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Nursing regulator reduces FtP caseload but still short of target

Nursing regulator reduces FtP caseload but still short of target

The Nursing and Midwifery Council (NMC) has reduced its fitness to practise (FtP) caseload by 14% in a year, but was still short of its 5,000-caseload target.

The change marks the first reduction in FtP caseloads since 2019 and the nursing regulator said it was ‘confident of continuing this downward trend’ going forwards.

Within its annual FtP report for 2022/23, the NMC reiterated how its ‘top organisational priority’ was to ‘swiftly and safely’ reduce the number of open FtP cases it has.

The drive comes after the NMCs caseload significantly increased in volume during the coronavirus pandemic, and as some casework was paused amid the pressures caused by the outbreak.

For the past three years the NMC has failed to meet timeline requirements for FtP requirements and last year the super regulator – the Professional Standards Authority – wrote to the government outlining its concerns about the NMC’s backlog of cases.

Within its new report, latest data showed that during 2022/23, the FtP caseload was reduced from 6,469 cases at 31 March 2022, to 5,577 cases at the end of March 2023 (-14%).

The NMC stressed that while it did not achieve its target caseload of 5,000 by March 2023, ‘positive progress was made, with a continuing decrease in the caseload for the first time since 2019’.

Within its report, the nursing regulator noted several changes it had made to its processes during the screening, examination, investigation and adjudication stages to help drive down open cases.

This included an increase in the number of decision makers on its screening team, a focus on ‘older and higher risk’ cases and work to improve the ‘efficiency and effectiveness’ of its virtual hearings.

Meanwhile, the NMC also said it was committed to ‘ensuring more equitable experiences and outcomes’ for those going through the FtP process, as part of its commitment to tackling inequality and discrimination.

It pointed to research from August 2022 which found that nurses who are Black, male, transgender or bisexual are more likely to be referred to the NMC.

The report said work around equality, diversity and inclusion was ongoing and that it an independent review it had commissioned around FtP cases was due to complete in 2023/24.

‘The review will enable us to make further adjustments to our ways of working, to ensure consistency and fairness when we handle all such cases,’ said the report.

The data

During 2022/23, the top three categories of allegations found proved included patient care (22%), prescribing and medicines management (16%), and record keeping (13%).

Data showed that 181 nurses were struck off the UK register in 2022/23, as well as six midwives and two nursing associates.

Meanwhile, 151 nurses were suspended, 60 had conditions placed on their practice and 28 were given a caution.

The NMC also appeared to miss some other targets around timeliness.

According to the report, the NMC imposed 65% of interim offers within 28 days of receiving concerns – versus a target of 80%.

In addition, it completed 61% of cases within 15 months of receiving concerns – versus a target of 80%.

Across 2022/23 the NMC also said it had received 5,068 new concerns – a decrease of 4% on 2021/21.

‘This is set against a backdrop of a growing register, so the proportion of registered professionals being referred to us is even smaller this year,’ the report said.

Looking ahead

Going forwards, the NMC aims to reduce its total FtP caseload to 4,000 cases.

It suggested this will be done by:

  • developing its casework approach, including improvements to management oversight and proactive escalation of issues causing delay
  • optimisation of key casework processes, using external expertise to streamline and speed up work while maintaining quality
  • testing and piloting new ways of working, including moving towards having single case owners so we provide a more consistent service as part of its person-centred approach to the FtP process.

Annual report

The FtP report comes alongside the publication of the NMC’s Annual Report document which highlights other initiatives and projects being worked on as part of its strategy for 2020-2025.

This included its changes to the English language requirements to offer more flexibility to international applicants on the register, alongside changes to education programme standards following the UK’s exit from the EU.

The annual report also issued an update on the NMC’s ongoing investigation into the potentially fraudulent registration of some nurses from Nigeria, amid concerning data around a computer-based test these nurses completed.

FtP is ‘primary focus’

Andrea Sutcliffe, NMC chief executive and registrar, said: ‘Our primary focus has been to reduce our fitness to practise caseload so we can make quick and fair decisions that protect the public.

‘We’ve continued to strengthen and improve our education standards to support learning, and introduced changes in our English language requirements to ensure they’re both fair and robust.’

She recognised there was ‘still much more to do over the final two years of this strategy’ and pointed to work being done with the government on ‘reforms which will transform the way we work’.

As part of this, she pointed to the NMC’s ongoing exploration of the potential regulation of advanced practice ‘to ensure consistent standards of care for people’, as well as the regulators work to help ‘improve safety in maternity services’.

Ms Sutcliffe added: ‘I’d like to say thank you to all my colleagues and members of council for their hard work over this last year and for their commitment to make further progress in the year ahead.’

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