NMC proposes consultation on first fee increase in a decade to support fitness to practise reform

The Nursing and Midwifery Council (NMC) has announced its intention to launch a public consultation on a proposed increase to its registration fee—the first such proposal in ten years. The regulator cites significant financial pressures and a growing registrant base as key drivers behind the move, which aims to sustain core regulatory functions and invest in long-term transformation programmes, including improvements to the fitness to practise process.

Since 2015, the NMC has maintained a flat registration fee of £120, despite a 24% increase in the number of professionals on its register and a 21% rise in fitness to practise referrals. According to the NMC, this has resulted in a 28% real-terms reduction in income, amounting to approximately £180 million in lost revenue over the past decade. To maintain operations, the regulator has begun drawing on its financial reserves and is now proposing a strategic shift to ensure future sustainability.

As part of its cost-saving measures, the NMC plans to reduce its workforce by 145 roles—roughly 10% of its staff. Chief Executive Paul Rees emphasised that any fee increase would be kept as low as possible and would be reinvested into critical areas such as streamlining the fitness to practise process, enhancing education standards, and improving organisational culture. The regulator also reaffirmed its commitment to equity, diversity, and inclusion, including its ambition to become an anti-racist organisation.

The consultation will seek views from nurses, midwives, nursing associates, students, and the wider public. The NMC aims to ensure that any changes are informed by stakeholder feedback and reflect the needs of the professions it regulates. However, the proposal has already drawn concern from professional bodies and unions, including Unison, which warned that the fee hike could place additional financial strain on a workforce already facing high levels of stress and undervaluation.

The NMC maintains that the proposed changes are essential to delivering high-quality regulation and protecting the public. Central to this is the fitness to practise function, which the regulator says must be fair, proportionate, and efficient. By investing in digital infrastructure, staff training, and process reform, the NMC hopes to reduce delays and improve the experience for professionals and service users alike.

Paul Rees MBE, Chief Executive and Registrar, said:

“For the first time in a decade, we are proposing to increase the registration fee.

“The intention of the freeze was to help nursing and midwifery professionals at a time of a cost-of-living crisis and high inflation. At the same time, it has seen our income contract by 28% in real terms – and will equate to £180m in lost income up to the end of the current financial year.

“We are now using up our reserves to pay for day-to-day running costs, and our Executive Board no longer believes the freeze in the fee is sustainable.

“We are currently reducing our costs – and have taken the difficult decision to propose reducing our headcount by 145 roles, which is 10% of posts.”

He added: “If there is an increase in the registration fee, we will use the increased funding to pay for the ongoing transformation of the NMC – as we gradually improve Fitness to Practise; work to improve education and standards; fix our culture and embed equity, diversity and inclusion, including becoming an anti-racist organisation.

“The changes we are making will enable us to meet our core priorities of protecting the public, maintaining confidence in the nursing and midwifery professions and upholding the standards of proficiency.

“Through building a new NMC, we are ensuring that we become the strong and independent regulator that everyone wants to see.

“If the consultation goes ahead, we will encourage everyone to share their thoughts on the fee changes. 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, we would be keen to hear your thoughts.”

The consultation is expected to open later this year, with final decisions to follow after a full review of responses.

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