Professional Standards · NMC Guidance
NMC Agreed Outcomes: How to Resolve a Case Without a Hearing
NMC agreed outcomes offer a way to resolve a fitness to practise concern without the time, cost, and stress of a full hearing. For a nurse, midwife, or nursing associate facing a concern, understanding when an agreed outcome is available — and what agreeing to one actually means — can shape the whole direction of a case.
This guide explains what happens when a concern is reported to the NMC, what NMC agreed outcomes involve, and the steps that give a registrant the best chance of resolving matters without a Fitness to Practise Committee hearing.
Key Takeaways
- NMC agreed outcomes include advice, warnings, and undertakings agreed with Case Examiners, and consensual panel determination agreed with a Fitness to Practise Committee panel.
- Agreeing an outcome usually means accepting the facts of the concern and, in most cases, accepting that fitness to practise is currently impaired.
- Agreed outcomes are not available in the most serious cases — particularly those with a realistic prospect of the nurse being struck off.
- A registrant is never forced to agree to an outcome; if no agreement is reached, the case proceeds to a full hearing instead.
- Engaging early, showing insight, and providing reflective evidence significantly improves the chance of reaching an agreed outcome.
What happens when a nurse is reported to the NMC?
When a concern is reported, the NMC first screens it to check that it relates to fitness to practise and meets the threshold for investigation. If it does, an investigation begins, and evidence — witness statements, clinical records, and information from the nurse's employer — is gathered. Concerns can come from patients, colleagues, employers, or members of the public, and even an anonymous referral can trigger a full investigation if it raises a credible fitness to practise issue.
Once the investigation is complete, the case goes to Case Examiners, who decide whether there is a case to answer. Throughout this stage, the nurse is invited to respond, and their engagement and any evidence of insight can directly influence whether the case is suitable for an agreed outcome rather than a full hearing.
What Are NMC Agreed Outcomes?
NMC agreed outcomes are ways of resolving a fitness to practise concern by agreement, rather than through a contested hearing. They fall into two main routes: outcomes agreed with Case Examiners before a hearing is needed, and consensual panel determination, agreed with a Fitness to Practise Committee panel.
In both routes, the registrant must accept the facts of the concern, and usually accept that their fitness to practise is currently impaired, before an outcome can be agreed. The final decision still rests with the NMC or the panel — an agreed outcome is a proposal that must be approved, not an automatic result.
| Route | Case Examiner Outcomes | Consensual Panel Determination |
|---|---|---|
| Who decides | Case Examiners, without a hearing | An independent panel, based on a written agreement |
| What's agreed | Advice, a warning, or undertakings | The facts, impairment, and an appropriate sanction |
| Not used for | Cases with a realistic prospect of striking off | Cases with a realistic prospect of striking off |
What can a nurse be struck off for?
Not every concern can be resolved through NMC agreed outcomes. Striking off remains reserved for the most serious cases, including:
- Sexual misconduct or abuse of a patient's trust
- Serious dishonesty, such as falsifying records or qualifications
- Deliberately concealing serious harm caused to a patient
- Persistent lack of insight or repeated failure to address a serious concern
- Serious criminal convictions relevant to fitness to practise
Where there is a realistic prospect of striking off, the case will normally be referred to a full Fitness to Practise Committee hearing rather than resolved by agreement, because the panel needs to test the evidence and hear directly from those involved. This protects both the public and the registrant, since a decision with such serious consequences should not rest on paperwork alone.
How to Work Towards NMC Agreed Outcomes
The following steps help a nurse, midwife, or nursing associate work towards NMC agreed outcomes where this is appropriate:
- Engage promptly with the investigation and respond within the deadlines given
- Be honest about the facts, even where this feels uncomfortable, since disputing clear evidence can rule out an agreed outcome
- Gather evidence of insight — reflective accounts, CPD completed, and any remedial steps already taken
- Seek advice from a trade union representative, defence organisation, or regulatory solicitor before agreeing to anything
- Respond constructively to any proposed undertakings or sanction, rather than accepting the first proposal without review
- Keep a copy of everything sent to and received from the NMC throughout the process
A well-evidenced, honest response gives Case Examiners and panels the material they need to agree an outcome rather than referring a case onward. Explore our full range of CPD-certified probity and ethics courses for nurses and midwives facing regulatory scrutiny.
Conclusion
NMC agreed outcomes exist because not every concern needs a full hearing to be resolved fairly. For nurses, midwives, and nursing associates who engage early, accept the facts honestly, and show genuine insight, an agreed outcome can bring a case to a close far sooner than a contested hearing would. Where the concern is serious enough to carry a realistic risk of striking off, agreement is rarely available, and preparing for a hearing becomes the priority instead. Browse more NMC and nursing regulatory guidance on our blog.
If you are currently going through this process, structured reflective learning can strengthen the insight you bring to any proposed outcome. Speak to your union or defence organisation as soon as a concern is raised, and start building your evidence today.
Frequently Asked Questions
What happens if nurses don't follow the NMC code?
Breaching the NMC Code can lead to a concern being raised and, if serious enough, a fitness to practise investigation. Outcomes range from informal advice for minor breaches, through warnings and undertakings, up to suspension or striking off for the most serious or repeated breaches.
What does the NMC say about consent?
The NMC Code requires nurses, midwives, and nursing associates to gain informed consent before providing care wherever possible, to respect a person's right to decline treatment, and to keep clear records of the consent discussion. Failing to obtain valid consent can itself be the basis of a fitness to practise concern.
What are the 4 NMC standards?
The NMC Code is built around four themes: prioritise people, practise effectively, preserve safety, and promote professionalism and trust. Most fitness to practise concerns, including those resolved through NMC agreed outcomes, are mapped back to one or more of these four themes.
How long do NMC agreed outcomes take to resolve?
Agreeing an outcome with Case Examiners is usually faster than waiting for a full hearing, though timescales still depend on the complexity of the case and how quickly evidence is gathered. Consensual panel determination still requires a panel to review and approve the agreement, which adds some time to the process.
Can a nurse refuse an agreed outcome and ask for a hearing?
Yes. Agreeing to an outcome is voluntary, and a nurse can choose to dispute the facts or impairment and have the case heard by a Fitness to Practise Committee instead. This may be the right choice where the registrant genuinely disagrees with the concern raised.
This guide is for general information and educational purposes only and does not constitute legal advice. For advice specific to your situation, contact a specialist regulatory solicitor or your trade union.