The nursing regulator has reported its first month-on-month improvement in its fitness-to-practise (FtP) backlog since 2023, despite a continued high number of referrals.
As of February 2025, the Nursing and Midwifery Council (NMC) had 6,498 live cases, a decline from 6,511 the previous month and from a record high of 6,633 in December 2024.
“High volumes of referrals continue to put our teams under significant pressure”
Lesley Maslen
It comes as the FtP caseload has been gradually increasing since August 2023, when the NMC had 5,387 open cases.
In the four months leading up to August 2023, case numbers had been decreasing month by month.
The backlog means some registrants have seen delays in their cases being resolved, creating additional distress for nurses, midwives and nursing associates whose fitness to practise is being questioned.
The NMC has faced criticism for its handling of its FtP caseload, and in April 2024 it launched a plan to try and improve.
The regulator said it was now making “meaningful progress” on tackling its FtP issues, but acknowledged that there was still much work to do.
It said the recent reduction in its backlog had been driven by an improvement in cases being resolved at screening – the first stage of the process in which the NMC decides whether a referral deserves further investigation.
As of February 2025, there were 2,680 cases sitting at the screening stage – a reduction from a peak of 3,098 in September 2024.
However, on the other hand, the NMC said the FtP caseload at investigations – the next stage after screening – had been growing.
“We are exploring what more we can do to progress older and lower risk cases at [the investigations] stage, using clinical, legal and case examiner expertise to speed up case progression,” stated the NMC in a report that will go before its governing council tomorrow.
One key measure the NMC uses to monitor its FtP timeliness is the proportion of cases closed within 15 months.
The NMC has a target to resolve 80% of cases within 15 months, but it has not met this since before 2019.
The latest data showed that, in the year ending February 2025, an average of 67.1% of cases were closed within 15 months – an improvement from 65.9% the previous month and 61% in February 2024.
The growing backlog comes within the context of a rising number of concerns being raised with the NMC about nurses, midwives and nursing associates.
In February 2025, the NMC received 574 new referrals – above the average of 546 referrals per month recorded between April 2024 and February 2025.
The number of referrals in 2024-25 has been much higher than in 2023-24; between April 2023 and February 2024, the average was 493 per month.
The NMC flagged a number of initiatives that it had implemented to try and improve its FtP management, one of which was targeted at reducing unnecessary referrals from the public.
It was noted in the NMC’s report to its council that the majority of referrals from members of the public do not progress beyond the screening stage, either because the concerns do not constitute a regulatory issue, or because they are about someone who is not on the NMC register.
To try and address this issue, in February 2025, the NMC launched a new form for members of the public to use when making a referral, which includes a checklist aimed at making sure their referral is needed.
The report noted early signs that the checklist may be helping to stamp out unnecessary referrals from the public, but more data is needed.
Another initiative that the NMC has put in place, in January 2025, is a new pilot to better support vulnerable registrants whose FtP referrals relate to a physical or mental health need that they have, for example those with dementia or with substance use issues.
The year-long pilot involves a multidisciplinary team of safeguarding, clinical and legal staff meeting weekly to review cases, and aims to implement a more “bespoke and compassionate” approach to dealing with health-related cases.
Lesley Maslen, NMC executive director of professional regulation, said: “As we move into the second year of our fitness to practise plan, we’re seeing meaningful progress.”
She said the improvements seen were a “testament to colleagues’ hard work”.
However, she added: “We cannot afford to be complacent. High volumes of referrals continue to put our teams under significant pressure.”
She noted that the rise in referrals was one of the reasons why the NMC “realigned” its FtP plan recently, as well as to take into account recommendations made in the independent culture review.
The review, published in July 2024 by former chief crown prosecutor Nazir Afzal, found a “toxic” internal culture at the regulator and warned that the backlog of FtP cases was having a detrimental impact on staff.
The FtP report will go before the NMC Council tomorrow to discuss.
