NMC fee rise would see third of nurses ‘reconsider’ registration, Unison warns

More than a third of nurses and midwives have said they would ‘reconsider’ renewing their Nursing and Midwifery Council (NMC) registration should a proposed fee increase go ahead, according to a survey.

Unison’s survey of more than 3,000 registrants revealed that 6% felt they would ‘definitely leave’ as a result of a fee rise.

Unison’s national nursing officer Louie Horne unveiled the results at today’s NMC Council meeting, while questioning the regulator on whether it had assessed workforce and patient safety risks associated with a fee rise.

The NMC has been consulting on increasing its registration fee from £120 to £143 per year – equivalent to an additional £1.92 per month – amid concerns about its financial sustainability. The regulator said today that responses were currently being analysed and would be considered by the council before any decision was made.

The fee has been frozen for the last 10 years, leading to a 28% real terms reduction in income for the NMC, it said previously.

While the consultation closed on Monday, NMC interim executive director of resources and technology services, Christopher Kinsella, told a council meeting today that ‘no firm assumptions’ can yet be made on whether the rise will be introduced.

And he said the regulator was already planning on the basis that the fee rise may not go ahead.

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‘We are currently building a budget for the 2026 to 2027 financial year which excludes the proposed fee increase,’ he said.

‘This is because no firm assumptions on the fee can be made at this point.’

Mr Kinsella reiterated that if the fees were not raised, there would be a negative impact on the NMC’s reserves.

In council papers published ahead of the meeting, the NMC said its financial reserves would hit ‘unsafe levels’ by the summer of 2027.

Impact on the patient safety 

During the meeting today, Unison’s national nursing officer Ms Horne raised concerns about the impact of a fee rise on the workforce and patient safety, setting out that its recent survey of more than 3,000 members suggested 37% would ‘reconsider’ renewing their registration and 6% said they would ‘definitely leave’ if the rise goes ahead.

‘How has the council assessed the workforce and patient safety risk of this decision, particularly at a time of acknowledged shortages?’ Ms Horne asked.

In response, Paul Rees, NMC chief executive and registrar, highlighted the scale of the regulator’s financial challenge and the need for sustainability.

‘Clearly, any organisation has to ensure that they are financially sustainable, and the NMC has seen substantial deficits over the last couple of years,’ he said.

‘Very real financial challenges’

Noting that the NMC’s deficit was ‘about £90m’ last year, Mr Rees said the deficit for this year was expected to be ‘approximately £24m’.

Mr Rees said the deficits reflected the fact that the NMC has not increased registration fees for 10 years.

‘By the end of March 2026, it will have foregone £180m in lost income,’ he said.

‘So, the NMC does face very real financial challenges.’

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Mr Rees said the NMC had consulted on increasing the fee by £1.92 per month and would now consider the responses.

‘It is incumbent upon us now to look at the response to that consultation,’ he said.

‘Hyper vigilant’ 

Emma Westcott, NMC executive director of strategy and insight, said feedback from the consultation was still being analysed and would be considered by council before any decision was made.

‘We are crunching all the information we have heard, and the process is that the council will receive the feedback first before it makes any decisions,’ she said.

‘That is really important, and I know that the council will be really hyper vigilant about its impact on our registrants in the sector, as well as its impact on the NMC.’

Ms Horne also asked how the council could justify increasing overseas application fees at a time when there has been almost a 50% drop in internationally educated nurses and midwives joining the register, given the importance of international recruitment to workforce sustainability.

The question was not answered in the meeting, but the NMC provided a written response to Nursing in Practice this evening.

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An NMC spokesperson reiterated the impact of its 10-year registration fee freeze, as well as its increased spending on regulatory improvements.

‘The NMC has held its fees flat for 10 years to help nursing and midwifery professionals, whether UK or internationally educated, at a time of a cost-of-living crisis and high inflation,’ they said.

The decision to consult on a fee rise was approved at an NMC council meeting in October 2025, with the proposals first revealed by Nursing in Practice.

The regulator has previously said registration fees account for around 97% of its income and are central to its role in protecting the public, maintaining confidence in the professions and upholding standards.