There are times when we might need to allege that a nurse, midwife or nursing associate’s fitness to practise is impaired for more than one of the reasons set out in our legislation. For example a nurse or midwife’s fitness to practise could be impaired because of misconduct and a conviction or caution.
The panel is only allowed to know about the conviction or caution once it has made a decision about the misconduct allegation.
When this happens, we’ll list the allegations on separate pages and any documents about the conviction or caution will clearly state that the panel can’t see them until it has decided on the facts about the alleged misconduct.
“That you, a registered nurse:
On 6 January 2018 failed to administer insulin to Patient A as prescribed.
Your actions as set out at charge 1 contributed to the death of Patient A. And in light of the above, your fitness to practise is impaired by reason of your misconduct.
CONVICTION CHARGE – NOT TO BE SEEN BY PANEL UNTIL AFTER DECISION ON CHARGES 1 AND 2
That you, a registered nurse:
On the 7 July 2018 at the Oxford Crown Court were convicted of one count of assault occasioning actual bodily harm contrary to s47 of the Offences Against the Person Act 1861.
And in light of the above your fitness to practise is impaired by reason of your conviction.”
We will make an exception to this approach if the misconduct has an obvious and close link with the conviction.
An example is the nurse or midwife has a criminal conviction or caution, and has deliberately concealed this from their employer, or from us. For example:
"That you, a registered nurse:
1. On the 1 January 2016 at the Oxford Crown Court were convicted of one count of assault occasioning actual bodily harm contrary to s47 of the Offences Against the Person Act 1861.
2. Failed to disclose the conviction set out in charge 1 to your employer.
3. Failed to disclose the conviction set out in charge 1 to the NMC.
And in light of the above your fitness to practise is impaired by reason of your conviction as set out in charge 1 above, and your misconduct as set out in charges 2-3 above.”
Sometimes, there may be cases made up some concerns about lack of competence, and some about misconduct, such as dishonesty. When this happens, we’ll make sure the charge document is clear about which charges show a lack of competence and which charges show misconduct:
“…and your fitness to practise is impaired by reason of your lack of competence as set out in charges 1- 6 above, and your misconduct as set out in charges 7-8 above.”
Generally a panel will only consider one or two kinds of allegation, such as lack of competence or misconduct, but there’s no formal limit to the number or combination of multiple allegations that a panel can consider.
The guidance in our library, needs to be read alongside our NMC Guidance during the Covid-19 emergency period. We have new rules that are in force during the period of the coronavirus emergency that are relevant to how it applies.
Want to download and print whole sections of this FtP library? Visit the downloads page.
Understanding Fitness to Practise
- Aims and principles for fitness to practise
Allegations we consider
- Allegations we consider - overview
- Lack of competence
- Criminal convictions and cautions
- Not having the necessary knowledge of English
- Determinations by other health or social care organisations
- Fraudulent or incorrect entry to the register
- How we determine seriousness
- Why we screen cases
- When we use interim orders
- Examining cases
- How we manage cases
- Meetings and hearings
- Resolving cases by agreement
- What sanctions are and when we might use them
Taking account of context
- Taking account of context - overview
- 1: We’ll approach cases on the basis that most people referred to us are normally safe
- 2: We’ll seek to build an accurate picture about the nurse, midwife or nursing associate’s practising history
- 3: We’ll always carefully consider evidence of discrimination, victimisation, bullying or harassment
- 4: Where risks are caused by system and process failures, we’ll concentrate on the action we can take to help resolve the underlying issues
- 5: In cases where a nurse, midwife or nursing associate was required to use their professional judgement we’ll respond proportionately
- 6: Evidence of steps the nurse, midwife or nursing associate has taken to address serious concerns caused by a gap in knowledge or training or personal context factors
- 7: We’ll always look into whether group norms or culture influenced an individual’s behaviour before taking action
- 8: Where an incident has occurred because of cultural problems, we’ll concentrate on taking action to minimise the risk of the same thing happening again
- What context factors we think are important to know about when considering a case
- Insight and strengthened practice
- Engaging with your case
Our overall approach
- Our overall approach - overview
The Three Stages of our Screening Decision
- The Three Stages of our Screening Decision - overview
- Stage One: Do we have a written concern about a nurse, midwife or nursing associate on our register?
- Stage Two: Is there evidence of a serious concern that could require us to take regulatory action to protect the public
- Stage Three: Is there clear evidence to show that the nurse, midwife or nursing associate is currently fit to practise?
- Clinical advice
- Referrals to other regulators
- Referrers that wish to remain anonymous
- If we don't refer a case
- Determining the regulatory concern
- Screening incorrect or fraudulent entry cases
- Our overall approach
- Interim orders, their purpose, and our powers to impose them
- Applying the interim order test
- Applications for interim orders
- Review periods, extensions and multiple referrals
- Case Examiners
Preparing for the FtP Committee
- Reviewing cases after they get referred to the FtPC
- Why do we have guidance on charges?
- Jargon buster
- General approach
- How a charge becomes final
- Practical drafting issues
- Particular features of misconduct charging
- Drafting charges in health cases
- Other fitness to practise charges
- Multiple allegations
- Drafting charges in incorrect or fraudulent entry cases
- Documents panels use when deciding cases
- Gathering further evidence after the investigation
- Notice of our hearings and meetings
- Hearing fitness to practise allegations together
- Telephone conferences
- Preliminary meetings
- Dealing with cases at hearings or meetings
- Voluntary removal
- Cancelling hearings
- Constitution of panels
- Proceeding with hearings when the nurse, midwife or nursing associate is absent
- Case management during hearings
- Hearings in private and in public
- When we postpone or adjourn hearings
- Supporting people to give evidence in hearings
FtP Committee decision making
- Consensual panel determination
- Offering no evidence
- Abuse of process
- Directing further investigation during a hearing
- Making decisions on dishonesty charges
- Voluntary removal at hearings
- Deciding on incorrect or fraudulent entry
- Factors to consider before deciding on sanctions
- Considering sanctions for serious cases
- Available sanction orders
- Available orders for fraudulent or incorrect entry
- Interim orders after a sanction is imposed
- Directing reviews of substantive orders
- Reviewing case examiner decisions
- Interim order reviews
Substantive order reviews
- Substantive order reviews - overview
- Standard reviews before expiry
- Early review
- Exceptional cases: changing orders with immediate effect at a standard review
- Review of striking-off orders
- New allegations
- Reviewing orders when there may have been a breach
- Reviews where an interim order is in place
- Allowing orders to expire when a nurse or midwife’s registration will lapse
- Appeals and restoration