Fitness to practise: a new approach

  • Putting people at the heart of fitness to practise
  • Redefining the purpose of hearings
  • Emphasising the need to give nurses, midwives and nursing associates the chance to remedy and address the concern
  • Looking at ways employers can deal with complaints at a local level
  • Underlining the importance of considering the context of a case.

A new approach that puts people first

Our new approach to fitness to practise builds on improvements we’ve already made to the way we investigate concerns about the people on our register, which we believe will help us to protect the public in a fairer, more effective, proportionate and consistent way.

Alongside a focus on keeping people safe, we're committed to putting patients and families at the heart of everything we do.

What is the new approach?

We'll treat patients and families with compassion and respect, and properly listen to and resolve concerns about nurses, midwives and nursing associates. We'll provide better information and more support for patients and families, as well as a rolling programme of training and development for our employees.

We think it's important that we work more closely with employers so that as many issues as possible can be resolved quickly and effectively at a local level. We'll give more consideration to the context in which incidents occur, in recognition of the complex issues and unique pressures nurses and midwives face every day in the NHS.

When concerns are raised with us, nurses, midwives and nursing associates will be encouraged to be open about what has happened and to talk to us as early as possible about what they have done to put things right.

If more needs to be done, we'll try to agree with the nurse, midwife or nursing associate, the steps that they need to take before they're fit to practise safely and professionally.

Read our new Fitness to Practise strategy (Cymraeg).

How we got here

We recently held a consultation, Ensuring patient safety, enabling professionalism, on our proposed a new strategic direction. We wanted a wide range of people to tell us what they thought of it.

We received 892 responses from individuals and organisations, with a large majority saying they supported our proposals. Read the analysis of consultation responses.

We also conducted some research with members of the public and nurses and midwives and employers from a diverse range of backgrounds. Over 200 participants took part in the research and overwhelming majority supported our proposals.

We analysed the feedback, which showed there was broad support for our aim to move away from a culture of blame and denial, to a system that puts more emphasis on learning from mistakes. Read the qualitative research report.

Respondents also welcomed new measures to reform the existing fitness to practise process, which has been shown to put immense strain on all concerned.

We used the feedback from the consultation to refine our new strategic direction for fitness to practise. Our Council then approved this on 25 July 2018.

Where we're taking our next steps in fitness to practise

More support for patients, families and members of the public

We’ve already created a new area on our website which provides support to patients, families, and other members of the public who are thinking about raising a concern or a complaint.

We have developed a brand new public support service, which will provide tailored support to make sure patients, families and the public are protected, valued and respected in our fitness to practise process.

We'll launch the full service in October 2018.

We're updating our policies

In September 2018, we’ll be updating our fitness to practise policies to make sure they align with the policy principles in the new strategy. 

We’ll also roll out new criteria for when a case needs to be heard at a hearing, with the aim of resolving more cases at meetings, and only holding full hearings in exceptional circumstances.

We'll also introduce a process for using statements of case in meetings.

Trying new ways of doing things

From September 2018 to February 2019, we’ll be piloting some of the new approaches set out in the strategy.

These include:

  • updating our guidance on how and when an employer should refer an employee to us.
  • better and clearer information for members of the public designed to help them take their complaint forward in the most appropriate way.
  • a new tool to help us take contextual factors surrounding mistakes into account, at each stage of our decision-making process.
  • tailored advice for nurses, midwives, and nursing associates, and their employers, about how they can take steps to make sure that whatever went wrong, won't happen again - we call this remediation.
  • new processes designed to sort things out quickly - we'll produce a statement which will set out what our position is and what we would expect the panel to decide, based on the information we have.

We’ll then use this statement as a basis of a discussion with the nurse, midwife or nursing associate concerned, to resolve as many aspects of the case as possible. It may be that those discussions change our view of the case we intend to put before the panel.

What will happen after that?

We’ll review the findings of these pilots in March 2019 and make decisions about what to implement and when. 

Please look out for further updates.