Decision making

Reference: HEA-7b

Last Updated 28/07/2017

Print

Consideration of a voluntary removal application 

Back to top

If a nurse or midwife applies for VR before a substantive hearing, the application is accompanied by a recommendation on whether the matters meet the appropriate criteria for VR. This recommendation is produced by our staff who follow the same criteria as the Registrar. The application will not be considered until the case examiners have decided whether there is a case to answer. This is so that we understand the full extent of the regulatory concern. If an application for VR has been made at the investigation stage, the nurse or midwife may be invited to re-submit their application once a case to answer has been found.

When a nurse or midwife applies for VR during a substantive hearing, the panel is not informed of the VR application unless and until they find that the nurse or midwife’s fitness to practise is impaired. If the panel makes a finding that the nurse or midwife’s fitness to practise is impaired, it can then make a recommendation for VR to the Registrar. If VR is rejected the panel will go on to consider whether to impose a sanction. 

Whether the VR application is made before or during a hearing, all decision-makers should carefully consider and balance:

  • the public interest, that is, public protection, declaring and upholding professional standards, and maintaining public confidence in the professions and their regulation
  • the interests and future plans of the nurse or midwife
  • any comments received from the maker of the allegation.

If a nurse or midwife is subject to an interim suspension order or interim conditions of practice order, this will need to be revoked by an interim order panel before an application for VR can be granted.1 The Registrar will be aware of the interim order when they make the decision on whether VR should be granted or not. If the Registrar decides that VR is suitable, we will invite a panel to revoke the order, as VR has been granted by a Registrar. Only then will the VR will take effect.

If VR is granted at a hearing, the panel will make a decision to take no further action.2 This will revoke the interim order and the VR will come into effect immediately.

Public interest

Back to top

When a nurse or midwife is removed from the register, the public is immediately protected from the risk of future harm by that nurse or midwife. However, this should always be considered alongside the wider public interest concerns of declaring and upholding professional standards and maintaining public confidence in the professions and us as a regulator. The Registrar should make sure that all public interest concerns are addressed in their decision to grant or refuse a VR application.

There is a public interest in allegations of impaired fitness to practise being properly scrutinised in public. When this happens, professional standards are seen to be upheld and public confidence in the professions and the NMC is maintained and promoted. This element of the public interest should be carefully considered when VR is applied for before a hearing has started, as the allegations will not be considered in a public hearing if the application is granted.

The Registrar should pay particular regard to the seriousness of the regulatory concern. This may depend upon how much harm was caused, or could have been caused, to the public. Harm to a person may be physical, mental, emotional or financial. For example, VR is unlikely to be suitable if the misconduct has led to serious harm, such as cases of sexual misconduct or if a patient has died. In these cases there could be a significant impact on public confidence if the details were not considered in a public forum.

The public interest element is less likely to be a material consideration when a VR application is made during a hearing, as the panel will not consider VR applications until it has made a finding on whether the facts are proved and the nurse or midwife’s fitness to practise is impaired.

When considering VR applications arising from a panel recommendation at a hearing, the Registrar will be assisted by:

  • the panel’s determination on impairment, and
  • the panel’s assessment of public interest concerns.

If VR is granted, details of the allegation will be made available on request to relevant enquirers. This ensures that health authorities and future employers are informed of a nurse or midwife who has outstanding fitness to practise concerns. The allegation will also be considered if the nurse or midwife subsequently applies for readmission to the register.

Interests and future plans of the nurse or midwife

Back to top

Nurses and midwives will often be at different stages of their career when applying for VR. There will also be individual circumstances influencing their decision to apply.

The Registrar should consider the following factors:

  • the likelihood that the nurse or midwife may seek readmission to the register
  • the length of time since the nurse or midwife last practised
  • any evidence that the nurse or midwife intends to practise in the UK or elsewhere in the future.

Likelihood of seeking readmission to the register

Back to top

The Registrar should consider whether a nurse or midwife’s application demonstrates a committed intention to leave the profession and not seek readmission in the future. For example, a nurse or midwife may express their intention to follow an alternative career path, and provide strong evidence in support of this.

Alternatively, a nurse or midwife may show a genuine desire to be removed from the register, having taken steps to leave the profession before we raised concerns with them. Additionally, a signed declaration form can provide evidence of a nurse or midwife’s future intention.

Length of time since the nurse or midwife last practised

Back to top

The time that has passed since the nurse or midwife last practised is a relevant factor for the Registrar to consider. This is because if a nurse or midwife has not practised for a long time, this could indicate that they will not seek readmission to the register in the future. Any future application for readmission would be less likely to be granted due to a deterioration of clinical knowledge and skill over the passage of time.

Evidence of intention to practise in the UK or elsewhere in the future 

Back to top

If a nurse or midwife intends to practise in the UK or elsewhere in the future, this should be a factor that weighs heavily against granting VR. If a nurse or midwife expresses an intention to practise either overseas (on a part-time basis or in private practice in the future), this is as relevant as if the nurse or midwife expresses an intention to practise on a full-time basis in the UK. While our remit is confined to regulating nurses and midwives in the UK, we have a wider public interest in ensuring the protection of patients everywhere.

Comments received from the maker of the allegation

Back to top

The Registrar should consider any comments received from the maker of the allegation.3 The maker of the allegation is not necessarily the person who reported the matters to us. Where appropriate it may be the alleged victim of the misconduct, or, in a criminal case, it may be the person or organisation that initially reported matters to the police.

We will request their comments in writing or over telephone, depending on timescales. If the VR application arises during the hearing when the maker of the allegation is present, the panel will ask them for comments before making its VR recommendation to the Registrar.

In cases where the allegation relates to health, we do not disclose the details of the nurse or midwife’s health condition to the maker of the allegation. Given that health details are generally regarded as confidential it will not always be possible for the maker of an allegation to be fully informed of the reasons why VR was appropriate in every case.

The views of the maker of the allegation form only one element that the Registrar has to consider as part of their overall decision making.

1Article 12(3)(b) of the Nursing and Midwifery Order 2001 ('the Order')
2Article 29(4) (b) of the Order
3This is a statutory requirement under Rule 14(2B)(a) of the Registration Rules