An NMC clinical competence concern is an allegation that a nurse, midwife or nursing associate has practised to "an unacceptably low standard of professional performance", judged on a fair sample of their work. The NMC calls it lack of competence, and it treats it differently from misconduct: it is about what you know and can do, and a competence concern can be put right with training, supervision and evidence. This guide sets out, from the NMC's fitness to practise library read on 29 October 2026, what counts, what the NMC looks at, what can happen, and what to do now.
In short
- Lack of competence is judged on a fair sample of your work; one mistake is not enough unless it was exceptionally serious.
- It is not misconduct, and striking off is not available for lack of competence until you have been on conditions or suspension for two continuous years.
- Skills updating, supervised practice and a reflection close the gap. The CPD course that fits is Ensuring Clinical Competence and Patient Safety, £79 (£50 with Bulk Buy 10) for 2 CPD hours. All the CPD courses linked from this guide are by Probity & Ethics, written by Dr Shehzad Iqbal.
What is a clinical competence concern at the NMC?
The NMC treats a concern about clinical competence as an allegation of lack of competence. Its fitness to practise library (reference FTP-2b, updated 28 July 2026) defines it as "an unacceptably low standard of professional performance", "judged on a fair sample of a professional's work". It can include a lack of knowledge, skill or judgement that shows a professional is not able to practise safely and effectively.
Can a single mistake lead to a lack of competence finding?
The NMC says a single clinical incident does not show a general lack of competence unless it was exceptionally serious. Its guidance gives two examples at either end:
- A nursing associate fails to escalate a patient's deterioration once. That alone is not lack of competence; the NMC would need more incidents.
- A midwife gives an opioid intravenously and the woman has a cardiac arrest. Even as a single incident, that could be serious enough.
What counts as a fair sample depends on the kind and seriousness of the concerns and on how much you work. For part-time staff, the NMC may look at fewer cases or a longer period.
How is lack of competence different from misconduct?
Competence is about what you know and can do. Conduct is about what you choose to do with that knowledge and skill. The NMC says a lack of knowledge or skill "by itself, it is not also misconduct". Its example is a mental health nurse who used an inappropriate restraint: if her training was out of date, that points to competence; if she knew the right method but lost patience, that points to conduct. Where both are alleged, the charges must keep them separate. Our guide nursing misconduct covers the conduct side.
What triggers a clinical competence referral?
Competence referrals come from employers, colleagues, patients and families. Typical subjects in the NMC's own examples are failing to escalate a deteriorating patient, failing to refer women with reduced foetal movements, unsafe restraint and medication errors. A referral from an employer can follow a local capability process, and the NMC's charge will list the incidents it relies on, "including any during supervision or a capability process", and may refer to missed objectives or failed assessments.
What evidence does the NMC look at?
The NMC's guidance says it considers:
- the circumstances at the time of the concerns;
- your practising history, not only the period of concern, to see whether the concerns are general or limited to one area;
- how any gap in knowledge or training arose, including the support and supervision your workplace gave you;
- any evidence of discrimination, victimisation or wider cultural or systemic problems.
What can happen at the end of a competence case?
The outcomes range from no further action, through conditions of practice (supervision, training, limits on your work) and suspension. The NMC's sanctions guidance (SAN-3e) says striking off is not available where impairment comes from lack of competence until the professional has been "on either a suspension order or a conditions of practice order for a continuous period of two years". Our guide NMC sanctions explained sets out each outcome.
Can a competence concern be put right?
Yes, and the NMC's own example shows how. A midwife who did not refer three women with reduced foetal movements completed further training and asked for supervision, with no further concerns; the NMC says proceedings would be unlikely to continue. Once a gap is identified, the NMC looks at how it arose and whether you have taken steps to stop it happening again. Our guide NMC insight and remediation explains what the NMC looks for.
How should you respond to an NMC competence concern?
- Get advice. Speak to your union or indemnity provider before you reply.
- Ask for the evidence. Find out which incidents are relied on, over what period.
- Close the gap. Complete updating on the specific skill with your employer, and a course on clinical competence and patient safety with a dated certificate.
- Arrange supervised practice. A supervisor's report on your recent work is strong evidence.
- Audit your own work. Records, escalations or medicines rounds checked over a period, with the results.
