We look at the Nursing and Midwifery Council’s (NMC) “top priorities” for improvements to its fitness to practise investigations and processes.

Andrea Sutcliffe, NMC Chief Executive and Registrar, recently discussed the NMC’s plan for making improvements to its fitness to practise processes and investigations saying:

“We’re now working on an ambitious range of improvements to our FtP processes and decision making. These changes will help us to reduce this caseload quickly and fairly. They’ll also help us to make the right decisions, at the right time. And they’ll ensure that people’s concerns are handled appropriately at every stage.”

Resolving concerns locally

In February 2021 the NMC published “Fitness to Practise Guidance for Employers” in order to help employers decide whether a concern should be referred to the NMC or not.

The purpose of the employer’s guidance was to encourage employers to take more ownership of fitness to practise investigations locally and to limit NMC referrals to the most serious cases.

The NMC will strengthen its focus to encourage more concerns to be resolved locally, so that it only takes forward the most serious cases “to keep the public safe.”

Nurses, midwives and nursing associates could expect therefore to see more investigations undertaken by their employers without the need for the NMC to become involved.

The strengthening focus on local investigations and resolution has translated through to the NMC’s referral forms.  The revised referral form is “strengthening our guidance for everyone on when to make a referral. By supporting those considering making a referral in this way, we’re able to be more efficient and focus our work on referrals that are necessary to protect the public”.

Screening guidance

Updated Screening Guidance will give more flexibility to screeners – the first stage of the NMC’s fitness to practise process – to encourage concerns to be investigated locally.

The most recent update to the Screening Guidance was May 2021.  The updated guidance includes a section for employers that states:

“Our fitness to practise principles make it clear that local investigation and resolution are always the preferred way to deal with concerns, provided that approach does not leave the public at risk.

“Our Employer Link Service supports employers when deciding if we need to become involved in a concern. They provide advice to employers at the conclusion of a local investigation on whether or not regulatory action needs to be taken. Our employer resource aims to help employers conduct local investigations.”

Taking account of context

Similar to strengthening the focus on local resolution, there will also be “greater account” of the NMC’s new approach to taking account of context going forward.

This new approach to taking account of context is outlined in eight commitments set by the NMC:

  1. Approach cases on the basis that most people referred to us are normally safe
  2. Seek to build an accurate picture about the nurse, midwife or nursing associate’s practising history
  3. always carefully consider evidence of discrimination, victimisation, bullying or harassment
  4. Where risks are caused by system and process failures, we’ll concentrate on the action we can take to help resolve the underlying issues
  5. In cases where a nurse, midwife or nursing associate was required to use their professional judgement we’ll respond proportionately
  6. Look for evidence of remediation where a serious concern was caused by a gap in knowledge or training or personal context factors
  7. Always look into whether group norms or culture influenced an individual’s behaviour before taking action
  8. Where an incident has occurred because of cultural problems, we’ll concentrate on taking action to minimise the risk of the same thing happening again

Multi-disciplinary decision making

The NMC is trialling a new approach it calls “multi-disciplinary decision making”.  This new approach “brings the right people from different teams together at the outset when concerns are raised”.  The NMC says it will “enable robust and informed decisions to be made more quickly and with the appropriate specialist input at the earliest opportunity.”

Time will tell if, and what, practical impact these proposed changes will have and how long it will take to embed.  We know however that nurses, midwives and nursing associated who are represented often have better outcomes when facing fitness to practise proceedings.

Kings View Chambers are leading and specialist fitness to practise barristers with a proven and excellent track record.  If you are subject to fitness to practise proceedings or investigation, contact us for a no obligation and free initial case assessment.

Disclaimer: This article is for guidance purposes only. Kings View Chambers accepts no responsibility or liability whatsoever for any action taken, or not taken, in relation to this article. You should seek the appropriate legal advice having regard to your own particular circumstances.

Stephen McCaffrey

I am a NMC Defence Barrister who has represented large number of medical professionals before their regulatory bodies in either first instance proceedings or appeals. 

I can help with all matters relating to NMC Fitness to Practise referrals issues including:

  • What to do if you have been referred to the NMC
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  • Advice, assistance and representation for hearings before the Conduct and Competence Committee
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