Opening a letter from the Nursing and Midwifery Council is one of the most unsettling experiences a nurse, midwife or nursing associate can face. Your first instinct may be to call the NMC, write an immediate response, or speak to your employer. Before you do any of those things, stop. The steps you take in the first few days can have a significant bearing on how your case proceeds.
What the letter means, and what it does not
A letter from the NMC at this stage usually means a concern has been referred to them, by an employer, a patient, a colleague, or a member of the public. Receiving it does not mean a formal fitness-to-practise case has been opened. It does not mean the NMC has concluded anything about your practice. In most cases, it is the beginning of a screening process, not the end of anything.
The NMC receives thousands of referrals every year. Many are concluded at the initial screening stage without any further action. What determines whether your case progresses and how it progresses: largely shaped by the quality and timing of the response you provide.
Do not respond immediately
This is the single most important piece of advice we give to anyone who calls us after receiving an NMC letter. The NMC will give you time to respond, typically 28 days. Use it.
A response written in a state of shock or anxiety, without legal advice, can inadvertently make admissions that are difficult to walk back, fail to engage with the specific concern being raised, or omit context that would be highly relevant to the screening decision. Nurses and midwives are trained to be honest and reflective, qualities that can work against them when they put pen to paper without understanding what the NMC is actually looking for.
Do not speak to your employer about it first
It is tempting to go to your line manager or HR department, particularly if you are still employed in the role connected to the concern. Resist this instinct, at least initially. Your employer has their own interests, which are not the same as yours. Anything you say informally may be recorded and could later be disclosed to the NMC as part of the investigation. Your employer may also have a separate duty to report to the NMC, or to take their own internal action.
Get independent legal advice first, then make an informed decision about what, if anything, to say to your employer and when.
Understand what type of letter you have received
NMC correspondence at the early stage generally falls into one of several categories:
- An acknowledgement of referral: the NMC is telling you a concern has been received and is being reviewed. No response is required at this stage, but the clock has started.
- A request for your response to a concern: the NMC is inviting you to provide information about the matters raised. This is the most important letter to handle carefully.
- Notification of an investigation: the case has passed screening and a case officer has been assigned. The process is now more formal.
- Notice of an interim order application: the NMC is seeking to restrict or suspend your practice on an interim basis, pending the outcome of an investigation. This requires urgent action, ideally within hours.
Each type of letter requires a different response, and the appropriate approach varies depending on the facts of your case.
What the NMC is assessing at the screening stage
The NMC’s screeners are not deciding whether you are a good nurse or midwife. They are deciding whether the concern, if proved, could amount to impaired fitness to practise, and whether there is enough information to justify an investigation. Screeners work quickly and are making threshold decisions based on the papers in front of them.
A well-drafted response at this stage, one that directly addresses the concern raised, provides relevant context, and demonstrates insight where appropriate, can result in no further action being taken. A poorly drafted response, or no response at all, may result in a case progressing to full investigation that could otherwise have been resolved early.
Gather your records now
Whatever the NMC has written to you about, start gathering any documentation that is relevant. This includes patient records (through proper channels), incident reports, supervision notes, reflective accounts, training records, rotas, and any correspondence with colleagues or managers at the relevant time. Evidence that exists now may not be available in six months. Systems change, records are archived, colleagues move on.
Do not, however, approach patients or former colleagues directly to gather statements without taking advice first. There are proper processes for obtaining evidence, and missteps here can create additional problems.
The timeline ahead of you
NMC investigations typically take between one and three years from referral to final outcome, though this varies considerably. The process moves through screening, investigation by a case officer, review by case examiners, and, if the case is not resolved earlier, a fitness-to-practise hearing before a panel. At each stage there are opportunities to present information, make submissions, and influence the outcome.
Early intervention by a specialist solicitor is not about preparing for the worst. It is about giving you the best possible chance of the case concluding at an early stage, with the least possible disruption to your career and your life.
If you receive a notice of interim order application
A notice of interim order application is a different category of letter entirely and requires immediate action. The NMC is applying to impose an interim conditions of practice order or interim suspension order on your registration before any findings of fact have been made. Interim order hearings can be listed at short notice and you will typically have very little time to prepare a response. If you receive this type of letter, contact a specialist solicitor the same day. Interim orders can restrict or suspend your ability to practise for up to 18 months at a time, and an unopposed hearing will almost always result in the NMC obtaining the order it is seeking.
If you are a nursing associate
Nursing associates are regulated by the NMC on the same register as nurses and midwives and face the same fitness-to-practise process. However, nursing associates occupy a newer and less well-understood role, and panels may not be familiar with what your role involves, what level of autonomy you exercise, or what professional standards apply to you specifically. A response to the NMC that does not clearly contextualise your role and responsibilities may be assessed against an incorrect standard. We ensure that all NMC responses on behalf of nursing associates include clear contextual framing of the role.
What a good response to the NMC looks like
A well-constructed response to an NMC screening letter directly addresses the specific concern raised, provides relevant factual context that screeners may not have, and where appropriate demonstrates insight: an understanding of why the concern was raised, what you have reflected on, and what you have done or will do differently. Insight is not an admission of wrongdoing. It is evidence of professional self-awareness, and screeners and case examiners are specifically looking for it when assessing whether the concern represents a current risk to patients or to public confidence in the profession.
What to do right now
- Read the letter carefully and note any deadline given for a response.
- Do not contact the NMC, your employer, or anyone connected to the concern until you have taken legal advice.
- Make a note of everything you remember about the events the concern relates to, while your recollection is fresh. Keep this private.
- Identify what documents may be relevant and consider how you can access them through proper channels.
- Speak to a solicitor who specialises in NMC fitness-to-practise proceedings, not a general employment lawyer, and not your union representative alone.
Regulated by a different body?
We act for regulated professionals across all major UK bodies. If your regulator is different, we have guides for GMC-registered doctors, SRA-regulated solicitors, GPhC-registered pharmacists and pharmacy technicians, and HCPC registrants. For full detail on how we defend NMC investigations and hearings, visit our NMC fitness to practise service page.
Regulatory Defence acts exclusively in fitness-to-practise proceedings. If you have received a letter from the NMC and would like to understand your position before deciding how to proceed, we offer a free initial telephone consultation with no obligation. Call us on 0800 088 4700 or use the contact form on our NMC defence page to arrange a call at a time that suits you.