Fitness to practise: the number of referrals made to the NMC has grown by nearly half over the last year, and while this is not necessarily a bad thing, registrants must understand the process.
Subject: Medical societies (Services)
Medical societies (Powers and duties)
Author: Munday, Dave
Pub Date: 08/01/2011
Publication: Name: Community Practitioner Publisher: Ten Alps Publishing Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 Ten Alps Publishing ISSN: 1462-2815
Issue: Date: August, 2011 Source Volume: 84 Source Issue: 8
Topic: Event Code: 360 Services information
Product: Product Code: 8622000 Medical Associations NAICS Code: 81392 Professional Organizations SIC Code: 8621 Professional organizations
Organization: Organization: Nursing and Midwifery Council; Nursing and Midwifery Council
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 263250634
Full Text: Nurses, midwives and specialist community public health nurses often forget about the role that the NMC performs, sometimes thinking it is simply where we pay our now yearly registration fee to allow us to practise. However, this is only part of a much bigger picture. Its main role is to protect the public, and this is something as registrants that we should understand.

Over the last few years, the number of referrals to the regulator has grown. Between 2009 to 2010 and 2010 to 2011, the number of cases referred by employers increased by 46% (546 cases). You could argue that this is a positive thing in that employers, clients and members of the public are more aware of the regulator and the role they play. This may also be partly due to regulators having been brought front and centre following dire failings in care from examples like MidStaffs and the more recent serious care failing at Winterbourne View Care Home.

This article aims to address some of the key questions that members can have about fitness to practise (see Box 1).

Where do referrals come from?

As would most likely be expected, the greatest number of referrals come from employers (1743 cases in 2010 to 2011, 41% of all the cases in the year). The police and members of the public referred a similar number (909 and 915 cases respectively, approximately 22%), whereas referrals from other professionals surprisingly made up only 1% (38 cases). With 605 'other' cases the total number of referrals was 4211.

Complaints process

A referral to the NMC can come from:

* A registrant's employer

* A colleague (who may also be an NMC registrant)

* A client or their carer

* A member of the public.

Referrals can also come from agencies like the police if they are aware of the registration status of an individual.

Once the complaint has been made, this is then screened by the NMC. This includes checking that the complaint relates to someone who is on the NMC register and that the nature of the complaint is something that the NMC should be involved with. If satisfied that there are grounds for a case, the details will be passed to the case progression team. This team then prepares the case for initial presentation to the investigating committee.

The investigating committee does not meet any of the people concerned, working only from the paperwork that has been collected and deciding whether there is a case to answer. At this stage, there are five possible next steps:

* Close the case with no further action

* Refer the case for an interim orders hearing to be held

* Refer the case to another investigating committee panel for adjudication if the case concerns incorrect or fraudulent entry in the register

* Refer the case to the Conduct and Competence Committee if there is an alleged impairment of fitness to practise

* Refer the case to a panel of the Health Committee if the person under investigation is considered unfit to practise due to a health problem.

Of the 4211 cases that were referred to the NMC in 2010 to 2011 (0.6% of the 667 072 registrants), 2215 cases were followed up with investigations.

Over the years, the NMC has made the process more and more 'legalistic', and to fully support our members Unite have responded similarly. Now when our members face NMC hearings, as well as receiving support from their local workplace representative, the regional officer will also make a referral to Unite's legal department so that the member can receive appropriate legal support at any hearings.

Throughout this process (and as with other issues), if the regional officer requires the specialist support of the health sector professional officers this will be provided.

Types of allegations

The NMC highlights four broad areas into which allegations may fall.


Behaviour that falls short of what can reasonably be expected of a registrant.

Lack of competence

Lack of knowledge, skill or judgment that means a registrant is unfit to practise.

Character issues

Cases concerning character nearly always involve some form of criminal behaviour.

Poor health

Long-term, untreated or unacknowledged physical or mental health conditions.

Committees and their adjudication

If it is considered that there is a case to answer, the case will be referred to either the Conduct and Competence Committee or Health Committee for adjudication.

At either, the panel is made up of nurses or midwives and lay members. The hearing is also attended by the case presenter (a legal expert acting as prosecutor for the NMC), the NMC's officer (who facilitates the hearing) and record-keeper. Both the investigating committee and Conduct and Competence Committee are held in public, whereas the Health Committee is in private.


If the panel decides that the registrants fitness to practise is impaired, they have a range of sanctions which they can impose. The NMC stresses that the sanctions are not there to punish the registrant but to protect members of the public, maintain public confidence and uphold proper standards. The available sanctions are:

* A caution order (one to five years)

* A conditions of practice order

* A suspension order

* A striking off order

* Removal or amendment to the register (in the case of incorrect or fraudulent entry)

* A conditions of practice order and suspension order can both be imposed as an interim measure.

Further details about these sanctions can be accessed online, see: Hearings/How-the-process-works/Sanctions

Of the 2215 cases investigated in 2010 to 2011, 1294 led to sanctions being imposed and 197 to striking off orders (0.03% of total registrants). It is interesting to note that there was a decline in striking off orders compared with 2009 to 2010 (202 cases) despite there having been a large increase in referrals to the NMC.

Dave Munday

Unite/CPHVA professional officer
Box 1. Members' frequently asked questions

My employer has raised concerns regarding my fitness to practise. If I
leave their employment will that be the end of it?

Your employer would still have a duty to refer any registrants who they
believe to be unfit to practice, so resigning may not stop any process
that would be followed by the NMC

My employer/client has said that they've referred me to the NMC. How do
I find out what's happening?

The NMC assigns case officers who can be contacted to advise whether a
complaint has been registered. Due to delays in dealing with cases, it
is important to check again after 28 days. The NMC website has details
about how to contact them (

Is there anywhere I can look for more detail about the fitness to
practise process?

The NMC website has many pages dedicated to fitness to practise,
including information for registrants, employers and members of the
public. For our members, the How the process workspage may be the
most helpful starting point, see:

At what point should I contact the union about any fitness to practise

As we refer cases to our legal department, it is important to contact
your workplace representative and/or your regional officer at the
earliest opportunity so we can ensure that any referrals we make are
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