- Write a reflection. What went wrong, why, what you have learned and what you now do differently. See our NMC reflective statement guide.
Can you keep working during a competence case?
In a competence case you can keep working unless an interim order is made. Your employer may put you on supervised practice or restrict your duties. Our guide can I work during an NMC investigation? covers interim orders and telling employers.
Which course fits a competence concern?
Start here
Ensuring Clinical Competence and Patient Safety
Recognising the limits of your competence, escalation, risk, incident reporting, learning from errors and keeping your skills current, with a reflection on your own practice.
- £79 (£50 with Bulk Buy 10)
- 2 CPD hours
- Certificate on completion
Courses that work alongside it
The Bulk Buy offer is any 3 courses for £200, 5 for £300 or 10 for £500. Probity & Ethics is CPD certified and accredited by The CPD Certification Service. Not sure which course fits? Request a free 15-minute Zoom call with Dr Shehzad Iqbal. Our NMC courses guide covers every kind of NMC concern.
The CPD courses linked from this guide, Ensuring Clinical Competence and Patient Safety as Healthcare Professionals, Module on Insight, Professionalism in Documentation for Healthcare Professionals and Prescribing Guidance and Standards for Healthcare Professionals, are by Probity & Ethics, written by Dr Shehzad Iqbal, CPD certified and accredited by The CPD Certification Service (provider no. 13197) and offered since 2020.
Key Takeaways
- Which course should I take for an NMC clinical competence concern? Our Clinical Competence course is written for this, for nurses and midwives, and follows the NMC Code; pair it with a written reflection that names the standard engaged.
- Will a course help my NMC investigation? A course is evidence of insight and remediation, which the NMC case examiners look for — strongest with a written reflection and changes in your practice. No course can guarantee an outcome.
- When should I send the certificate and reflection to the NMC? With your written response, before the NMC case examiners decide — or before an NMC Fitness to Practise Committee or a review if the case has gone further.
- Can I finish the course before my deadline, and is it CPD accredited? Yes — it is online and self-paced with a certificate on completion, and CPD certified and accredited by The CPD Certification Service, counting towards your NMC revalidation.
Frequently asked questions
What is a clinical competence concern at the NMC?
It is a concern that a nurse, midwife or nursing associate is not practising to the standard expected. The NMC calls the allegation lack of competence: "an unacceptably low standard of professional performance", judged on a fair sample of the professional's work. It is about what you know and can do, not about deliberate choices, which the NMC treats as conduct.
Can one mistake lead to a lack of competence finding?
Not on its own. The NMC says a single clinical incident does not show a general lack of competence unless it was exceptionally serious, such as its own example of an opioid given intravenously that caused a cardiac arrest. It looks for a pattern across a fair sample of your work, and for part-time staff it may look at fewer cases over a longer period.
What is the difference between lack of competence and misconduct?
Competence is what you know and can do; conduct is what you do with that knowledge and skill. The NMC's own example: a nurse who used an out-of-date restraint method because her training had lapsed raises a competence concern; a nurse who knew the right method but lost patience raises a conduct concern. Where both are alleged, the charges must keep them separate.
Can I be struck off for lack of competence?
Not straight away. The NMC's sanctions guidance says striking off is not available where impairment comes from lack of competence until you have been on a suspension order or a conditions of practice order for a continuous period of two years. Conditions, supervision and a review come first.
What evidence helps in a competence case?
Evidence that the gap has been closed: updating on the skill in question, a period of supervised practice with a supervisor's report, competency sign-offs, audits of your recent work and a reflection on what went wrong. The NMC's example of a midwife who completed further training and asked for supervision ended with proceedings unlikely to continue.
Which course fits an NMC clinical competence concern?
Ensuring Clinical Competence and Patient Safety, with Professionalism in Documentation if records are part of the concern and Prescribing Guidance and Standards if medicines are. Add Module on Insight and Module on Reflection for the response itself. Each online course is £79 (£50 with Bulk Buy 10) for 2 CPD hours.
Do the courses count for revalidation?
Yes. Each online course gives 2 CPD hours to record for NMC revalidation, and a course can be the subject of one of your five written reflective accounts. Probity and Ethics is CPD certified and accredited by The CPD Certification Service.
Sources
This guide is based on the following NMC pages, read on 29 October 2026.
