Analysis

NMC to examine impact of fitness to practise hearings

Action is promised by regulator after a Nursing Standard investigation reveals nurses accused of misconduct can suffer a mental health crisis

A project to understand the impact of fitness to practise (FtP) investigations on nurses’ mental health is about to get under way at the Nursing and Midwifery Council. The nursing regulator says it is committed to undertaking work to ‘better understand’ the link between mental health and the investigation process.


Jemima Reynolds has set up a support group for nurses. Photo: David Gee

The commitment followed a Nursing Standard story highlighting that the RCN counselling service had supported more than 100 nurses facing FtP investigations in the past year. Many of those nurses were reported to be feeling suicidal.

The NMC said it will be establishing the work’s terms of reference and project lead ‘in the coming weeks’, but declined to give any further information, other than that it was likely it would continue into next year.

‘We expect identifying mental health issues with registrants will be part of the piece of work we are undertaking,’ an NMC spokesperson says.

Duty of care

Unions and the medical regulator, the General Medical Council (GMC), say the NMC has yet to share its plans.

‘So far the NMC has not discussed this with us,’ says Unison head of nursing Gail Adams. ‘While the NMC has a responsibility to protect the public, it also has a duty of care to registrants.

‘The psychological impact of going through the FtP process is very difficult for individuals. We suggest FtP panels should have training on mental health so they have awareness and understanding.’

Ms Adams says she hopes the NMC appoints an independent project lead with  expertise in mental health.

She adds that understanding is required ‘to engage with registrants to get the best possible feedback about what it can do differently’.

Nurses who turn to the RCN counselling service have typically experienced stress, depression, anxiety or suicidal ideation, and much of the work the counselling service undertakes with them relates to NMC proceedings.

Counselling service lead Sarah Murphy welcomes the NMC’s attempt to address issues experienced by nurses undergoing FtP.

Nurses’ voices

But she stresses this work should ‘include the voices of nurses who have been through FtP proceedings’.

The NMC is not the only health regulator looking to improve support for registrants going through disciplinary processes.

The General Medical Council has been looking at this issues for a number of years. An independent review it commissioned in 2014 found that 24 doctors committed suicide between 2005-2013 while under investigation.

The GMC is considering proposals from England’s former national clinical director for mental health, Louis Appleby, to transform its FtP processes and give better support to vulnerable doctors.

But, in contrast to nurses, doctors already have access to a variety of support services.

These include the Practitioner Health Programme (PHP) a confidential, NHS-funded service for doctors and dentists who are unable to access confidential care through mainstream routes due to the nature of their role or health condition.

Offer of help

In fact, the lack of support for nurses has not gone unnoticed by this organisation.

PHP medical director Clare Gerada says that a backlog of NMC cases – in 2013, the NMC had 1,800 cases to deal with and was hearing 22 cases a day – led her to approach the NMC to see if her organisation could help support nurses. 

Professor Gerada says: ‘We have been concerned about the mental health impact of referrals to the NMC for a number of years.

‘We were so concerned we contacted the NMC two years ago and met chief executive Jackie Smith.’

However, despite PHP’s offer of help, Professor Gerada says nothing further came of that approach and a lack of funding for nurses means PHP’s hands are tied.

‘There is a crying need for a support system for nurses who are suspended and suffering,’ Professor Gerada adds.

‘Some nurses do trickle through to us such as very senior ones who cannot access care locally.

‘In exceptional circumstances, we can see nurses if they get funding, but it might take five to eight weeks.

‘It is a lonely space [for nurses] – we run groups for suspended doctors and it is a lifeline as they go through the most difficult of times.

‘These are human beings suffering and they have essentially been left with no support.’ 

Peer support 

Band 5 children’s nurse Jemima Reynolds has set up a private online support group called You Are Not Your Mistake, for nurses who are undergoing
disciplinary processes.

Ms Reynolds was inspired by a group for healthcare practitioners called Tea and Empathy, set up on Facebook.

This group, which has more than 1,500 members, was formed after junior doctor Rose Polge died earlier this year.

Ms Reynolds says it is crucial that the NMC offers referred nurses more support at an early stage. 

‘This is a growing issue,’ she adds. ‘More nurses are being referred to the NMC than ever before and, unlike doctors, there is nowhere for them to go.’

She adds not only is there a lack of clinical support for nurses going through disciplinary proceedings, peer support can be lacking too.

‘Look at the floor’

‘When I made a mistake at work, doctors and consultants would come and ask how I was doing,’ Ms Reynolds says. ‘Nurses would look at the floor and walk away.’

For more information about You Are Not Your Mistake, contact Ms Reynolds by emailing youarenotyourmistake@gmail.com 

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