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All change at the Nursing & Midwifery Council: a new approach to fitness to practise

The role of the Nursing and Midwifery Council (NMC) is to protect the health and wellbeing of the public. It makes sure nurses and midwives have the skills they need to care for people safely, with integrity, expertise, respect and compassion. Part of the NMC’s function is to take action when things go wrong. The NMC has recently advised that it will be introducing a new approach to its fitness to practise procedures in order to move away from a blame culture.

The new strategic direction ‘Ensuring public safety, enabling professionalism’ states that the “focus is on reducing risks to patients and service users in the future by encouraging openness and learning, not on punishing nurses and midwives for past mistakes”. The full strategy can be read here.

In September 2018, the NMC updated its fitness to practise policies to ensure they were in line with their new strategy. Additionally, between September 2018 and February 2019, the NMC will be piloting some of the new approaches which are set out in the strategy.

Some key changes have already been made. For example, since August 2017 case examiners have had wider powers to deal with cases without the need for a hearing. The role of the case examiner is to make a decision on how a matter should proceed once the NMC has completed its investigation. In addition to their ability to close a case without any action or refer a case to a hearing, case examiners may now close a case with advice, a warning or by inviting the registrant to agree to undertakings. This brings the NMC in line with other regulators such as the GMC and the GDC.

The NMC is required to produce an annual fitness to practise report and submit this to Parliament along with its annual report and accounts. The latest fitness to practise report for the year 2017-2018 was published on 5 November 2018. The statistics show that during 2017-2018, the NMC received 5,509 new complaints which is 1% more than the previous year. Of those new complaints, in 4,778 cases the NMC had identified a registered nurse or midwife. At the initial assessment stage, the NMC closed 3,081 cases (56%), which is a decrease from the previous year (60%). Interim orders were imposed in 583 cases, compared to 705 the previous year. In 2,234 cases, decisions were made by case examiners at the end of the investigation stage. Proportionally fewer cases were referred for a substantive hearing by case examiners this year. This reflects the wider powers given to case examiners in August 2017. Final decisions were made by panels in 1,207 cases. In 257 (21%) of those, the registrant was struck off the register. In the previous year, 1,513 decisions were made by panels with 23% of cases ending in the registrant being struck off.

The NMC has started to make progress in a number of areas, but there is more it must do for those involved in the fitness to practise process. The NMC admits that there is more to be done. The NMC states that in 2018-2019 it intends to:

  1. Continue to change and improve transparency and the way it communicates with those who come in to contact with it;
  2. Continue to develop and embed the new approach to resolving complaints about nurses and midwives;
  3. Prepare to open a new part of the register for nursing associates in England;
  4. Continue its review of the overseas registration process; and
  5. Progress work on standards for the future midwife.

At Lester Aldridge we have experience of acting on behalf of nurses who are being investigated by the NMC. We feel that the changes to the NMC’s fitness to practise processes are overdue. It is hoped that the significant developments being introduced by the NMC will improve the way cases are handled. In particular, it is hoped that the changes will allow matters to be dealt with more efficiently at the early stages and lead to fewer substantive hearings. The recent statistics published by the NMC which show fewer cases being referred to final hearings, may be reflective of the changes already introduced.

If you require any advice or assistance in relation to NMC misconduct or fitness to practice proceedings, contact our experienced healthcare team on 01202 786135 or at

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