Paul Rees: ‘We need to build the new NMC that everyone wants’

Speaking exclusively to Nursing in Practice, Paul Rees, chief executive and registrar at the NMC, shared the organisation’s plans to increase in-person fitness to practise (FtP) adjudications, plus the launch of a new cultural maturity model and new values that are expected to be released this year.

The chief executive and registrar of the Nursing and Midwifery Council (NMC) says that a new management team is ‘turning the organisation around,’ and that initiatives in areas of development such as cultural change and new values should be expected soon.

Work is needed to drive forward change in the regulator, he says.

‘We just now need to make sure that we can keep powering ahead on the same trajectory for the coming period, to make sure that we successfully build the new NMC that everyone wants,’ he adds.

‘We are turning the organisation around’

Mr Rees describes how the regulator’s fresh focus on cultural change, embedding equality diversity and inclusion (EDI) and improving FtP processing and outcome times are central to how the regulator seeks to become an ‘exemplar organisation’ for registrants and the public.

‘The NMC went through a dark period in 2023 and 2024,’ Mr Rees acknowledges.

‘We’re under new management. We are turning the organisation around. We’re building a new organisation; we’re transforming the culture; we’re improving performance and we’re on the start of the journey. People can see that the organisation is starting to change and that’s really important.’

The NMC has brought in new executive staff to help deliver on the changes it aims to make.

This includes the hiring of Ron Barclay Smith who was appointed as NMC chair in April.

In another change, Emma Westcott, was made permanent executive director of strategy and insight in May.

The appointments follow past concerns about the executive team that were raised in an independent culture review.

‘So, with those additions to the team and with my having been appointed as the substantial chief exec and registrar, the executive board is really sort of working hard and working well,; firing on all cylinders,’ Mr Rees says.

Mr Rees was confirmed in his role as chief executive and registrar in July, after several months as interim chief executive.

A new set of values

The NMC has been consulting on a new range of organisational values that it will be officially launched in the next few weeks, Mr Rees says.

He explains that the five new values will be:

Integrity
Fairness
Respect
Equity
Effectiveness.

The values are the result of consultation with the staff team and the NMC Council, he says, and will reflect the ongoing direction of the organisation.

‘That represents us in terms of the values we need to have at this particular time.

‘It will lead to a culture that is inclusive, empowering and positive, and to actually give greater clarity as to what that would actually look like in practical terms.’

Targets for transformation

Mr Rees’ comments come after the NMC launched a culture transformation plan in March following the Independent Culture Review that was published last year and exposed systemic bullying, racism and harassment at the regulator.

As part of the plan, the NMC has said it is ‘modernising’ its Code and revalidation process with a keen focus on equality, diversity and inclusion (EDI), behaviour outside of professional practice and use of social media.

‘We also want to work with employers to make sure that there aren’t disparities in terms of referrals, because unfortunately that is an issue currently,’ Mr Rees tells Nursing in Practice.

‘We want to work with education institutions to make sure that there aren’t disparities of treatment of nursing and midwifery students. So, I think that’s a really important part of what we’re doing to build the new NMC,’ Mr Rees stresses.

Earlier this month, the NMC launched a survey on the future of the Code and revalidation, asking what change is needed to better reflect the UK’s ‘evolving health and social care landscape’ and ‘new and emerging challenges in practice’.

The NMC hopes to have introduced the new Code and revalidation process by autumn 2027, with the goal of consulting on the changes between September and December 2026.

In the meantime, the NMC will carry on with the next phase of its practice learning review, pursuing the five key lines of inquiry that were approved at a Council meeting in January.

These include plans to evaluate the nursing curriculum and to expand the support that the NMC offers to students, including those with protected characteristics.

The review follows an NMC report into practice learning requirements for nursing and midwifery students.

‘We are really excited to be making improvements when it comes to education and standards,’ Mr Rees said.

The NMC is also working on producing standards for advanced practice, which it hopes to be ready by March 2028.

‘Advanced practice is an area that’s growing and it’s really important that we do have the standards clear.

‘So, I’m really excited that we’re going to be doing that really important work on improving education and standards,’ Mr Rees explains.

Fitness to Practise changes

The NMC is planning to ‘roll out further improvements’ in its approach to FtP in the next few months to improve its investigations and adjudications processes.

Mr Rees outlines how the NMC will be increasing the number of face-to-face FtP adjudications that it can offer, following a move to online adjudications during the pandemic.

‘So, it’s really important that we get a good number of hearings in the in-person environment, but we plan to continue making those improvements,’ he adds.

He explains how the NMC has changed the guidance that colleagues use in screenings. While the NMC used to look at the ‘seriousness’ of a case, the focus is now on the risk that is posed by the registrant involved.

‘So, the question really is, is there a risk that this registrant is not a fit to practise?

‘If there isn’t a risk that they are not fit to practise then it’s not a case for the NMC, so that guidance has helped clarify what people [are] looking for in screening.’

He adds: ‘We need to make sure that we extend those improvements across the whole scope of Fitness to Practise.’

Mr Rees notes that decisions from in-person adjudications are often reached around two days quicker than those that take place online.

At the start of September, the NMC said it would use the coming months to deliver further targeted reforms to transform the FtP experience, including clearer, more compassionate first contact with people when concerns are raised about their practice.

It has also promised more support and resources for registrants who are unrepresented in the FtP process.

In January, Nursing in Practice reported on calls for the NMC to improve its transcription process for virtual FtP hearings amid concerns about written errors in automated transcripts.

A cultural maturity model

The NMC is also hoping to have published a ‘cultural maturity model’ by the end of the year, Mr Rees tells Nursing in Practice.

At the Royal College of Nursing (RCN) Congress in May, nursing staff warned that FtP investigations risk inflicting ‘significant psychological and professional harm’ on registrants and may be impacting patient safety.

They also highlighted feelings of distrust by nursing staff towards the regulator, including from among minority ethnic groups. In April, the NMC signed the Unison anti-racism charter as part of its ongoing commitment to becoming an ‘anti-racist organisation’.

In July, the NMC recommissioned two investigations into whistleblowing at the regulator until later this year. The NMC said there had been several factors that have caused delays to the reviews – which were meant to be received in early 2024.

‘This is a really big job of work. The Independent Culture Review highlighted lots of serious problems with the NMC,’ Mr Rees comments.

The model will ‘set out in detail’ how the NMC plans to embed EDI across the organisation, as well as ensuring ‘psychological safety’ for staff and registrants.