1. Deciding whether to make a referral decision tree
Add name, title and date information if required

2. Referral decision tree
This decision tree should be used together with Advice and information for Employers of Nurses and Midwives, which includes guidance about managing fitness to practise (FTP) issues, the type of allegations we investigate and issues to consider before referral.
What sort of concerns are you investigating:
Misconduct or competence
Serious ill health
Character, criminal behaviour?

3. Misconduct and lack of competence
has a patient been seriously harmed or is there a risk to patient safety?
refer to NMC
yes
have there been previous conduct, competence concerns?
refer to NMC no
yes no
yes
is nurse/midwife’s
conduct or competence being investigated?
investigate using local procedures
(refer to NMC if FTP concerns emerge) no

4. Is nurse/midwife engaging with treatment and management
Serious ill health
has a patient been seriously harmed or is there a risk to patient safety?
Refer to NMC
yes
Is nurse/midwife engaging with treatment and management
Use local procedures
(keep situation under review, including possible referral to NMC if required) no
yes
yes no
Does nurse/midwife have insight and acknowledge their health condition?
Refer to NMC no

5. Do you have concerns about the nurse/midwife’s fitness to practise?
Character
Call us on for further information and advice
Does the incident involve a criminal investigation, charge, caution or conviction
Refer to NMC
investigate using local procedures (refer to NMC if FTP concerns emerge) no
yes no
Do you have concerns about the nurse/midwife’s fitness to practise?
Refer to NMC
yes