Who Can Refer a Nurse to the NMC?
Anyone can make an NMC referral about a nurse, midwife, or nursing associate on the NMC register. The NMC will always respond to any concern it receives, regardless of who raises it. Understanding who can refer a nurse to the NMC helps you recognise the sources of risk and respond appropriately.
- Employers and NHS trusts — NMC employer referrals are the most common type. Employers use the NMC's Employer Link Service to discuss concerns before making a formal NMC referral. The NMC expects employer referrals to be submitted by an authorised person, typically the Director of Nursing, and to have gone through a local quality assurance process
- Patients and family members — any patient or member of the public can report a nurse to the NMC. Patient complaints to the NMC are a significant source of NMC referrals and cover issues from clinical care failures to communication problems and conduct concerns
- Colleagues — other nurses, doctors, and healthcare professionals can make an NMC referral if they have concerns about a colleague's fitness to practise. The NMC Code requires professionals to raise concerns about colleagues who may be putting patients at risk
- The police — following criminal charges, convictions, or cautions that are relevant to the nurse's fitness to practise. The police routinely inform the NMC when a registered nurse or midwife is charged with a serious criminal offence
- Other regulatory bodies — regulators such as the Care Quality Commission, other healthcare regulators, or Social Work England may refer concerns to the NMC
- Coroners — following inquests where concerns about nursing care have been raised
- The nurse themselves — through an NMC self-referral when they are aware of a serious issue affecting their fitness to practise
- Anonymous referrals — the NMC accepts anonymous NMC referrals, though these can be harder to investigate if insufficient detail is provided
The NMC expects employers to try to manage concerns locally before making an NMC referral. The Employer Link Service (020 7462 8850) provides advice on whether a fitness to practise referral is fair and necessary. Employers should also consider the NMC's Just Culture guidance when deciding whether to refer, to ensure NMC referrals are not made as an alternative to proper local management of performance or conduct issues.
Common NMC Referral Reasons
Understanding the most common NMC referral reasons helps you recognise risks in your own practice and take preventive action. The NMC investigates concerns that fall into several broad categories, and the specific NMC complaint reasons vary widely from case to case.
- Clinical errors and failures in patient care — medication errors, diagnostic failures, inadequate assessment, failure to escalate deteriorating patients, and substandard clinical practice
- Dishonesty and fraud — falsifying clinical records, dishonesty in professional communications, fraudulent qualifications, and financial fraud. Dishonesty is one of the most serious NMC referral reasons and is treated with extreme seriousness
- Criminal convictions and cautions — serious criminal offences, particularly those involving violence, sexual offences, drug-related offences, drink-driving, or theft
- Professional boundary violations — inappropriate relationships with patients or service users, sexual misconduct, and failures to maintain professional boundaries
- Drug and alcohol misuse — practising while under the influence of drugs or alcohol, or drug and alcohol dependency that affects fitness to practise
- Breaches of confidentiality — sharing patient information without authorisation, accessing records without legitimate clinical reason, and social media disclosures
- Bullying and harassment — persistent bullying or harassment of colleagues, students, or patients
- Health conditions — physical or mental health conditions that impair the ability to practise safely, where the condition is not being appropriately managed
- Failure to maintain competence — persistent failure to maintain the skills, knowledge, and competence required for safe practice
The NMC Referral Screening Process
When the NMC receives an NMC referral, the screening team conducts an initial assessment to decide whether the concern warrants further investigation. The NMC referral screening process applies three key questions that determine whether the case proceeds or is closed.
The NMC must have a written account of the concern about a nurse, midwife, or nursing associate who is on the NMC register. The screening team verifies that the person named in the NMC referral is registered and that the concern has been documented in writing.
The screening team assesses whether the evidence points to a concern serious enough to require the NMC to take regulatory action to protect the public. Minor issues, matters that are more appropriately dealt with by the employer, or concerns that fall outside the NMC's remit may be closed at this stage. The NMC may also seek comments from your employer or colleagues as part of the screening process.
