdiction and appeals
      • The High Court
        • The interim order powers of the NMC are capped to the extent that interim orders may be made for a maximum duration of 18 months. Extensions are increasingly commonplace, but extension beyond 18 months is the preserve of the High Court. The NMC may apply to the High Court under Article 31 of the 2001 Order to extend an interim order by no more than 12 months; though subsequent extension requests can be made at the expiry of any such extension(s).
        • Final FTP decisions are also subject to oversight. The 2001 Order provides for appeals against specified decisions and orders. The route is again to the High Court; a statutory appeal rather than judicial review. The precise scope of the appeal depends on the decision being challenged.
        • Such appeals are not rehearings. The High Court’s role is supervisory in character. It is concerned with whether the tribunal has erred in law, acted unfairly, reached an irrational conclusion, failed to take account of relevant matters, taken account of irrelevant matters, or imposed a sanction that is wrong in the sense recognised by professional discipline appeals. The court is not ordinarily concerned to reweigh evidence merely because it might have reached a different conclusion.
        • This reflects a broader jurisprudential balance unfamiliar to many practitioners in different areas of law. Panels are specialist tribunals tasked with applying professional standards and evaluating risk and trust. Though the High Court has a supervisory role to ensure legality, fairness, rationality, and proper reasoning, particular deference is paid to the ‘specialist’ decisions of FTP panels; the High Court seldom assumes the role of primary decision-maker.
        • Judicial review remains available in relation to decisions for which there is no adequate alternative remedy by statutory appeal, including some interim and procedural decisions. Judicial review is not a route for rearguing merits. It is a route for challenging legality, fairness and rationality.
      • The Professional Standards Authority
        • Though the NMC has no power to appeal decisions of its own panels, the NMC is subject to oversight by the Professional Standards Authority (PSA). The PSA is the oversight body for the healthcare regulators. It reviews final FTP decisions and may refer cases to the High Court where it considers that a decision is insufficient for the protection of the public. The power to do so derives from section 29 of the National Health Service Reform and Health Care Professions Act 2002.
        • The statutory language of section 29 is broad and is directed at the sufficiency of decisions for public protection. The PSA explains that it reviews every final decision and may refer cases where it considers that the decision is insufficient for public protection, and that this may include appealing against sanction, a finding, or a lack of a finding (including a decision not to find impairment). It is a public interest mechanism aimed at preventing undue leniency and maintaining consistency and confidence across the regulatory landscape.
        • The existence of PSA oversight has a practical effect on the conduct of NMC litigation. It encourages careful and explicit reasoning by panels, particularly on impairment and sanction. It also makes plain that a case does not end simply because the NMC and registrant reconcile themselves with an outcome. Public interest considerations, represented through PSA oversight, remain engaged.
        • The PSA’s section 29 mechanism also reflects a deeper point about professional regulation which practitioners new to the area must bear in mind. The system is not designed solely to do justice between the regulator and the registrant. It is designed to protect the public. PSA referrals are an expression of that design, and they operate as a safeguard where a regulator’s tribunal is perceived to have under-achieved the statutory objectives. Where an outcome appears too good to be true for a particular registrant, it is often because the wider public interest has not been adequately reflected in the tribunal’s evaluative judgement, leaving the decision vulnerable to correction on appeal by the PSA.
      • Fitness to practise jurisprudence does not develop in isolation within a single regulatory scheme. The courts, particularly the Administrative Court, consider appeals arising from multiple statutory regimes, including those governing doctors, nurses, dentists, pharmacists and other professionals. As a result, leading authorities of general application on misconduct, impairment, sanction, procedural fairness and proportionality frequently originate from different regulatory contexts.
      • Some caution is required when transposing authority across regulatory schemes, particularly where relevant authority arises outside of closely comparable healthcare regulatory schemes; “each regulatory scheme, for solicitors, for doctors, for barristers, and so on, must be construed and applied on its own terms. Great care must always be taken when seeking to apply an authority under one scheme to [a case] under a different scheme. Regulation of the professions is established under a series of discrete statutory codes; principles developed in one scheme may say little that informs the approach required in a different scheme.”[4] The weight to be given to public confidence, the availability of particular sanctions, review mechanisms, and the framing of statutory grounds may differ materially. Authority from another regulator is therefore persuasive, often determinative at the level of principle, but it must always be tested against the specific language and architecture of the Nursing and Midwifery Order 2001 and the NMC rules.
    • The limits of regulatory power
      • The NMC’s powers are significant, but not unlimited. The NMC cannot resolve employment disputes, award compensation, or determine civil liability. It cannot intervene outside statutory grounds, and it cannot lawfully pursue matters that fall outside its jurisdiction.
      • Understanding those limits is essential in practice, because much of the anxiety and frustration experienced by participants in NMC proceedings stems from a disparity between what they believe the NMC should and what it is legally empowered to do.
      • Complainants frequently wish the NMC to investigate systemic failings of NHS trusts or hospitals, poor staffing, or workplace culture. FTP proceedings cannot be used as proxies for the other remedies. Those may be serious matters, but they do not sit neatly within the NMC’s jurisdiction unless they reflect the work of a single regulated person. They may be matters for employer governance, for commissioners, for NHS England, for the Care Quality Commission, or for safeguarding bodies. They are, however, largely outwith the NMC’s remit; the fitness to practise of each individual on the register.
      • Similarly, registrants frequently wish the NMC to vindicate them against unfair treatment by an employer. The NMC cannot do so. Employment disputes have their own statutory and contractual mechanisms. Registrants rarely arrive at FTP proceedings in a vacuum. For many, the FTP process is the final stage in a long and bruising sequence of events: internal disciplinary proceedings, HR grievances, safeguarding investigations, suspensions, capability processes and, not uncommonly, dismissal. By the time of the FTP hearing, the registrant may have spent years contesting allegations across multiple forums, with a substantial documentary trail and a strong sense of personal injustice. That history is often emotionally weighty and, from the registrant’s perspective, central to their narrative. For the practitioner, however, a clear distinction must be maintained. Much of what feels most important to a registrant may be of limited or no relevance to the statutory questions the panel must answer. Part of effective representation lies in acknowledging the significance of that history, while rigorously identifying what genuinely advances the issues of fact, impairment and sanction; ensuring that peripheral grievances do not obscure the tribunal’s focused evaluative task.
      • The legal and practical discipline required in NMC proceedings is therefore one of separation and connection: separating distinct statutory questions and processes, while recognising the ways in which evidence, risk and outcomes can interact across regimes. Each must be understood on its own terms.

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[1]   SI 2002/253

[2]   Article 3(9), Nursing and Midwifery Order 2001

[3]   Nursing and Midwifery (Amendment) Order 2017

[4]   Beckwith v Solicitors Regulation Authority [2020] EWHC 3231, at [19]