Association of Radical Midwives

Midwives Haven

Support for midwives in times of trouble

You are not alone!

Referral to the Nursing & Midwifery Council (NMC)


Being referred to the NMC is one of the most worrying and stressful things that can happen to a midwife and, unfortunately, the process is not a quick one. Once a referral has happened, the wheels of the NMC grind slowly and, whatever the final outcome, referral involves you in a considerable amount of paperwork, writing, and emailing/telephone calls for a period of at least 15 months but sometimes, even longer.

That being said there is a huge amount of support and knowledge to help you on this journey. Midwives Haven and a sister support group called NMCWatch have built up considerable experience of the NMC’s FtP process and the personnel involved and there is nearly always somebody who will try to answer a question, share a template, attend a meeting or whatever you need.
First of all, there are plenty of midwives out there setting off on the same journey as you. The NMC receives a midwifery referral approximately each working day of the week. Here are some figures to try to help put your referral in perspective…..

Outcomes of NMC Case Examinations (2019-20)

  • 20 midwives were referred for a FtP hearing
  • 2 midwives were given “advice”
  • 5 midwives were offered “undertakings”
  • 55 had no further action (NMC-speak for “no case to answer”)
    (The disparity in numbers is due to the time delay between referral and outcome of the investigation/case examiner stage.)

FtP hearings (2019-20)

28 midwives had FtP panel hearings, of whom:

  • 4 received no sanction (facts not proved or fitness to practise not found to be impaired).
  • 24 were found to have their fitness to practice impaired, of which
  • 3 received a caution
  • 7 had Conditions of Practice (CoP) imposed
  • 10 were suspended from the register
  • 4 were struck off the register

First Steps

If you have been referred to the NMC, you may feel you do not know where to turn or where to start so below are some ideas that may help

1Get some understanding of the FtP process

2Link in to support networks and peer expertise

NMCWatch: Registrant Care Facebook Group

The group was established in 2017 by Cathryn Watters, an oncology nurse who managed to get her striking off overturned on appeal to the High Court and who has worked and campaigned ever since to help others referred to the NMC.

In this group you will find nurses and midwives who have been through FtP referrals or who, like you, are currently referred. There is usually someone who can answer your question or point you in the right direction. NMCWatch also has a repository of useful documents and templates, and runs online webinars.

Midwives NMC Defence Research Group Facebook Group

Midwives NMC Defence
This group was set up in 2019 to help independent midwives referred to the NMC (IMs are referred disproportionally) but also has a number of employed midwives in the group. It helps midwives find the research and evidence they need to defend themselves, especially with regard to supporting women to make autonomous decisions surrounding care in childbirth.

CiC Wellbeing

CiC WellbeingThere is also an independent confidential careline available, paid for by registrants fees through the NMC but run by CiC – to give support and practical help and advice to you during the FtP process.
“The careline counsellors are experienced working with sensitive and personal information. They can also signpost you towards specialist organisations to help with specific issues.”
You can contact the CiC Careline free on 0800 587 7396

3Keep a diary and acquire a couple of big arch-lever files and some Post-it notes

Being referred means that one day you may have to give evidence about what you did in connection with the event(s) leading to your being referred. So you have to remember as much as you can about what you did or did not do, the names of colleagues, dates and times and other material details about care you have given or which it was claimed you did not give and write it down as your confidential record.

If you haven’t already done so, start your own diary. You’ll need at least to record all communications, meetings and events – personnel, dates and times, and any verbal communication. You also need to record any meetings which you had prior to and which led to your being referred.

File all emails and letters carefully in date order (oldest at the front, most recent at the back), take screenshots of any texts and back them up to your personal computer; and you’ll least one hard copy print of each – mobile phones have a habit of going on the blink just when you want to retrieve something. In our experience, being able to produce evidence about the process and who said what and when can be important later on. Follow up telephone conversations with an email to confirm any agreements reached with the NMC and any disagreements about what has been said.

When you send an email, put a “delivery receipt” and a “read receipt” on it so that you know it has reached its destination and not been ignored. You should also save to drive delivery and read receipts for important emails you send. Mark anything confidential as “CONFIDENTIAL” in the subject line. These things can help you stay a little in charge of the time-frame and conduct of the process.

