Professional Standards · NMC Guidance
NMC Striking Off: What It Means for Nurses and Midwives
Few letters cause more alarm to a nurse or midwife than one confirming they have been struck off. NMC striking off is the most serious sanction the Nursing and Midwifery Council can impose, and it ends a registrant's ability to practise anywhere in the UK.
This guide explains what NMC striking off actually means, what conduct can lead to it, how common it is, and what options remain afterwards, so nurses and midwives know where they stand.
What Is NMC Striking Off?
NMC striking off is an order made by the Nursing and Midwifery Council's Fitness to Practise Committee that removes a nurse, midwife or nursing associate's name from the register. From the date it takes effect, the person cannot work in any role that requires NMC registration.
NMC Striking off is not available for every type of impairment. The table below shows how it compares with suspension, the next most serious sanction.
| Feature | Suspension Order | Striking-Off Order |
|---|---|---|
| Effect on registration | Registration paused for up to 12 months at a time | Name removed from the register entirely |
| Route back | Reviewed before the order expires | Formal restoration application after five years |
| Available for health or competence alone | Yes | Only after two continuous years on a restrictive order |
| Typical grounds | Remediable misconduct, with some insight shown | Fundamental dishonesty, sexual misconduct, no insight |
What can a nurse be struck off for?
The NMC's Sanctions Guidance says NMC striking off is likely to be appropriate where a registrant's actions are fundamentally incompatible with remaining on the register. The types of case most likely to end in a striking-off order include:
- Dishonesty, including a breach of the professional duty of candour
- Sexual misconduct towards a patient or colleague
- Abuse of children or vulnerable adults
- Serious, sustained clinical failings with no realistic prospect of remediation
- Failing to engage at all with the fitness to practise process
A striking-off order generally cannot be used where impairment is due only to health, lack of competence or not having the necessary knowledge of English, unless the registrant has already been continuously subject to a suspension or conditions of practice order for at least two years. Full detail is set out in the NMC's own NMC Sanctions Guidance.
How many nurses get struck off each year?
Reported NMC figures show that more than 1,000 nurses and midwives were struck off the register over the five years to 2024, with just over half of all substantive Fitness to Practise hearings in that period ending in a striking-off order. The nursing press has reported that the annual number of strike-offs has risen sharply in recent years, a trend not fully explained by the growth in the size of the register itself.
Exact annual totals vary year to year and are published in the NMC's own Annual Fitness to Practise Report, so figures should always be checked against the latest edition rather than assumed to stay constant.
How an NMC striking-off decision is reached
An NMC Striking Off decision is only reached after a structured process before the Fitness to Practise Committee.
- Referral and investigation: a concern is screened and investigated, and if the case meets the threshold it is referred to a panel hearing.
- Fact-finding: the panel decides which of the allegations are proved on the evidence before it.
- Impairment: the panel decides whether the registrant's fitness to practise is currently impaired.
- Sanction: if impairment is found, the panel works through the sanctions in order of increasing severity, from no action to striking off, choosing the least restrictive option that still protects the public and public confidence.
- Effective date: a striking-off order usually takes effect at the end of 28 days, unless an interim order already prevents the registrant from practising.
Is restoration possible after NMC striking off?
A struck-off nurse or midwife is not barred from the profession forever. After five years, they can apply to the NMC for restoration to the register. A restoration application is not an appeal against the original decision, and the burden rests entirely on the applicant to satisfy a panel that they are now fit to return to safe, unsupervised practice.
Panels look for genuine insight into what went wrong, evidence of remediation during the time away from the register, and proof that knowledge and skills have been kept up to date. Structured insight and remediation work can help registrants build this evidence, and nurses preparing a restoration case may also find it useful to see how other UK regulators, such as the GPhC, approach the same question in our GPhC removal guide.
Conclusion
NMC striking off is the regulator's most serious response, reserved for conduct that is fundamentally incompatible with remaining a registered nurse, midwife or nursing associate. Understanding what can trigger it, how the Fitness to Practise Committee reaches its decision, and what restoration involves helps registrants see the process clearly rather than only fear it. For anyone facing a hearing, or planning a future restoration application, building early evidence of insight and remediation matters more than anything else. Our insight and remediation courses help nurses and midwives build this evidence, and organisations supporting several colleagues can review our bulk-buy offer for group access.
Key Takeaways
- Which course should I take for an NMC complaint or investigation? Match the course to the allegation — Which course do I need? lists them by concern; for nurses and midwives, the NMC ethics and NMC professionalism courses follow the NMC Code.
- 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
01What is NMC misconduct?
NMC misconduct is conduct that falls seriously short of the standards expected of a registered nurse, midwife or nursing associate, as set out in The Code. It covers a wide range of behaviour, from dishonesty and poor record-keeping to abuse or serious clinical failings, and is one of the grounds on which the Fitness to Practise Committee can find a registrant's fitness to practise impaired.
02What can a nurse be struck off for?
The cases most likely to end in striking off involve dishonesty, sexual misconduct, abuse of children or vulnerable adults, serious clinical failings with no realistic prospect of remediation, or a complete failure to engage with the fitness to practise process.
03How many nurses get struck off each year?
Reported NMC data shows over 1,000 nurses and midwives were struck off in the five years to 2024, with annual numbers varying and trending upward in recent years. The exact figure for any single year is published in the NMC's Annual Fitness to Practise Report.
04Can a nurse apply to return to the register after being struck off?
Yes. A struck-off nurse or midwife can apply for restoration after five years. The application is not an appeal, and the registrant must satisfy a panel that they have genuine insight, have remediated the original concerns and are safe to return to practice.
05Is striking off the only outcome available to the NMC's Fitness to Practise Committee?
No. Striking off is the most serious of several possible sanctions, which also include a caution order, conditions of practice order and suspension order. The panel must consider them in order of increasing severity and choose the least restrictive sanction that still protects the public and public confidence.
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 medical defence organisation.
The CPD courses linked from this guide, Module on Remediation, Module on Insight and Rebuilding Trust of Patients, Colleagues, Public, and Healthcare Regulator, 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.