If there is clear evidence that you have already reflected appropriately on the issues, provided evidence of relevant retraining, or taken steps to address the concerns, the NMC may decide the case does not need to be referred for investigation. This is why early engagement — completing CPD, writing a reflective statement, and demonstrating insight from the very beginning — can make a critical difference to whether your NMC referral is closed at screening or progresses further.
NMC Self-Referral: When Should You Report Yourself?
An NMC self-referral is when a nurse, midwife, or nursing associate informs the NMC about a serious professional or personal issue that may affect their fitness to practise. The NMC Code states that you must inform the NMC of any caution or charge against you, or if you have been found guilty of a criminal offence (other than a protected caution or conviction). However, not every situation requires NMC self-referral.
You do not need to self-refer to the NMC if you have a health condition that is well managed and does not affect your practice, if you are involved in a private legal dispute unrelated to your practice, if you have received a protected police caution, or if you are being investigated by your employer (your employer will decide whether an NMC referral is necessary). You should consider NMC self-referral if you have received a relevant criminal conviction, if you have a serious health condition that impairs your ability to practise safely despite support, or if you are aware of a matter that the NMC would expect you to disclose. Before making an NMC self-referral, the NMC recommends contacting your trade union for advice.
The nurses who navigate NMC referrals most successfully are those who engage from the first moment they receive notification. Do not ignore the referral, do not hide from the process, and do not wait until a hearing is scheduled before taking action. Early engagement, honest reflection, and meaningful CPD from day one dramatically improve your chances of the case being closed without a hearing.
What to Do If You Have Been Referred to the NMC
Being referred to the NMC is stressful, but how you respond in the first days and weeks has an enormous impact on the outcome. Here are the steps every nurse, midwife, or nursing associate should take immediately after receiving notification of an NMC referral.
- Contact your union or solicitor immediately — get specialist legal advice from the RCN, Unison, or a solicitor experienced in NMC cases. Early legal advice is strongly associated with better outcomes in the NMC referral process
- Read the notification carefully — understand exactly what concerns have been raised and by whom. The NMC will provide details of the NMC referral and invite you to respond
- Do not ignore the referral — disengaging from the NMC process is one of the most damaging things you can do. Cases decided in your absence carry the full range of sanctions including striking off
- Inform your employer — the NMC Code requires you to tell your employers about any NMC referral or investigation. Failure to disclose could lead to additional dishonesty allegations
- Start CPD remediation immediately — complete courses relevant to the areas of concern. This demonstrates proactive engagement and can influence the screening decision
- Write a reflective statement — demonstrate genuine insight into what happened, why it was wrong, and what you have learned. The NMC specifically considers the quality of your reflection when deciding whether to close a case at screening
- Gather evidence of good practice — collect references, training records, and any evidence that supports your competence and professionalism
- Seek emotional support — the NMC offers a free Careline service providing confidential emotional and practical support 24 hours a day, 365 days a year. Use it. The NMC referral process is extremely stressful and your wellbeing matters
Malicious and Vexatious NMC Referrals
Unfortunately, not all NMC referrals are made in good faith. The RCN has raised serious concerns about employers misusing their referral protections to make malicious, discriminatory, or vexatious NMC referrals, many of which end with no case to answer. The NMC has also acknowledged concerns about disproportionate NMC referrals affecting Black, Asian, and minority ethnic nurses and midwives, and has committed to rolling out measures to address ethnic and gender disparities in the fitness to practise process.
If you believe your NMC referral is malicious or vexatious, raise this with your legal representative immediately. They can make representations to the NMC highlighting the circumstances of the referral and any evidence of bad faith. The NMC's screening process should identify NMC referrals that lack credible evidence or are not within the NMC's remit. However, you should still engage fully with the process — even if you believe the referral is unfounded, disengaging will only make the outcome worse.
