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Changes to our fitness to practise legislation

Changes will help us become more efficient and proportionate

From 28 July 2017, we will be introducing changes to our fitness to practise processes which will enable us to become a more efficient and proportionate regulator.

The proposed changes include:

1. Warnings, undertakings and advice

Case Examiners decide if there is a case to answer at the end of an investigation into an allegation about a nurse or midwife’s fitness to practise. Currently, Case Examiners only have the power to decide if there is a case to answer, and where they do, the case must progress to a hearing. These changes will give Case Examiners broader powers to give advice, issue warnings and recommend undertakings. This means we will be able to conclude less serious cases without the need to progress to a full hearing.

Warnings

This will involve a public marking (on our register) of serious concerns about a nurse or midwife without the need for a hearing. Warnings will only be appropriate where the nurse or midwife shows insight, remediation, and there is no risk to patients. Warnings will be published for 12 months on the nurse or midwife’s online entry on our register, including a short summary of the regulatory concern.

Undertakings

This will involve putting in place agreed measures to address areas of practice which cause a current clinical risk to patients. Undertakings would include steps the nurse or midwife should take within defined time periods to demonstrate remediation. Where undertakings are agreed, they would be published against the nurse or midwife’s entry on our register in all cases, with a brief summary of the regulatory concern (except in cases relating to health).

Advice

This will involve the NMC giving private guidance to a nurse or midwife to help them keep their practice safe following a minor breach of the Code. It would only be suitable where the concern is not serious enough to call into question the nurse or midwife’s fitness to practise, and will happen only if a nurse or midwife acknowledges the concern. This advice will not be made public at any point.

2. Reviewing Case Examiner decisions

Our current power to review Case Examiner decisions is being expanded. We will be able to review decisions to issue warnings, give advice, or that undertakings should no longer apply.

3. A single Fitness to Practise Committee

There are currently two final practice committees – the Conduct and Competence Committee and the Health Committee. However, having two committees can cause delays and additional hearing days. This can mean that when our committees assess the fitness to practise of a nurse or midwife they only focus only on one area of concern, when there may be others in the background. From 28 July 2017 these two committees will merge into a single Fitness to Practise Committee.

4. Substantive order reviews

Currently, practice committee panels are required to review every conditions of practice or suspension order they impose. The changes will allow practice committee panels to direct whether or not there is a need to review an order. This would help in cases where the nurse or midwife’s practice does not present a current risk of harm to the public, but a suspension order is otherwise necessary to uphold standards of professional conduct or public confidence in the nursing and midwifery professions.

Our functions are set out in the Nursing and Midwifery Order 2001 (the Order). The Order is supported by a series of rules which detail how we will carry out our functions.

We consulted on these changes in late 2016, and published a consultation report on 29 March 2017.