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For a nurse, midwife or nursing associate, a police investigation is rarely the only investigation. The Nursing and Midwifery Council can open its own case at the same time, apply a lower standard of proof, and restrict your practice before the police have decided anything.
Most registrants facing an allegation think about the criminal case first, because it is the one that carries the risk of a conviction. The regulatory case is often the one that decides whether they keep their career. The two processes have different rules, different standards and different timetables, and what is said in one can find its way into the other. Handled separately, by different advisers who never speak to each other, they can undo each other. Handled together, from the first contact with the police, each can be used to protect the position in the other.
We have prosecuted and defended criminal cases, and we act for regulated professionals facing their regulator and the police at the same time. This guide explains how an NMC fitness to practise case works when there is a criminal investigation running alongside it: when you must tell the NMC, what an interim order is and how it is challenged, what a panel can do, how a conviction or a caution is treated, and where the defence of both begins.
The Nursing and Midwifery Council regulates nurses and midwives in the UK, and nursing associates in England. At the end of March 2025 there were 853,707 professionals on its register, a record high, and only a small minority are ever referred to the fitness to practise process. Referrals are rising, though: the NMC reported a 13% increase in new fitness to practise concerns in the year to March 2025. Its purpose is to protect the public, uphold professional standards and maintain public confidence in the nursing and midwifery professions. Fitness to practise means having the skills, knowledge, health and character to practise safely and effectively, and the fitness to practise process asks one question: is this person's fitness to practise currently impaired? Under article 22 of the Nursing and Midwifery Order 2001, the NMC can find fitness to practise impaired by reason of:
Concerns can be raised by anyone. Since 2019-20, members of the public have been the largest single source of referrals, with employers, patients, colleagues and the police making up most of the rest. Most concerns about nurses, midwives and nursing associates relate to clinical practice, such as medicines management or record keeping, or to behaviour, including behaviour outside work. A criminal allegation can engage several of these grounds at once. The NMC can treat the underlying conduct as misconduct even where there is no conviction, and its guidance confirms it can investigate matters the police did not pursue where that is necessary to protect the public.
The criminal case and the NMC investigation are separate, and the differences matter more than most registrants realise.
| Criminal investigation | NMC fitness to practise | |
|---|---|---|
| Decision-maker | Police, then the CPS, then a court | NMC case examiners, then a fitness to practise committee panel |
| Question | Is there enough evidence to charge, and is the person guilty? | Is fitness to practise currently impaired? |
| Standard of proof | Beyond reasonable doubt, so the court is sure | More likely than not (the civil standard) |
| Can act before the other finishes? | Yes | Yes, including interim orders |
| Outcome | NFA, caution, charge, acquittal or conviction | No case to answer, warning, advice, or a panel sanction up to striking off |
Impairment is not only about risk to patients. Under the approach in Council for Healthcare Regulatory Excellence v Nursing and Midwifery Council and Grant [2011] EWHC 927 (Admin), a panel can find fitness to practise impaired to uphold public confidence in the nursing and midwifery professions and to maintain proper professional standards, even where the registrant presents no current risk. The lower standard is why an acquittal, or a decision by the police to take no further action, does not automatically end an NMC case. The NMC can still find on the balance of probabilities that the conduct happened. We explain the same point for doctors in our guide to a GMC investigation and a criminal case at the same time, and for teachers in our guide to teacher misconduct and the TRA.
Paragraph 23.2 of the NMC Code requires registrants to tell the NMC, and any employer, as soon as they can about any caution or charge against them, and about any conviction or finding of guilt. The NMC's guidance calls a failure to report a conviction or caution a clear breach of the Code, and a registrant who conceals one risks a separate dishonesty allegation that can be more serious than the original matter. Protected cautions and convictions do not need to be declared.
An arrest or an interview under caution is not a charge, so the Code's reporting duty is usually triggered later than people assume. Your contract of employment may impose a different duty, and the NMC may learn of the matter from your employer or the police in any event. The timing and the content of a self-referral are decisions to take with advice, because the referral is the first account the NMC reads, and it can be read again by the people deciding the criminal case.
The most immediate risk to a registrant under criminal investigation is an interim order. Under article 31 of the Order, a practice committee can make an interim suspension order or an interim conditions of practice order if it is satisfied the order is necessary to protect the public, is otherwise in the public interest, or is in the registrant's own interests. No finding of fact is made, and the committee does not decide whether the allegation is true.
An interim suspension stops you working as a nurse or midwife, often for many months, while the criminal case is still at the investigation stage. An interim conditions order can be almost as damaging, if the conditions make it impossible for an employer to keep you. The interim order hearing is often the first point at which the regulatory case can be fought, and the submissions made there need to be consistent with the position being taken with the police.
If a fitness to practise committee panel finds that a registrant's fitness to practise is impaired, article 29 of the Order gives it four sanctions, alongside taking no further action:
A registrant has 28 days to appeal a panel's order to the court, and the order does not take effect until that period has passed or the appeal is decided. Striking off is reserved for the most serious cases, and the NMC's guidance treats certain criminal matters as among them: where a registrant has a conviction for a specified offence, which includes sexual offences, or has received a custodial sentence, including a suspended one, the NMC will almost always take the case to a panel.
