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Standard reviews of substantive orders before they expire

Reference: REV-3a

Last Updated 12/10/2018


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When a conditions of practice or suspension order has been imposed, we are legally bound1 to review the order before it expires (unless the panel making the original order expressly decided that a review was not necessary). 

We’ll usually schedule the review to take place eight weeks before the order is due to expire, which allows us time to reschedule the review if for any reason the review can’t go ahead.

How the panel reaches a decision

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At the review, we will ask the panel to consider whether the nurse or midwife’s fitness to practise remains impaired in light of any new facts or information about the issue of impairment. The nurse or midwife is also able to put new information before the panel. At a review hearing, if anyone (either us or the nurse or midwife) wants to establish that a fact happened, they will need to prove this on the balance of probabilities.

The panel will then go on to consider what has happened in the nurse or midwife’s practice since the last hearing or meeting , and will take into account the following factors:

  • Has the nurse or midwife complied with any conditions imposed? What evidence has the nurse or midwife provided to demonstrate this? What is the quality of that evidence and where does it come from?
  • Does the nurse or midwife show insight into their failings or the seriousness of any past misconduct? Has their level of insight improved, or got worse, since the last hearing?
  • Has the nurse or midwife taken effective steps to maintain their skills and knowledge?
  • Does the nurse or midwife have a record of safe practice without further incident since the last hearing?
  • Does compliance with conditions or the completion of required steps demonstrate that the nurse or midwife is now safe to practise unrestricted, or does any risk to patient safety still remain?

If the panel decides that the nurse or midwife’s fitness to practise is no longer impaired and no further restrictions on their practice are needed, they can allow the existing order to expire and the case will conclude.

However, if the panel decides that some restriction on the nurse or midwife’s practice remains necessary, because their fitness to practise is still currently impaired, they will decide what sanction, if any, to impose.

What powers does the panel have?

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A panel can:

  • extend the existing order
  • make a new order
  • allow the existing order to expire.

When extending the duration of the existing order, a panel cannot extend a conditions of practice order by more than three years at a time, or a suspension order by more than one year at a time.2

When replacing one order with another in a case based on health, lack of competence, or not having the necessary knowledge of English, a panel cannot make a striking-off order unless the nurse or midwife has been on a substantive conditions of practice order, a substantive suspension order, or a combination of the two, for more than two years.

Any time spent on an interim order does not count towards the two year period.

For example, if a nurse or midwife has been subject to two 12 month suspension orders (one following on immediately from the first), a panel cannot make a striking-off order at the second standard review.

This is because the nurse or midwife will not have been on a substantive order for a total period of two years when the panel is carrying out the review hearing, as the review hearing takes place before expiry of the second 12 month suspension order.

Any change to the order, or extension of the order, does not take effect until the existing order expires.

Making an immediate change to the order, rather than waiting for the change to happen once the existing order has expired, is only necessary in exceptional cases.

1 Article 30(1) of the Order
2 Article 30(5) of the Order

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.

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