NMC: Fitness to practise concerns

Introduction

This practical guide outlines the processes of the Nursing and Midwifery Council (NMC) and the RCN services that are available, if you are referred to the NMC. 

The Nursing and Midwifery Council (NMC) is an organisation set up to regulate nurses and midwives across the UK, and nursing associates in England. As the regulator, the NMC investigates concerns about the nursing profession to make sure they meet the NMC’s standards as set out in the Code and assess whether that individual’s ‘fitness to practise’ is impaired.

The NMC can consider concerns from a range of sources including patients, members of the public, the police and employers.

The NMC will investigate various concerns including:

• misconduct
• lack of competence
• not having the necessary knowledge of English
• criminal behaviour
• serious ill health
• determinations by other health and social care organisations.

The NMC has helpful information about fitness to practice and the types of concerns it considers in their guidance:  Advice and information for employers of nurses and midwives.

The NMC recognises that it is very distressing for a nurse to be subject to fitness to practise proceedings. However, the NMC has an obligation investigate any complaints they receive in line with their fitness to practise process. 

Support from your RCN legal representative

As soon as you hear from the NMC, you should contact us. 

You will be referred to the RCN's legal team who can provide you with advice and representation. A member of the RCN's legal team will be allocated to handle your case.  They will prepare each step of the case and ask you to provide your comments and give instructions.

Your representative's role is to present the case in a way that will bring about the best practicable outcome for you, which will be discussed with you.

You will be sent a client care letter by our legal team at the time of your referral which clearly sets out what you can expect from us and what you need to do.

Your case may progress in one of several different ways. Rather than try to outline them all here, it is best to concentrate on your own path. You will be guided by your RCN legal representative, who can answer any questions you may have on the process. It is helpful to engage with the NMC during their processes. A a step by step guide on the fitness to practice process is available on the NMC website.

You cannot be investigated by the NMC for fitness to practise concerns if you are no longer registered, but can be investigated if the investigation started before your registration lapsed. 

If you were not in RCN membership at the time of the incident that led to the referral, please read our advice on legal support for matters which occurred outside membership. 

NMC investigations

As detailed above, our legal services team will support and guide you through the process. The NMC have information on how they carry out their investigations which will provide a general overview of what you can expect.

If you are subject to any disciplinary investigation by your employer, you may find our guidance on investigations to be helpful. If this happens, please get in touch so that we can arrange further support. Please note, that you have an obligation under section 23 of the Code to co-operate with all investigations and audits and to tell your employer about any caution or charge, conditional discharge in relation to or have been found guilty of a criminal offence. In addition, you must tell employers about any practice restrictions or conditions placed on you by the NMC or other relevant body.

NMC hearings 

The NMC's guidance can help you with what to expect if you are attending a hearing. Many hearings are now “virtual” and you can see our advice guide on virtual hearings for some hints and tips.

As part of their investigation about concerns raised, the NMC will want to speak to other people who may be able to help them. If you are contacted by the NMC to be a witness, you will be asked to provide an account of what is being investigated by the NMC or to provide documentation or other information that may help their investigation.  You may be contacted by an investigator from the NMC or a legal firm acting on their behalf. 

We have a witness advice guide which also explains the support the RCN can offer you.

As a witness, you can also get support from the NMC's witness liaison team and use their resources for witnesses.

There is no obligation to refer yourself to the NMC unless you:

• have received a caution, charge, conviction or conditional discharge for a criminal offence
• are, or have been disciplined by any regulatory or licensing organisation (including organisations that don't work in health and care).

A failure to not tell the NMC about the circumstances above may be a breach of the Code and could result in the NMC taking regulatory action. 

If your employer tells you or tries to encourage you to ‘self-refer’ to the NMC, this is ultimately your choice. We do not usually encourage self-referral because:

• your employer might not make that referral and consequently you experience an avoidable NMC investigation
• the NMC will not criticise you for failing to self-refer (unless there is a specific obligation under the NMC Code)
• though the NMC may give you some credit for self-referring, they may only give this limited weight.

It is important that you contact us to discuss your situation and seek advice if you think it may be necessary to self-refer for any reason. We can consider the individual facts of your case and help you make an informed decision.

We have more information making declarations about criminal matters in our advice guide, police interviews, cautions and convictions. You can find further information on making a self-referral to the NMC, including when you don't need to, on the NMC website.  

NMC investigations can be lengthy and you may find that you have restrictions placed upon your practice. This may include where you can work or limits may be placed on the type of work you can do.

You may have concerns about maintaining your registration through Continuing Professional Development (CPD) and accessing other learning; the latter can be harder if you are not working under a contract of employment as this is often a condition of acceptance onto courses. Continue with your CPD, your reflection on what has happened, and any learning that is relevant to your situation.

Securing any voluntary and paid work (within any restrictions on practice set by the NMC) can be helpful with your case as you may be able to obtain references to present to the NMC panel.

Additionally you may have questions about disclosing your situation to prospective employers and our guidance 'Applying for a job following dismissal' may be useful and includes further information on restrictions and the type of work you can do.

Changing employers

Many employment application forms ask the applicant whether they have ever been referred to the NMC and these need to be completed accurately. The NMC Code also states you must declare to an employer or new employer, any restriction on your practice imposed by the NMC.

Once you have been referred, we usually advise that you tell a new employer because this will engender a trusting relationship with your new employer.  The NMC is likely to get in touch with the new employer at some point anyway. However, there is no obligation for you to tell a new employer that a previous employer intends to refer you to the NMC. It is your choice whether to share this information but it may be advisable not to, as it may not happen.  Please also see the section on  'self-referral' above. 

Working in an unregistered support role

There is nothing to prevent nurses or midwives working in support roles if they choose. There are, however, a number of issues to consider including accountability (professional and legal), employment liability (vicarious) and revalidation. You can find more information in our guidance on revalidation and 'Applying for a job following dismissal'. We also have guidance on readmission to the register and practising whilst lapsed.

We recognise that being referred to the NMC can be distressing and isolating. Being referred can also lead to other issues with finances, relationships and maintaining professional registration. 

Member support services can provide further help and support for you during this difficult time. Members often reflect on how isolated they felt during the investigation. You may be prohibited from speaking to colleagues or just lose touch. Some members turn to family and friends for support, but they may not always understand what you are going through.

Counselling service

If you are feeling stressed, disappointed or upset at any point, our counselling service may be able to help. We offer short term, telephone based counselling as part of your membership and we understand the impact that a referral to the NMC can have on all areas of your life.

If you want to make an appointment, please contact us.

Financial wellbeing

If your financial situation changes because of a referral to the NMC, an assessment from the RCN's financial wellbeing service can help you maximise your income and check your eligibility for benefits.

Our welfare service can also offer further advice and assistance including managing rent arrears and challenging benefit decisions. If you require help from the welfare service please contact us.

Careers Service

Peer support service

 If you're worried about your immigration status due to a referral to the NMC, please contact us to be put in touch with our Immigration Advice Service.

If you have concerns about the fitness to practise of a colleague you should raise your concerns internally, following your employers policy. After raising your concerns, you or your employer may decide to raise these concerns externally.

At all stages, ensure that you keep records of your concerns, and any steps you have taken to resolve them, as you may need to refer to them at a later date.

Please see our raising concerns guidance and refer to the NMC website for information about fitness to practise and their guide, Raising and escalating concerns: guidance for nurses and midwives.

If you have been struck off the NMC register, you can apply for restoration after five years. This is not the same as readmission to the register; restoration only happens if you have been removed or struck off by a fitness to practise panel.

Please visit the NMC website for more information and contact us for advice.