If the Investigating Committee finds an allegation of fraudulent or incorrect entry proved, it may order the Registrar to remove the entry, amend the entry, or it may take no action.1 The Committee also has the power to impose an interim order at the same time.
The appropriate outcome will depend on the circumstances of the case. The Committee should bear in mind that they are not deciding whether the nurse, midwife or nursing associate would now meet the entry requirements, but rather what action should be taken following their decision that the entry was fraudulent or incorrect.
The Investigating Committee should consider its purpose carefully in line with our overarching objective of protecting the public, which includes maintaining public confidence in the professions we regulate. Members of the public who need or rely on the services of nurses, midwives and nursing associates should be able to trust that people registered with us are entitled to practise as registered professionals.
Making an order that the Registrar remove the entry
If the Investigating Committee has decided that the person gained or maintained their registration through wrong information, it should assess carefully whether the person’s registration should be removed, including considering whether other actions might be more appropriate.
If the Investigating Committee has decided that someone has gained entry to our register because of fraud, their decision on what action to take should assess carefully whether the person can continue to be registered without undermining the public’s trust in the accuracy of our register. When coming to their decision, the Investigating Committee should consider whether the fraud was perpetrated by the nurse, midwife or nursing associate or a third party. The fact that the person's application to gain, maintain or renew their registration was supported by deliberately misleading information is likely to be a strong factor in favour of removing the entry because our duty to maintain the register is a vital part of protection of the public.
Removing the entry might also be the appropriate outcome if the entry was incorrectly made and the person concerned didn’t act dishonestly. In deciding whether to remove the entry following a finding that the entry was incorrectly made (but not fraudulent), the Investigating Committee should take account of:
- the Registrar’s specialism in making registration decisions
- whether the panel decided the entry was incorrect because the Registrar didn’t know about information that needed a value judgment or balancing exercise.
For example, an entry was incorrect because the Registrar wasn’t aware of a minor criminal conviction. It’s more likely to be appropriate to order that the entry is removed than, for example, a mistake relating to revalidation requirements. This is because the existence of a criminal conviction is likely to require the Registrar to exercise their judgement to decide whether the person should be permitted to be on our register.
Hearings often result in removal even when the entry is incorrect, rather than fraudulent, because the Registrar was not in a position to make a value judgement or balancing exercise about the registration based on the correct information.
If their entry is removed, the person concerned can subsequently apply for registration. If they do this, the Registrar (or one of our Assistant Registrars who also make decisions on behalf of the Registrar) can make a new registration decision, using their specialism and our health and character guidance to help them reach the right decision.
Where a nurse, midwife or nursing associate is already subject to a suspension or conditions of practice order, this wouldn’t prevent the Investigating Committee ordering their removal from the register because of a fraudulent or incorrect entry. The circumstances leading to the suspension or conditions of practice order will be taken into account by the Registrar if the professional subsequently applies for registration.
Making an order that the Registrar amend the entry
An order to amend the entry in the register may be appropriate if:
- there is information on the register that we can amend (for example the date of joining the register)
- the entry was incorrect
- there was no fraud or dishonesty
- there is no wider concern regarding the integrity of the entry, and
- there’s no issue over any of the registration requirements that needs the specialist judgement of the Registrar.
Taking no action
Taking no action may be appropriate if the error or inaccuracy in the application process was trivial or unimportant. It may also be appropriate where the nurse, midwife or nursing associate has corrected the error or inaccuracy, or where the Registrar has since correctly entered the nurse, midwife or nursing associate on the register based on all relevant information.
This is only likely to be an appropriate outcome where the entry was incorrect because of a clear-cut issue that the person has shown they have now put right, such as completing the required number of hours of practice or continuing professional development, or having professional indemnity insurance in place.
Action should be taken if the issues in the case need a value judgment or balancing exercise about whether the person would now meet the requirements for registration (such as health or character). This is because these issues should be decided by the Registrar, who is in the best position to make such judgments if the person decides to reapply for registration in the future.
Imposing an interim order following an order of amendment/removal
If it makes an order, the Investigating Committee should bear in mind that any substantive order that it makes will not take effect until after the deadline has passed for lodging an appeal against their decision, or if their decision is appealed, until the appeal has been resolved. The Panel will therefore need to consider whether it is necessary to impose an interim order. In doing so, it should consider whether the fact that its decision will not take effect immediately would present a risk to:
- members of the public
- public confidence in nurses, midwives and nursing associates
- the person whose entry in the register it has been considering.
The Committee will need to consider the circumstances of each individual case. Where the Committee has decided that a register entry has been fraudulently procured and that removal from the register is therefore the right course of action, the Committee will need to consider carefully whether an interim suspension order should be imposed to prevent the individual concerned from practising with immediate effect.
Among the factors to be considered will be:
- where the professional concerned has been found to have participated in fraudulent activity, the public protection issues that could arise from allowing someone who has engaged in fraud to continue practising
- whether it is consistent with the Committee’s overall decision and will maintain public confidence in the integrity of the register to allow an individual whose entry on the register has been secured by fraud to continue practising.
The role of employers
We will contact employers directly if they employ someone on the register, or someone who is applying to join the register, is suspected of an incorrect entry or fraudulent activity to let them know of our investigations. We might also request information about the person who has been referred to support our investigation and risk assessment process.
For example, we are alerted to concerns that a midwife has not completed the required practice hours in the three years prior to their revalidation application. We contact the organisations that have employed the registrant during this period to ask them to confirm the number of practice hours they completed.
Where we suspect that someone has obtained or might obtain their registration fraudulently, we write to them explaining our concerns, the regulatory approach we plan to take and the implications for them. We recommend that they share a copy of their letter with their employer.
Employers who are unsure whether a registered professional or applicant has been contacted by the NMC regarding an incorrect entry or fraudulent behaviour can contact a dedicated team at the NMC who will be able to confirm whether an individual has received a letter from us at Registration.Investigations@nmc-uk.org.
Should employers have any concerns about a person’s ability to practise safely and effectively, they can choose to conduct their own risk assessment and restrict the person’s practice according to their own policies, to manage any potential risk identified for patient safety. However, we encourage employers not to take any action before their employees have received the record of our decision relating to their case to avoid pre-empting our regulatory decision making.
We encourage employers to consider what support they can offer employees who are awaiting the outcome of our investigation. In particular, they should take appropriate steps to reduce any discrimination in the workplace in relation to these concerns.
For example, we encourage employers to support registrants in completing any revalidation shortfalls. If we are investigating a professional for IEFE and they are willing to remedy the concern, for example being signed off correctly by a new confirmer, undertaking further practice hours or completing further CPD, this may give us sufficient reassurance in terms of risk.
If employers have concerns about an individual’s competency that does not relate to an IEFE case, they can raise those concerns through our fitness to practise process as soon as possible. Find out more.
Employers can also speak with our Employer Link Service if they need additional support. Find out more.
Next: Support for those being investigated
1 Article 26(7) of the Nursing and Midwifery Order 2001 (‘the Order’)