A conviction largely decides the NMC case. Under rule 31 of the NMC's Fitness to Practise Rules, a certified copy of the certificate of conviction is conclusive proof of the conviction, and the panel will not reopen whether the registrant committed the offence. The regulatory argument then turns on impairment and sanction: the nature of the offence, insight, remediation and the risk of repetition.
A police caution is not a conviction, but it is an admission of guilt, it is reportable, and it can found an allegation of impairment. Accepting a caution to bring a police investigation to a quick end can be one of the most damaging decisions a nurse, midwife or nursing associate makes, because it hands the regulator an admission it would otherwise have to prove. We explain what accepting one actually costs in our guide to police cautions.
The two cases feed each other. The account given in a police interview can be obtained by the NMC. A reflective statement written for the regulator can be read by the people investigating the crime. An admission made to an employer to save a job can become evidence in both. Every decision in one forum has to be taken with the other in view.
That is why the most important work is done before charge. If the police decide to take no further action, the NMC loses its most powerful evidence, the conviction, and must prove its own case on the facts. Written pre-charge representations put the evidence and the legal analysis to the police and the CPS before that decision is made. We explain how a NFA decision is secured, and what it does not erase, in our guide to false allegations and NFA.
Where a charge has already been brought, the same analysis is put to the prosecution to seek a review of the charging decision and, where the evidence does not support it, a discontinuance, rather than waiting for the trial.
Every concern goes through an initial assessment, where the NMC decides whether it needs to investigate. If it does, the NMC investigation gathers documents and statements, often from your employer, and asks you to respond. Professionals can put forward their own evidence and representation at each stage of the process, and it pays to engage early and carefully. Case examiners then decide whether there is a case to answer. In practice, what case examiners decide depends heavily on how well the registrant has responded, what insight they have shown, and what evidence of learning and strengthened practice they can produce. They can close the case, give advice or a warning, or agree undertakings with you; where there is a case to answer, they refer it to the Fitness to Practise Committee.
NMC hearings follow a set structure. A hearing is held in three stages: the panel decides the facts, then whether those facts mean fitness to practise is currently impaired, taking account of insight, reflection and learning, and whether a finding is needed to uphold public confidence and professional standards even if there is no current risk to patients, then what sanction, if any, is needed. Some cases are dealt with at a meeting on the papers rather than a full hearing, and in suitable cases the facts, impairment and sanction can be agreed through a consensual panel determination. At the end of a suspension order or a conditions of practice order, a review hearing decides whether it is extended, replaced or allowed to expire. NMC hearings are usually held in public, which is why the press can report them, and why reputation needs to be managed alongside the legal case.
We act privately for nurses, midwives and nursing associates, and other healthcare professionals, across England and Wales facing a criminal investigation and their regulator at the same time. One team runs both cases, so the strategy is set once and every step is taken with both in view. When we are instructed:
We explain how we approach regulators generally in our guide to facing a criminal allegation as a regulated professional, and our professional discipline service covers the regulatory side in detail. No solicitor can promise an outcome, and we do not. What we can promise is that both cases will be handled together, from the start.
If you are a nurse, midwife or nursing associate who has been arrested, invited to a police interview, or contacted by the NMC, speak to us before you respond to either.
Not necessarily. The NMC can investigate at the same time, and can impose an order while the criminal case is running. It may decide to wait for the criminal outcome before deciding the facts itself, but that is its decision, not yours.
The Code requires you to tell the NMC about a caution or charge as soon as you can. An arrest or interview is not a charge, but your employer may require earlier notice, and the timing and content of any self-referral should be decided with advice.
Yes. The NMC applies the civil standard, so it can find that conduct happened on the balance of probabilities even where the police took NFA or a court acquitted. Striking off is reserved for the most serious cases.
Anyone. Most concerns come from members of the public, employers and patients, and the police can share information about an arrest or charge. The NMC must then decide whether the concern needs to go through the fitness to practise process.
Yes. Your first response to an NMC investigation, and any self-referral, can be read by the people deciding the criminal case. Seek advice before you engage with either process, so that your representation in one supports you in the other.
Often many months, and longer where a criminal case is running alongside it. An interim order can be imposed in the meantime and must be reviewed every six months.
An order suspending a registrant, or imposing conditions on their practice, while an allegation is investigated. It can last up to 18 months and can be extended by the court. No finding is made about whether the allegation is true.
You can apply for restoration, but not until five years after the striking-off order took effect, and not more than once in any twelve-month period.
It can. A caution is an admission of guilt that must be reported, and it can found an allegation that your fitness to practise is impaired. Take advice before accepting one.
Lex Vindico Group is regulated by the Solicitors Regulation Authority. We represent individuals nationally across England and Wales in criminal, regulatory, and parallel-proceedings defence at every stage: our work starts at the pre-charge stage and continues through charge, trial and appeal.
This article is written by Akram Mula, LLM, Solicitor Advocate and CPS-approved Prosecutor, founder of Lex Vindico Group. It is general legal information about NMC fitness to practise proceedings and parallel criminal investigations, not legal advice on any specific case. For advice on your specific circumstances, contact our team directly.
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