Nursing and Midwifery Council (NMC): Safeguarding Public Health and Upholding Professional Standards

 The Nursing and Midwifery Council (NMC) is the professional regulatory body for nurses and midwives in the United Kingdom. It also regulates nursing associates in England. As a statutory organization, the NMC plays a critical role in maintaining public trust by setting professional standards, regulating education, maintaining a register of qualified practitioners, and taking action when care standards fall below expectations. This article explores the history, functions, structure, roles, and impact of the NMC in the healthcare system.

1. Background and Historical Context

The NMC was established in 2002 under the Nursing and Midwifery Order 2001, replacing the UK Central Council for Nursing, Midwifery and Health Visiting (UKCC). Its creation marked a significant step in modernizing healthcare regulation and aligning it with increasing public expectations for safety, transparency, and professionalism in care delivery.

Over the years, the NMC has evolved in response to changing societal needs, advances in medical science, and public inquiries into healthcare failures. One notable milestone was the 2013 publication of the Francis Report, which urged regulators, including the NMC, to adopt a more patient-centered approach and enhance transparency in their operations.

2. Mission and Core Purpose

The NMC’s core purpose is to protect the public by ensuring that nurses, midwives, and nursing associates provide safe and effective care. Its mission focuses on the following pillars:

  • Setting standards of education, training, and conduct

  • Maintaining a register of qualified practitioners

  • Ensuring ongoing professional development and revalidation

  • Investigating concerns about registrants' fitness to practice

This framework ensures that only those who are fit to practice remain on the NMC register and that the public can trust the care they receive.

3. The NMC Code: Professional Standards of Practice

At the heart of the NMC’s regulatory framework is “The Code”, a comprehensive guide that outlines the professional standards that nurses and midwives must uphold. The Code is divided into four core themes:

  1. Prioritise people – Ensuring patients are treated with respect, compassion, and dignity.

  2. Practise effectively – Delivering safe, evidence-based, and holistic care.

  3. Preserve safety – Addressing risks and raising concerns to prevent harm.

  4. Promote professionalism and trust – Acting with integrity and being role models for the profession.

Every registered nurse, midwife, and nursing associate is required to uphold the Code in all aspects of their professional life. Breaches may lead to investigation and possible disciplinary action, including removal from the register.

4. Education and Training

The NMC is responsible for approving nursing and midwifery education programs across the UK. It sets standards for curriculum content, teaching methods, clinical placements, and assessment criteria.

Nursing and midwifery students must graduate from an NMC-approved course to be eligible for registration. These educational standards ensure that graduates are prepared for the complexities of modern healthcare, including managing chronic illness, delivering person-centered care, and using digital technologies.

Additionally, the NMC introduced standards for nursing associates in England to bridge the gap between healthcare assistants and registered nurses. This new role enhances workforce flexibility and supports career progression in nursing.

5. Registration and Revalidation

To practice legally in the UK, all nurses, midwives, and nursing associates must be registered with the NMC. The register is publicly accessible and includes information on registrants’ qualifications, scope of practice, and fitness to practice status.

To maintain registration, practitioners must undergo revalidation every three years. This process ensures that they remain up to date with clinical knowledge and skills. Revalidation requirements include:

  • 450 practice hours (900 for dual registration)

  • 35 hours of CPD (continuing professional development)

  • Five pieces of practice-related feedback

  • Five written reflective accounts

  • A reflective discussion with another NMC registrant

  • A health and character declaration

Revalidation fosters continuous professional growth and reinforces public confidence in the nursing and midwifery workforce.

6. Fitness to Practise and Disciplinary Process

When concerns are raised about a registrant’s conduct or competence, the NMC has the authority to investigate their fitness to practise. These concerns may involve:

  • Clinical errors or unsafe practice

  • Professional misconduct

  • Criminal convictions

  • Breaches of the Code

The fitness to practise process typically follows several stages:

  1. Initial screening and assessment

  2. Case investigation

  3. Interim orders (if urgent risk)

  4. Fitness to Practise hearing

Depending on the outcome, sanctions may include warnings, conditions of practice, suspension, or removal from the register. The process is rigorous and transparent, ensuring fair treatment for all parties while protecting public safety.

7. Supporting Public and Professional Confidence

The NMC also promotes public and professional confidence by engaging in research, policy development, and public consultation. It frequently collaborates with other health and social care regulators, such as the General Medical Council (GMC) and the Care Quality Commission (CQC), to share information and drive improvement in care standards.

In times of national crisis, such as the COVID-19 pandemic, the NMC has shown flexibility by adapting registration requirements and enabling temporary registration of retired or overseas professionals to support workforce shortages.

Moreover, the NMC works to promote equality, diversity, and inclusion (EDI) within the profession. It monitors data on ethnicity, gender, and socio-economic background to identify disparities in disciplinary action and career progression, helping to reduce inequality across the workforce.

8. Accountability and Governance

The NMC is accountable to the UK Parliament and operates under the oversight of the Professional Standards Authority for Health and Social Care (PSA). It is governed by a council composed of lay members and professionals from across the UK’s four nations.

Key governance functions include:

  • Approving strategy and business plans

  • Monitoring performance and risk

  • Ensuring financial stewardship

  • Overseeing the work of committees and executive staff

Transparency is maintained through public board meetings, annual reports, and consultation exercises on major policy changes.

9. Challenges and Future Direction

Like all regulatory bodies, the NMC faces ongoing challenges:

  • Responding to increasing demand for healthcare services

  • Managing workforce shortages and burnout

  • Addressing inequalities in disciplinary outcomes

  • Modernising digital systems and data use

  • Adapting to legislative reform and evolving healthcare roles

In response, the NMC has committed to a strategy of “Regulating with compassion” (2020–2025), which aims to:

  • Strengthen understanding of registrants’ lived experience

  • Improve the regulatory process to make it more compassionate and proportionate

  • Use data insight to inform smarter regulation

  • Build public and professional trust

This strategy reflects a shift from punitive oversight to a supportive, learning-focused approach to regulation.

Conclusion

The Nursing and Midwifery Council (NMC) is a cornerstone of the UK’s healthcare system. By regulating more than 800,000 nurses, midwives, and nursing associates, it plays a vital role in protecting the public, upholding high standards of care, and shaping the future of the health professions. With a clear focus on public safety, professional integrity, and regulatory innovation, the NMC continues to inspire confidence in the care people receive across the United Kingdom.

Whether you're a healthcare professional, policymaker, patient, or student, understanding the role of the NMC is essential in appreciating the robust framework that supports health and wellbeing in the society.

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