Make a note of all the documents you may need to address the allegations made against you and start collecting them together in a separate electronic file and a hard copy “evidence” ring binder again in strict date order oldest at the front. That can help you and your representative to identify gaps in the documentation which you still need to get hold of.

Unlike in internal disciplinary procedures there’s nothing to stop you trying to contact witnesses if you have their contact details and believe they can help your case; many may say they cannot help but sometimes colleagues may be willing to speak up for you, and sometimes patients may have complaints about matters of which you have been held responsible by the employer but the patient’s complaint was not directed at you.

Data Protection Act 2018, Schedule 2, Para 5

(3)The listed GDPR provisions do not apply to personal data where disclosure of the data—

  • (a)is necessary for the purpose of, or in connection with, legal proceedings (including prospective legal proceedings),
  • (b)is necessary for the purpose of obtaining legal advice, or
  • (c)is otherwise necessary for the purposes of establishing, exercising or defending legal rights, to the extent that the application of those provisions would prevent the controller from making the disclosure.
Also see:

It will aid you greatly if you are able to scan, photocopy and print documents (such copying for the purpose of legal proceedings [and whistleblowing] is expressly permitted) and the ownership of or access to a good printer can prove invaluable and reduce stress at key times.

4Getting legal representation (or not…)

Advice & Tips on legal representation

  • The main midwifery and nursing unions have contracts with Thompson’s to provide you with legal representation. However the terms of these contracts and rates of pay can mean that the lawyer chosen for you will have limited reading time to acquaint themselves with and to prepare your case and often leave the detailed reading in on matters until immediately before they are in contact with you. They will also have limited time for your case. It is therefore very important that you plan what you want to say to your lawyer during any phone call or meeting and use the time available to good effect.
  • You should provide your legal representatives with all relevant documents you have, or are asked for, as soon as you can, and make sure they are aware of other documents you don’t have but which they should be asking for from the NMC, or your employer (eg: copies of your personnel file, records covering treatment, etc.). They also need to know the details of any witnesses from whom statements are needed to help you prepare your answer to any referral.
  • An introductory narrative of your career and training to date and a detailed timeline and account of what has led up to your referral will help your lawyer understand the order and context of events. This is one of the first things we would suggest you write as it will prove useful in all contexts and help you anchor events, personnel and meetings in order.
  • If you have any problems or worries about your legal representation, do contact the union officer linked to your case. RCM officers in particular have very little to do with NMC cases once a Thompson’s appointed lawyer is involved and we have never seen anyone from the RCM at a NMC hearing. However the unions are under contractual obligation to provide you with legal representation and you have the right to complain if you are unhappy with your representation.
  • You should also, at the outset, check your house/contents insurance to see if legal cover is a benefit; it’s just possible you have cover which extends to regulatory proceedings (it’s more often of help in employment matters); if you do, you may want to investigate representation by one of the Insurer’s panel lawyers.
  • Make notes of your discussions and meetings with your lawyer and confirm important points by email. If you do not feel comfortable about advice which you are given you should record your concern in writing, especially where your concern is that the lawyer has not understood your position correctly. Should you subsequently want to make a complaint about a lawyer or how they conduct your case, evidence about your instructions and the outcome of discussions about them will be important.
  • If your representative is an advocate (barrister or solicitor) at a hearing the advocate has a discretion on how to present your case, and will not always follow your instructions, especially if the preparation is not very clear. Sometimes there are technical reasons why the advocate cannot follow instructions. So you need to be able to make clear if the advocate has simply failed to do what you have asked the advocate to do without a good reason.
A note of caution – unions ask registrants they are representing to sign to agree that they will only seek advice from the union or union-appointed lawyer. If they believe you to be seeking advice from anyone else, they reserve the right to cease to represent you. This means that peer support groups such as Midwives Haven cannot give you legal advice, though we can give you support and information. It also makes it difficult for you to seek a second legal opinion which can only be given by a legally qualified person.
Due to this, you are strongly advised to keep all other sources of advice under the radar and NOT to discuss them at all with a union representative or your lawyer. Likewise, we always introduce those of us who may accompany you to a meeting or hearing as a supporter.

