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Disproportionate number of black African nurses face fitness to practise process

Questions over why NMC sees so many referrals that require no further action
Black woman in front of NMC hearing. Picture: Charles Milligan

Questions over why NMC sees so many referrals that require no further action

Nurses of black African ethnicity are more likely than their white British colleagues to be referred to the Nursing and Midwifery Council (NMC), according to a report.

The NMCs annual Equality, Diversity and Inclusion (EDI) report outlines the differences in ethnicity, gender and age among registrants facing the fitness to practice (FtP) process.

Data on referrals

The figures show that black African nurses and midwives made up 12.4% of new referrals to the NMC in 2018-19, despite forming only 6.7% of the nursing register.

Conversely, nurses of white British ethnicity 70% of the nursing register are less

Questions over why NMC sees so many referrals that require no further action


Picture: Charles Milligan

Nurses of black African ethnicity are more likely than their white British colleagues to be referred to the Nursing and Midwifery Council (NMC), according to a report.

The NMC’s annual Equality, Diversity and Inclusion (EDI) report outlines the differences in ethnicity, gender and age among registrants facing the fitness to practice (FtP) process.

Data on referrals

The figures show that black African nurses and midwives made up 12.4% of new referrals to the NMC in 2018-19, despite forming only 6.7% of the nursing register.

Conversely, nurses of white British ethnicity – 70% of the nursing register – are less likely to face new FtP concerns about them, accounting for 61% of referrals.

Furthermore, analysis of case examiner decisions shows the ethnic groups with proportionately more ‘facts not proved and no further action taken’ in their cases were Asian Indian (65.8%) and black African (63%). 

Impact on registrants


Roger Kline Picture: Neil O'Connor

NHS race equality expert Roger Kline said the nursing regulator should ensure employers carry out impartial checks to ensure referrals are appropriate. When a case is dropped, a review of the processes that led to it being opened should take place, he said.

'It is unacceptable that such a disproportionate number of black African nurses are referred to the regulator,’ he said.

'That facts are not proved and no further action is required in many of these cases should also prompt the NMC to challenge the employer on why such a referral – with the impact on the registrant – was made in the first place.'

Understanding when to refer to the NMC

NMC director of fitness to practise Matthew McClelland said: 'We are working closely with employers to make sure they have good internal processes for addressing concerns fairly and thoroughly themselves, and know what and when to refer to us.’

Mr McClelland added that in coming months the NMC will be conducting further research into why disproportionate numbers of ethnic minority staff are referred to the regulator.

Other findings in the EDI report include:

  • Nearly a quarter (22.8%) of new concerns related to men, despite men making up only 11% of the register.
  • Nursing associates are younger on average than other registrants - 32.9% of nursing associates are aged 21-30, compared with 14% of nurses. 
  • 4,457 registrants (0.6%) said their gender identity doesn’t match the sex they were registered with at birth, up from 3,780 (0.5%) last year.

Further information

Read the NMC Equality and Diversity report


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