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Bulk Buy 10 Courses →Frequently Asked Questions
What is an NMC referral?
An NMC referral is a formal concern raised with the Nursing and Midwifery Council about a nurse, midwife, or nursing associate's fitness to practise. The NMC assesses whether the concern is serious enough to warrant investigation. Not every NMC referral leads to a full investigation — many are closed at the screening stage.
Who can refer a nurse to the NMC?
Anyone can make an NMC referral. Common sources include employers, patients and families, colleagues, the police, other regulatory bodies, coroners, and the nurse themselves through self-referral. The NMC responds to all referrals regardless of the source. Employer referrals go through the NMC's Employer Link Service.
What are the most common NMC referral reasons?
Common reasons include clinical errors, medication errors, dishonesty or fraud, criminal convictions, sexual misconduct, boundary violations, drug or alcohol misuse, bullying, failure to maintain professional standards, breaches of confidentiality, health conditions impairing practice, and failure to raise patient safety concerns.
What happens after an NMC referral is made?
The NMC screening team assesses: is there a written concern about a registered professional? Is there evidence of a serious concern requiring regulatory action? Is there clear evidence the professional is fit to practise? If the threshold is not met, the case closes at screening. If it is, the case moves to the investigation team.
What is an NMC employer referral?
An NMC employer referral is made by an employer or NHS trust. Employers use the Employer Link Service to discuss concerns before formal referral. The NMC expects referrals from an authorised person (typically Director of Nursing) with local quality assurance completed. Employers should attempt local management before referring unless concerns are very serious.
When should a nurse self-refer to the NMC?
Consider NMC self-referral if you have a relevant criminal conviction, a health condition that significantly impairs safe practice despite support, or are aware of a serious issue the NMC would expect you to disclose. You do not need to self-refer for protected cautions, managed health conditions, private legal disputes, or employer investigations. Seek union advice first.
Can a patient report a nurse to the NMC?
Yes. Any patient or member of the public can make an NMC referral. Patient complaints are a common source of referrals. The NMC applies the same screening threshold regardless of who makes the referral — the question is whether the concern raises serious fitness to practise issues.
How long does the NMC referral process take?
The timeline varies by complexity. Screening aims to be quick. Investigation targets 25 weeks from the decision to investigate. The Case Examiner stage typically takes around 15 months from referral. If the case proceeds to a hearing, total time from NMC referral to outcome can be two to three years or longer.
Can an NMC referral be closed at screening?
Yes. Many NMC referrals close at screening because the conduct is not serious enough, there is no credible evidence, the matter falls outside the NMC's remit, or there is clear evidence the professional is currently fit to practise. Being closed at screening is the best possible outcome after an NMC referral.
What should I do if I have been referred to the NMC?
Contact your union or specialist solicitor immediately. Do not ignore the referral. Read the notification carefully. Inform your employer. Start CPD courses relevant to the concerns. Write a reflective statement demonstrating insight. Gather evidence of good practice. Use the NMC's free Careline for emotional support.
Can an NMC referral be made anonymously?
Yes, the NMC accepts anonymous referrals. However, anonymous NMC referrals can be harder to investigate due to limited detail. The NMC assesses all referrals on their merits regardless of whether the referrer is identified. Vague or unsubstantiated anonymous complaints are more likely to be closed at screening.
Are there malicious or vexatious NMC referrals?
Yes. Some NMC referrals are made maliciously due to workplace disputes, discrimination, or personal conflicts. The RCN has raised concerns about employers misusing referral protections. If you believe your referral is vexatious, raise this with your legal representative. The screening process should identify referrals lacking credible evidence.
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This article is for general informational purposes only and does not constitute legal or professional regulatory advice. If you have been referred to the NMC or are considering a self-referral, seek independent legal advice from a specialist solicitor, contact your union (such as the RCN), and consider contacting the NMC's Careline for emotional support.