Relaxing the NMC’s fitness to practise sanctions has risky implications

Will this COVID-19 related decision affect public confidence in the nursing profession, asks former NMC advisory panel member

Picture: Charles Milligan

Actions taken by the Nursing and Midwifery Council (NMC) in response to COVID-19, including the decision to open a new part of the register for nurses and midwives who wish to return to work to support front-line staff, are admirable.

However, I find one of its measures difficult to understand.

NMC overturned some fitness to practice sanctions during the pandemic

Nursing Standard reported recently that the NMC had looked at how it conducts fitness to practise (FtP) casework in light of the pandemic. Four suspended registrants were allowed to return to practice: one with all sanctions removed, and three returning to practice with a caution.

An NMC statement to Nursing Standard explains: ‘As part of this, we have been able to identify a small number of cases where a sanction was imposed on public interest grounds only and where no risk to patient safety was found.

‘In some of these cases, our independent panels have carried out a review of the original sanction – alongside additional information provided by the registrant or their representative – to consider whether a new sanction is now appropriate so that individuals can return to practice where it is safe to do so.

‘As always, panel decisions will be reviewed by our usual quality assurance process.’

Justifications for FtP reviews have to be questioned

The NMC’s core value is to put the interests of patients and service users first by upholding safety, effectiveness, trust and professionalism.

I am proud to have been part of an overall improvement programme for the NMC, as a member of its advisory panel from 2012-2014. I represented registrants in the interview process for the appointment of a new council.

It is with great pride that I have seen progress at the NMC over the years, especially under the leadership of Andrea Sutcliffe.

‘If registrants’ integrity is seen to be expendable, a small number will believe they have licence to expect more lenient outcomes of future NMC referrals’

Its performance in FtP has made significant progress since I was chief nurse for north east London from 2003-2006 and chief nurse for NHS London from 2006-2013.

However, these case reviews and the justification of them prompt a number of concerns:

  • Was the impetus for the reviews the pandemic or political pressure to increase the workforce?
  • Are the interests of patients and service users being put first?
  • Are these decisions and outcomes safe and effective?
  • Do these decisions promote trust and professionalism?

A damaging message about the value of integrity

The NMC identifies COVID-19’s impact on the workforce as the trigger for these reviews.

They should be the result of a continued focus on organisational performance.

One of the registrants had been suspended from the register for six months for working shifts at another trust while off sick from her own. This would represent a clear breach of trust and integrity.

As a registrant, if you breach trust in one area of your professional life it raises concern about whether you can be trusted in any area of your professional life.

I am equally surprised that the employing NHS trust is reported to have said the nurse’s return was critical to the workforce. This begs the question: why is it suddenly okay to readmit this nurse to the register and the workforce?

Decisions and outcomes such as this will certainly raise a few questions for current registrants about the message they send. If registrants’ integrity is seen to be expendable, a small number will believe they have licence to expect more lenient outcomes of future NMC referrals.

How will public confidence in the profession be affected?

I am concerned too about the impact on the public’s perception of nursing and midwifery, and the confidence the public will have in us.

Decisions to return registrants to the workplace are fundamental to public perception and confidence and in certain circumstances they risk undermining regulation.

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Trish Morris-Thompson is visiting professor of nursing and midwifery leadership at Bucks New University and has held senior leadership roles in the NHS and care sector