Most nurses who receive notification of an NMC referral assume the worst. The language of fitness to practise, allegations, concerns, regulatory action, carries an implied weight that makes the screening stage feel like a foregone conclusion.
It is not. A significant number of cases are closed at screening, before they ever reach a Case Examiner or a Fitness to Practise Committee hearing. Understanding why is essential if you are facing a referral right now.
What the NMC screening stage actually tests
The NMC’s screening process is built around a single, focused question: is there evidence of an ongoing risk to public safety, public confidence, or professional standards that could require regulatory action?
That question has two important components. First, the risk must be ongoing, not historical, not theoretical, but present and continuing. Second, it must be the kind of risk that requires regulatory intervention specifically. Not every failing, even a serious one, meets that threshold.
The NMC is not a complaints resolution service, an employment tribunal, or a commercial arbitrator. Its role is to assess whether a registrant poses a risk that can only be addressed by restricting or stopping their practice. If the answer to that question is no, the case should close at screening, regardless of how serious the underlying allegations appear on paper.
Why serious-looking allegations don’t always translate into investigations
This is the point that surprises most registrants, and most complainants.
A referral can contain detailed, documented allegations of poor practice and still be closed at screening. The reason is that the NMC must assess conduct against the overarching public framework, the legal, policy, and guidance framework that defines what was actually required at the material time, and not against the specific expectations of the referrer.
Where that framework is flexible, where guidance uses language like “should” rather than “must,” or where the guidance contemplates a range of reasonable approaches, it becomes very difficult to establish a clear, significant breach. And without a clear breach of what was required, there is no basis to identify an ongoing risk requiring regulatory intervention.
This distinction matters enormously in practice. A referrer may have had precise contractual or organisational requirements. A registrant’s conduct may have been inconsistent with those requirements. But an inconsistency with a private contractual standard is not the same as a breach of the overarching public framework. The NMC’s jurisdiction does not extend to enforcing private contracts.
The “ongoing risk” threshold
Even where the NMC identifies some evidence of concern, the screening stage requires an assessment of whether there is an ongoing risk, not simply whether something went wrong in the past.
This means the NMC considers whether the circumstances giving rise to the concern are likely to persist. Context matters: a one-off incident in a specific commercial context may carry very different ongoing risk implications than a pattern of behaviour in direct clinical practice.
It also means that the NMC will consider whether any identified failing is the kind that requires regulatory restriction, or whether it is more properly addressed through employer processes, retraining, or other non-regulatory mechanisms.
What happens to the referral information
A case closed at screening is not expunged. The NMC keeps a record of all concerns raised. That record may be shared with other regulators or bodies in appropriate circumstances. And if new information emerges, or if something went seriously wrong with the screening decision itself, a review can be requested.
Importantly, a screening closure on one case reference does not affect any other open case references the NMC may hold in relation to the same registrant.
What this means if you have just received a referral
The gap between what a referral alleges and what the NMC can actually act on is often wider than registrants realise. The key factors that shape a screening decision include:
- Whether the alleged conduct amounts to a breach of the overarching public framework, not just a breach of the referrer’s expectations
- Whether the guidance framework in the relevant area is prescriptive or flexible
- Whether there is evidence of an ongoing risk, as opposed to a past incident
- Whether the concern is properly a regulatory matter, or something better addressed through employment, contractual, or other channels
- The context in which the registrant was practising at the material time
A well-prepared response to an NMC screening enquiry addresses each of these points directly. It is not simply a rebuttal of the allegations. It is a structured argument that engages with the NMC’s own framework for decision-making and demonstrates why the threshold for ongoing risk has not been met.
How we can help
If you have received a referral to the NMC, early specialist advice can make a material difference to how your case is handled at the screening stage. Regulatory Defence acts for nurses, midwives, and nursing associates facing NMC proceedings at every stage, including screening. Call us on 0800 088 4700 or visit our NMC fitness to practise page for more information. You can also contact us online for a confidential discussion.