Fitness to Practise process to change, proposals from NMC suggest

The Fitness to Practise process could be about to change, as new proposals from nursing regulator the Nursing and Midwifery Council are under consultation.
Fitness to practice hearing

The Fitness to Practise process could be about to change, as new proposals from nursing regulator the Nursing and Midwifery Council are under consultation. 

Photo: Charles Milligan

Fitness to Practise (FtP) hearings would only be held ‘in exceptional circumstances’ under radical changes to the process being proposed by the Nursing and Midwifery Council (NMC).

The regulator says the current system of holding nurses and midwives accountable for errors is ‘expensive, time consuming and adversarial’.

It believes the FtP process should be about managing the risk posed to patients or members of the public in the future and not about punishing people for past events.

In future, the NMC wants to resolve as many cases as possible by having registrants admit a mistake, even one which caused serious harm, at the earliest opportunity, then engage fully with the NMC, and demonstrate having learned from the error.

In cases where this approach is followed, the NMC says full hearings can be avoided and it ‘may no longer need to impose a more restrictive sanction – such as a long-term suspension or conditions of practice’.

Safety the first priority

Fitness to Practise cases

  • Currently the NMC receives around 5,500 referrals a year; 39% from employers, 28% from members of the public and 10% self-referrals
  • Approximately 80% of cases are concluded in 15 months
  • In 2016-2017, the NMC’s independent panels imposed more than 1,200 sanctions, around half of which involved removing a professional from the register permanently or temporarily
  • It currently spends more than 70% of its budget – obtained from the £120 registration fee – on Fitness to Practise

It insists public safety will remain at the core of the process and claims there is lots of evidence that patient safety is improved by a learning culture.

It adds: ‘The way FtP is currently set up does not encourage this’.

The NMC ruling council will meet on 28 March to decide whether to put the plan out for public consultation.

In board papers published ahead of the meeting, the NMC states: ‘We do not believe that full public hearings are always required to reach a decision that protects the public.

‘Their adversarial nature often has a negative impact on referrers, witnesses and registrants, and they are slow and resource intensive.

Public approval

In an interview with the Daily Telegraph, NMC chief executive Jackie Smith acknowledged the proposals could be met with a backlash from the public.

She said: ‘This is a consultation, if other organisations come back and say this doesn’t look right, we will take that seriously.

‘The key thing for us is what patients’ groups think and what the public thinks.’

If approved the consultation will run from 3 April until 29 May.

Changes to the Fitness to Practise process

The new strategy follows several recent changes by the NMC designed to streamline the Fitness to Practise (FtP) process

These include:

  • Introducing voluntary removal and consensual panel determination
  • Introducing case examiners to improve the efficiency, quality and consistency of decision-making at the end of the investigation stage
  • Setting up the Employer Link Service to support employers with referrals, provide learning and induction for the FtP process and share information


Further information

NMC Council papers for 28 March meeting

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