Changes to NMC fitness to practise could speed up a convoluted process

Reforms include a proposal for warnings to be issued when there is no case to answer but concerns about past conduct remain

Reforms include a proposal for warnings to be issued when there is no case to answer but concerns about past conduct remain

If the proposed changes are given the green light, the NMC will be able to
conclude some cases at an earlier stage. Picture: Charles Milligan

Plans to speed up the lengthy process for fitness to practise (FtP) hearings and reduce the number of cases that go to a full hearing are currently being discussed by the Nursing and Midwifery Council (NMC).

The regulator has already reduced the time that many cases take, but has now launched a consultation on further improvements.

If proposed changes are agreed, the NMC will be able to conclude some cases at an earlier stage, by giving additional powers to case examiners, who decide on whether there is a case to answer.

These powers could include the ability to recommend formal binding agreements, or undertakings, between the NMC and registrants. For example, a registrant may agree to undertake activities such as further training or work under supervision. 

Referrals increasing 

The examiners could also issue warnings when there is no case to answer but concerns about a registrant’s past conduct remain. These would stay on a nurse’s registration for 12 months.


The number of new concerns referred to the NMC in 2015-16

Such undertakings could prevent the need for a FtP committee to investigate the case further, while the most serious cases would still go to a hearing.

The consultation was launched last week, just before the NMC published its annual FtP report, which revealed the number of nurses and midwives referred increased for the third year in a row.

A total of 5,415 new referrals were received last year, 4.5% on the previous year.

Closure rate 

The regulator concluded 78% of its cases within 15 months, and says it is starting to reap the benefit of changes to the FtP process.

The annual report shows 2,665 FtP cases were closed at the initial assessment stage in 2015-16. This is a closure rate of 51%, up from 38% in 2014-15.

The regulator has been strongly criticised recently for the length of time it takes to complete cases. The longest-running case lasted 6 years and 10 months.

Changes have included adding senior decision-makers at an early stage of the process, strengthening early stage decision-making by revising guidance on preliminary assessment of allegations and establishing a team to manage high-profile, sensitive and complex cases.

Too long, too much

With many inappropriate cases being referred on by employers, the regulator launched an employer link service in September 2015 for UK health trusts and boards. 

Speaking at a debate on health regulation held in London, former RCN general secretary and chief executive Peter Carter highlighted the problem: ‘There are far too many examples of employers referring to the NMC without ensuring only appropriate cases end up before it.’


The number of FtP cases closed at the initial assessment stage in 2015-16

Launching the new consultation, which follows a Department of Health (DH) consultation on the same issues, NMC chief executive and registrar Jackie Smith said the regulator struggles with ‘outdated’ legislation.

‘We know and accept that it currently takes too long and costs too much to conclude cases,’ Ms Smith says.

Modernising processes 

‘The launch of this consultation is a crucial step towards modernising our processes, which will better enable us to protect the public.’

Former children’s nurse Jemima Reynolds, who has experienced FtP proceedings after making a mistake at work, has welcomed any approach that will make the process swifter for nurses involved. 

Ms Reynolds, who runs a support group for nurses referred to the NMC, says increasing the number of closures earlier in the process would be a ‘brilliant’ move. ‘It is a very destructive process,’ she says.

Concerns raised 

‘Cases take such a long time to go through and that is a difficult and lonely time. If things can be sped up for the right reasons, such as for the nurse’s well-being, rather than bureaucracy, that is important.’


The number of nurses and midwives on the NMC register as of March this year

But unions have some concerns about the plans. Unison head of nursing Gail Adams says she agrees that the processes need to become swifter and smoother for all involved, but believes warnings from the regulator should not be imposed on nurses.

The RCN raised similar concerns in response to the earlier DH consultation, stating that these warnings would be visible on otherwise unblemished records.

She says the NMC is following too closely the lead of the General Medical Council – which dictates the regulatory model used by doctors. 

Consensual process

The health and FtP committees should not be combined into a single committee as planned, she says. FtP hearings take place in a more adversarial manner not suitable for discussing a nurse’s health problems.

‘The warning process should be consensual and a learning opportunity for the nurse,’ she says.

‘I have spoken to all the other unions with regard to this. If they do not move on this issue we are not going to be in a position to recommend it to our nurses.’

Quicker action to close cases

The NMC says a number of improvements have allowed them to close many more cases at an early stage. Its annual FtP report includes one example of where it avoided an unnecessary referral:

A nurse, who was caring for a patient in his home, needed to run a personal errand and asked the patient’s wife if they could pop out for an hour because the shop would be closed by the end of their shift. The nurse told the patient’s wife that another member of the care team would stay with the patient. 

The patient’s wife refused and the nurse was subsequently filmed on the property’s CCTV making derogatory comments about her. The nurse was subsequently given a verbal warning by their employer, who felt it was sufficient after the nurse apologised to the patient’s wife. 

The employer phoned the employer link service (ELS), started by the NMC last year, to ask if they should refer the nurse to the regulator, as the patient’s wife was requesting they do so. 

After careful consideration of the matter, ELS advised that appropriate action had been taken by the employer and the matter did not meet the threshold for an NMC referral. 


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