The union stance above suggests that it is the union and not you who instructs the lawyer. This is incorrect – the lawyer is there to represent YOU and it is YOU who needs to instruct her or him. This means that after considering the legal advice you are given, either confirm you agree with it or, if you do not agree with it, that you make that clear and state clearly what you would prefer to happen. Follow any verbal discussion up with an email to confirm mutual understanding of the position. It is very important that you do not allow the process to take a course you are unhappy with or your instructions to be disregarded. You may end up disappointed about how your case was conducted yet have little comeback unless you can show that your instructions were disregarded.

5The NMC FtP Process

6How long does it all take?

The NMC aims to complete 80% of cases within 15 months and, in 2019 – 20, it met this target. However many cases are rejected at the screening stage or found to be “no case to answer” and conclude at Case Examiner stage. As only 10% of cases proceed to a full hearing, this means that a small but significant number of cases take longer to complete the Case examiner stage than 15 months without ever proceeding to a FtP hearing. In our experience it generally takes 15 months for a case to reach the conclusion of the Case Examiner stage.

At the time of writing (2021), the pandemic has caused a backlog of cases and it is unclear when these will be processed and how soon the 80% target will be reached again.
If your case goes to a full hearing, this will usually take around a year to schedule and prepare from the end of the Case Examiner stage. If you are subject to an IO, then the NMC will seek permission to extend it at the High Court to cover the period of the hearing. This is an opportunity for you to challenge it before a judge and seek to have it reviewed and lifted, varied, or shortened. High Court judges are increasingly showing interest in these cases and we would advise you, with your legal representative if you have one, to consider appearing and arguing against the NMC’s case especially if an extension of an interim Order is sought but no substantive hearing date has been fixed.

Once a substantive hearing has taken place If you then appeal the outcome of a FtP hearing (see the section on Appeals), you can expect this to be heard about 4 to 6 months later.

It is not uncommon for the core incidents of interest to the NMC being considered at hearings about 3 to up to 5 years after they happened.

7Case Officers

8Writing a reflective piece

There is considerable guidance on both the NMC’s website and NMCWatch’s Facebook page on writing a reflective piece.
What the NMC are looking for and what they mention time and time again are INSIGHT and REMEDIATION.

Many registrants use Gibb’s reflective cycle as the basis for their reflection and find that helpful – it seems to go down quite well with the NMC. But there is no such things as a one version fits all reflection – each reflection has to reflect on its registrant’s circumstances and the facts of that case.

Our experience shows that it is sensible not to let the NMC have a copy of your reflective piece until other registrants with experience and your union/legal representatives have read and commented on it. Experienced members of Midwives Haven and/or NMCWatch will be available to review preparation of and to read over your reflection with you if you want.

A reflective piece can be useful evidence of your insight and remediation at Interim Order hearings, Case examiners’ review and at a FtP meeting or hearing. Even if you are disputing the facts of a case, it is still possible to write a reflective piece that shows insight and even, to a degree, remediation but do ask your legal representative for advice.



The FtP process takes a minimum of 15 months and, if your case proceeds to a hearing, then it will probably (2021) take 2 to 3 years. This means that at some point you will need to revalidate. You can ask for more time but, in our experience, you should revalidate in the usual way if at all possible.
Make sure you do your best to fulfil and to log all your hours of midwifery-relevant experience and do keep abreast of your Continuing Professional Development [CPD]. Maintain your portfolio of practice and study, log any reading (including any research and reflection relating to your case), and make use of the many on-line CPD courses such as on RCM i-Learn, The Perinatal Institute, Open Learn and Future Learn.

Make sure you download, print off and save all certificates as soon as you have completed each course (or stage of a course). RCM i-Learn, for example, dates the certificate with the date you print it out and FtP panels may think, despite being told otherwise, that you have simply swotted up in the couple of days before a hearing. Being able to produce evidence that you are regularly and continuously staying up-to-date may be very important at Interim Order or Substantive Order hearings if you are seeking to get a suspension lifted or to argue against the imposition of one.

The below is the guidance to FtP panel members about what to consider regarding CPD during the FtP process:
“Evidence of training courses should be carefully considered. Decision makers should look at the duration of the course and the amount of time or focus placed on topics which address the relevant concerns. Courses with a practical element and formal assessment (with results available), can carry more weight than courses completed online or those without any means for the nurse, midwife or nursing associate to demonstrate understanding.”

