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Proposed changes to NMC fitness to practise process

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The Government is currently working with the Nursing and Midwifery Council (NMC), who is the professional regulator for qualified Nurses and Midwives, on proposals which will hopefully make the NMC’s fitness to practise processes more efficient and quicker.

There are two proposed changes which the Government has, in principle, agreed to and it is hoped that these will be introduced within the next year.

The first proposal involves implementing a system whereby professional case examiners make decisions at the Investigation stage to decide whether cases should be referred to a final fitness to practise hearing. The General Medical Council (GMC), which is the professional regulator for Doctors, already has a similar process in place which appears to work well and the NMC hope that this will provide more consistency in the decisions made at the Investigation stage.

The NMC currently refer cases to an ‘Investigating Committee’ once they have completed their investigations, which is comprised of 3 members, including at least one registered Nurse or Midwife and one lay member. The Panel considers all of the information before it to decide whether there is a case to answer and a real prospect of the allegations being proven if referred to a final hearing.

The RCN Chief Executive, Dr Peter Carter, has said, “In principle this is a positive move, and we hope it will improve efficiency at the NMC and help it better serve patients and nurses.”

It may be that the majority of cases will still proceed, however, with professional case examiners making the decisions it is hoped that the decisions made at the Investigation stage will be more consistent. It is not yet entirely clear, however, who these professional case examiners will be and whether they will in fact include actual registrants.

The second proposed change involves providing the NMC with a new power to review decisions to close cases at the Investigation stage. At this stage, after the professional regulator has concluded their investigations into the allegations made, the registrant is given the opportunity to make a written response before their case is placed before the Investigating Committee to make a decision.

It is questionable how this would in any way quicken up the NMC’s fitness to practise process or even make it more economical by reopening old cases and bringing them before the regulator for a second time.

Given that the NMC already has a backlog of cases which is likely to take until 2014 to clear, it may be that it only adds to this ongoing delay in hearing cases. As fitness to practise specialist lawyers, we know all too well how much time and hard work goes in to providing a carefully drafted response to the Investigating Committee and sometimes how difficult it is to persuade the Investigating Committee not to proceed with a case. It therefore does not seem fair or just for a registrant to be put through the same stressful process again after their case has already been concluded once.

The exact scope of this power will therefore need to be rigorously reviewed and we will need to see a lot more detail to comment specifically on how this power may actually work in practise if it is implemented.

However, with an increase in NMC registration fees together with an increase in the number of fitness to practise referrals, it is vital that the NMC makes a better use of their resources to ensure that the systems and procedures in place will provide the most effective and efficient way of dealing with cases as quickly as possible.

It was reported by the Nursing Standard that in 2012/2013 there were 589 nurses struck off the NMC’s register compared to only 365 the previous year. This appears to correlate with the number of fitness to practise hearings with an increase of more than 600 hearings from 2011/2012 to 2012/2013.

Jackie Smith, the Chief Executive and Registrar of the NMC, said in respect of the changes, “We at the NMC are ten years behind in how we can investigate concerns about the fitness to practise of nurses and midwives because of our outdated legal framework. The Prime Minister is delivering on his promise of reform, made when the Francis Report was published.”

It remains to be seen how these new fitness to practise processes will work in practise or whether they will in fact improve the NMC’s efficiency and flexibility so that concerns can be investigated more quickly.

What is clear, however, is that the Government will continue to consult with the NMC on these proposals in the coming months and significant changes are inevitable for regulators and the healthcare sector following the most recent failings in protecting patient safety which were identified in the Francis Report.

By Laura Hannah

If you have been referred to your professional regulator, it is vital that you seek legal advice and representation from a specialist to ensure that your case is managed effectively to place you in the best possible position. You can call our specialist solicitors now on 01616 966 229.