The Nursing and Midwifery Council (NMC) has launched a 12-week public consultation on proposals to raise the annual registration fee for nurses, midwives and nursing associates by the equivalent of £1.92 per month – having frozen the fee for the last 10 years.
Being mindful of cost-of-living pressures, the Regulator has not increased the fee for the last decade – however, as a consequence, its income has contracted by 28% in real terms, in comparison with where it would have been if the fee had kept pace with inflation.
This means that up to the end of March 2026, the Regulator has lost £180m in potential income.
At the same time as keeping the fee flat, the NMC’s responsibilities have increased significantly, and the complexity of its work has also grown.
The NMC now regulates a larger number of nursing and midwifery professionals than ever – with the Register having grown from 686,782 in 2015 to 853,707 in 2025. This includes nursing associates, a new profession in England since 2018.
The NMC is now the Regulator of 1 in 50 working-age people in the UK – with its register of health professionals being the biggest in the UK and one of the biggest in the world.
The NMC oversees 99 approved education institutions (AEIs) across the UK, offering more than 2,527 programmes serving more than 115,000 nursing and midwifery students.
At the same time, the Regulator faces an ever growing number of monthly Fitness to Practise referrals. In April 2024, the rolling average of referrals stood at 499 per month. This figure has risen to an average of 574 per month – an increase of 15%.
As a result of freezing the fee, while investing in regulatory improvements and responding to growing demand at a time of high inflation, the Regulator is now having to use its reserves to fund day-to-day activities.
In 2023–24, the NMC spent £1.1m more than it brought in through income. Last year, it posted a deficit of £19m. This year it is projecting a deficit of up to £27m.
To control costs, in October, the NMC published proposals to remove 145 roles from its headcount. This would amount to a reduction in its workforce of 10%. The Regulator also plans to reduce its non-staff costs by £3.1m per year.
But reducing its staff headcount and reducing non-staff costs will not be enough to ensure the NMC’s diminishing reserves stay at minimum safe levels. It is also having to propose an increase to its main fee, and its other fees – for instance the fees it charges internationally educated people to join the Register.
The fees account for around 97% of the NMC’s income and enable the Regulator to protect the public, maintain confidence in the professions and uphold standards.
The NMC is under new management, with Ron Barclay-Smith as Chair and Paul Rees MBE as Chief Executive and Registrar. The team are now building a new NMC, with the aim of ensuring it becomes the strong and independent Regulator that everyone wants to see.
As the organisation transforms its performance, it is investing in:
- Making Fitness to Practise faster and fairer
- Modernising the Code, revalidation and professional standards
- Assuring the quality and safety of education for nursing and midwifery students
- Embedding equality, diversity and inclusion in its regulatory processes, to better support the professions, and
- Improving technology and data to modernise the way it works.
It is because of this backdrop that the NMC is proposing to increase its fees. It is proposing to raise the main registration fee by the equivalent of £1.92 per month – from £120 to £143 per annum. If the NMC had raised the registration fee in line with inflation it would now be £166.
For those registrants who pay by quarterly instalments, the proposed increase would mean an additional £5.75 every three months.
For registrants who pay basic rate tax at 20% and claim tax relief on their fee, this would mean the main fee effectively becomes £114.40 per year – the equivalent of £1.53 more per month for those who already claim tax relief.
The consultation on the fees increase is open to anybody who wants to have their say, whether they are a nurse, midwife or nursing associate on the Register, a student, a member of the public or someone involved in the wider health and social care sector. It will close on 26 January.
Paul Rees MBE, Chief Executive and Registrar, said:
“For the first time in a decade, we are proposing to increase the registration fee – by the equivalent of £1.92 per month.
“Being mindful of the cost-of-living crisis, we have frozen the fee for the last 10 years. While it was well intentioned, the freeze has had a profound impact on the finances of the NMC, with our income contracting by 28% in real terms, in comparison to where we would have been if the fee had increased with inflation. The income lost over the last decade will equate to £180m by the end of the current financial year.
“We are currently reducing our costs – and have taken the difficult decision to propose reducing our headcount by 145 roles, equating to 10% of posts. But we are now consistently using up our reserves to pay for day-to-day running costs, which is no longer sustainable.
“We would use the increased funding to pay for the ongoing transformation of the NMC – as we gradually improve the timeliness of FtP; work to improve education and standards; fix our culture and embed EDI – while also making sure we can continue to meet our public duties.
“We encourage everyone to share their thoughts on the proposed fee changes through the consultation – whether you are a nurse, midwife or nursing associate on our Register, a student, a member of the public or someone involved in the wider health and social care sector.”
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