10Fitness to practise meetings and hearings

10.3. The Balance of Probabilities and your presentation

One of the important differences between criminal proceedings and civil proceedings such as NMC hearings is that the facts only have to be proven (by the NMC) on a simple balance of probabilities. That is to say, that the panel can find an allegation proven if they are only 50.1% inclined to believe the NMC case.

You and your representatives have to consider how to present a convincing presentation and that includes how you come across at the hearing. Being clear and consistent in your answers, taking time to consider your response to any question, and giving your evidence truthfully, even if it is discomfiting, are all important to counteract the very clear and forceful arguments put forward by the NMC case presenter.

Panels often confuse lack of clarity that can sometimes arise from you being nervous or feeling unsupported as you being “confused” or “unconvincing” (panel descriptions, not ours) and contrast that unfavourably with the NMC’s witnesses, especially Trust managers who have extensive experience of disciplinary procedures. Panels also are reluctant to conclude that a patient’s evidence is either unreliable or malicious. So you need to feel comfortable with yourself and speak as calmly and clearly as you can.

This is where good support, breathing and relaxation exercises, being satisfied with your appearance, good preparation, and practising your answers can help. If you feel you have come across poorly at one session, seek permission to revisit a point or answer. You and your vocation are important and the reality is that, if your case goes to a hearing, you will be fighting to protect your right to practise.

10.4. Witnesses

The NMC will invariably call witnesses but not always the witnesses you would expect to be called. They can include managers, women you have looked after, colleagues, students; but they will almost always avoid calling witnesses who are likely to support your version of events.

So you should also consider calling witnesses to appear on your behalf, including expert witnesses. If necessary they can appear by video link (the NMC has good facilities for this and makes frequent use of them). You are responsible for any expenses incurred but your union should agree to meet these if your legal representative agrees that their testimony and cross examination would be of value. However many midwifery experts give their time freely for midwives before the NMC and cost should not deter you from calling a witness on your behalf.

In our experience, registrants do not call witnesses often enough. For example, you may face an allegation about your management of a shoulder dystocia or the third stage and an expert midwife can testify that your management was not only acceptable practice but professionally supported by evidence; and not the mismanagement the NMC may try to argue it was. Or a colleague may be prepared to appear under oath for you and put a version of facts which is counter to the charges being brought against you; or attest to your skill and communication skills.

10.7. Guide to Stratford

The majority of hearings, both Interim Order Hearings, Meetings and Substantive Hearings, are held in the NMC hearings suite at Stratford in east London. Hearings are also held in Cardiff, Edinburgh and Belfast. You can request a hearing in the offices nearest you regardless of country of residence or work.

A downloadable guide to the NMC Stratford offices and Stratford itself, with travel, hotel and eating suggestions can be downloaded here.

10.8. Appeal against FtP outcome

You can appeal to the Administrative Court of the High Court of Justice (in England and Wales) or Court of Session (in Scotland – although you first need permission to do so in Scotland) against a FTP process or outcome within 28 days of being sent the Panel’s decision. Your union support an appeal if they think there is a greater than 50% chance of winning and on the recommendation of your legal representative. But you can appeal yourself and even conduct the appeal yourself (litigant-in-person). Midwives have done this successfully and the High Court has helpful information for litigants-in-person.

If your hearing ends near Christmas or another holiday period, ask your representative at the end of the hearing to formally request an extension to the 28 days.

In England and Wales, what you need to do in this time is complete High Court forms and put forward in a succinct form ALL the grounds for your appeal and a précis of the reasons why the Panel has erred (made a mistake) in your notice of appeal. There’s a different regime in Scotland but the clerks to the Court of Session can give a guide. What you need to do is to get on the relevant Court’s website and hunt down the rules concerning appeals, which tell you what is required to be submitted and in what format.

See Article 38 Nursing & Midwifery Order 2001 –
In England & Wales see Civil Procedure Rules – Appeals – Part 52 and Practice direction 52D – Statutory Appeals 52D

In Scotland see:

The actual hearing will be scheduled for 3 to 4 months later and you will have more time to prepare your “skeleton argument” and construct your bundle.

11The Professional Standards Authority (PSA)

Trauma Resolution Therapy

for midwives

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