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BME nurses more likely to be referred to NMC by employer – but white staff more likely to be struck off

Black and minority ethnic (BME) nurses are disproportionately referred to the Nursing and Midwifery Council (NMC) by employers – report.
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Black and minority ethnic (BME) nurses and midwives are disproportionately referred to the Nursing and Midwifery Council (NMC) by their employers, according to a new report.

The University of Greenwich was funded by the regulator to investigate its Fitness to Practise (FtP) processes in response to concerns of various organisations about the treatment of BME staff in the NHS.

Employer referrals

The report found that employers were the largest source of referrals of BME staff, and these referrals were most likely to go as far as the final stages of the FtP process. However, BME nurses and midwives were less likely to be struck off or suspended than white registrants.

Other key findings in the report include:

  • Nurses and midwives referred to the

Black and minority ethnic (BME) nurses and midwives are disproportionately referred to the Nursing and Midwifery Council (NMC) by their employers, according to a new report.


BME nurses more likely to face final stages of the fitness to practise process  Photo: Charles Milligan

The University of Greenwich was funded by the regulator to investigate its Fitness to Practise (FtP) processes in response to concerns of various organisations about the treatment of BME staff in the NHS.

Employer referrals

The report found that employers were the largest source of referrals of BME staff, and these referrals were most likely to go as far as the final stages of the FtP process. However, BME nurses and midwives were less likely to be struck off or suspended than white registrants.

Other key findings in the report include:

  • Nurses and midwives referred to the NMC are disproportionately older and men are over-represented.
  • Cases brought against nurses and midwives of white, 'other' or unknown ethnicities are more likely to be closed at screening stage. Cases brought against Asian or black nurses and midwives are more likely to be closed at the investigation stage.
  • Ethnicity is known for only 60% of referrals.
  • Region of training is related to progression through the FtP process. Having trained outside the UK increases the likelihood of the case going to investigation, and having trained in Asia or Africa increases the risk of the case going to adjudication. 

Report overdue

Joint director of the NHS Workforce Race Equality Standard implementation team and Middlesex University research fellow Roger Kline said the report was welcome but long overdue.

He told Nursing Standard the issue of disproportionate employer referrals had to be addressed: ‘The number-one challenge facing the NMC is to go back to the start of the food chain and ask "why is there this pattern of disproportionality?"’

‘When you look at the complaints made by the public, the pattern is more balanced between white and BME staff.’

Mr Kline said the other challenge is the problem of accurately recording ethnicity, especially among staff who self-refer.

Workplace disadvantage

The report highlighted a 2014 Nursing Standard investigation that found BME nurses accounted for 25% of disciplinary cases, despite only making up 19% of the workforce in England.

RCN director of membership relations Chris Cox said the college was deeply concerned by further evidence showing the disadvantage being experienced by BME staff.

'We feel all NHS employers and the independent sector clearly need to tackle all forms of racial discrimination in their processes.

'It is clear too many are being referred in inappropriate circumstances. We are already working with the NMC to address issues once a referral is made, but the more important issue is what employers are doing before it gets to that stage.'

Asked if employers could be referring cases without conducting proper internal investigations, he added: 'I think there is a tendency for matters not to be adequately dealt with internally as employers think they will be perceived as acting inappropriately. The trouble is this in itself creates unfairness in how staff are treated.'

Accurate records

Recommendations in the University of Greenwich report include an 'urgent need' to gather accurate data on ethnicity, area of practice and level of seniority and type of allegation for NMC referrals.

The authors also called for staff, managers and university students to be trained to deal with unconscious bias. 

The NMC said: 'We already undertake a range of work to ensure our FtP process is fair to all nurses and midwives and that it reflects the diversity of our register.

'Since this report was undertaken our data has improved, due to the introduction of revalidation, and we have committed to carrying out the research again allowing us to examine a larger dataset.'

It added it was meeting patient groups, employers, professional bodies and other regulators, and there was 'real appetite' to understand more about the research and achieve progress.

Further information

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