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NMC fitness to practice

Being referred to the Nursing and Midwifery Council (NMC) can be an anxious experience for nurses. However, the NMC fitness to practise processes are not intended to punish but protect patients and the wider public. If you receive a notice that you have been referred to the NMC, it will help to bring the case to a conclusion if you engage with the process. Promptly completing and returning the relevant paperwork, contacting your professional organisation, trade union or lawyer and your current employer are all steps that can help you through the process. Referrals made to the NMC come from many different sources, including employers, the public and the police. When the NMC receives a referral it follows an established process, set out in the NMC rules, ensuring that all allegations are dealt with effectively, consistently and transparently.

Before reaching an adjudication hearing or meeting, a referral will normally pass through a full investigation and an Investigating Committee meeting. NMC staff gather together the evidence, including statements from relevant witnesses and the response to the referral from the nurse who has been referred.

Sometimes risk factors may mean it is necessary to protect the public by putting in place an interim order to either suspend the nurse or impose conditions restricting their practice. An interim order can be made at any point during an investigation.

Nurses who admit all of the charges against them may be able to provisionally agree a sanction with the NMC, avoiding the need for a full hearing. This is called consensual panel determination. In certain circumstances, they may also have the option to voluntarily remove themselves from the register, for example if their fitness to practise is impaired due to serious or long-term health problems and they do not intend to practise again.

Nurses involved in fitness to practise hearings are encouraged to attend with their representative and put their case to the panel, which is made up of both registered nurses and midwives and lay members from outside of the profession. A number of other people may attend the hearings, including the legal assessor who advises the panel on the law, the NMC case presenter who will present the case and call witnesses, a shorthand writer who records the proceedings, NMC staff to run the hearing and observers, who may include members of the press.

Once the panel has heard all of the evidence they consider if any of the charges are found proved. Panels then decide whether a nurse's current fitness to practise is impaired. They may consider evidence of training the nurse has undertaken since the initial allegations, or look at references from their employer.

If the panel decides that the fitness to practise of a nurse is impaired there are a range of sanctions available to them, including:

  • Taking no action.
  • Making the nurse subject to a caution order. This is a formal finding about the nurse's fitness to practise but no further action will be taken and they will still appear on the register.
  • Imposing a conditions of practice order. These restrict the practice of a nurse for a specified period. Restrictions will differ but they could restrict the nurse from working in a particular setting or carrying out certain aspects of their job without supervision.
  • Suspending from the register. By making a nurse subject to a suspension order, they are prevented them from practising for a certain period of time and their registration will no longer appear as active on the NMC register. If a person tries to practise as a registered nurse during a suspension order they can face criminal charges.
  • Striking the nurse from the register. Striking off orders prevent them from working as a nurse in the UK. If they try to practise as a registered nurse they can face criminal charges.

The NMC exists to protect the public and this process is designed to ensure that only those who are fit to practise continue to provide care.

The fitness to practise procedures are intended to deal with the most serious cases, and employers are encouraged to undertake their own internal investigations first where appropriate, and refer to the NMC only where there are real concerns about the nurse's fitness to practise and patient safety.