Further guidance on conditions of practice

Reference: SAN-3d

Last Updated 28/07/2017

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Purpose of conditions

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The purpose of a conditions of practice order is to address the concerns which led to the finding of impairment of fitness to practise. In doing so, the aim of the order will be to protect the health, safety and wellbeing of members of the public, and where appropriate, maintain public confidence in the nursing and midwifery professions, and proper professional standards and conduct. Conditions of practice orders enable the nurse or midwife to continue to work following a finding that their fitness to practise is currently impaired, or, in the case of conditions as an interim order, while the allegations against them are being determined.

Effect of conditions

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Throughout the period that the conditions are in force, the nurse or midwife must comply with them. Failure to do so may result in the conditions of practice order being replaced with a more serious sanction. It may also amount to misconduct.

Each nurse or midwife has a single registration, although he or she may have entries in more than one part of the register. All conditions will apply to all parts of the nurse or midwife’s practice, unless the conditions of practice order states otherwise.

There is no power to impose a suspension order suspending part of a nurse’s or midwife’s registration. If a panel wants to prevent a person who is registered as a nurse and a midwife from practising in one of those professions, it must do so using a conditions of practice order.

This would be appropriate when the panel identifies problems in one of the individual’s professions which requires them to be prevented from working in that area but where a complete restriction on all areas of practice would not be necessary to protect the public.

Such an order does not amount to a complete restriction on the nurse’s or midwife’s ability to practise (and therefore is not equivalent to a suspension order) because it allows the individual to work in one area of professional practice.

Sometimes there will be an overlap between the two areas of professional practice. Panels should therefore consider whether to impose specific conditions on their work in the other profession to make sure that the public are properly protected from the risk of harm.

For example, where the allegation suggests that an individual has serious clinical problems relating only to midwifery practice and they also have problems with their communication, it may be appropriate to prevent the individual from working as a midwife and to impose conditions on their practice as a nurse to address their record keeping errors.

Such an approach would achieve a proportionate response where the panel considers there is a need to prevent the individual from practising in one profession but they can safely practise with restrictions in the other.

Conditions are published, and details of any conditions of practice order are made available to anyone enquiring about a nurse or midwife’s registration. Accordingly, it is important that panels specify any conditions that must not be published generally, for example, those relating to the nurse or midwife’s health

General principles

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Conditions of practice should be relevant, proportionate, workable and measurable.

Relevant means that the conditions should relate to and address the matters giving rise to the finding of impairment of fitness to practise or, in the case of an interim conditions of practice order, to address the risks to the public, the public interest, and the registrant’s own interests raised by the allegations.

Proportionate means that the conditions must be no more than necessary to achieve the legitimate aims of protecting the public and upholding confidence in the profession. They must strike a fair balance between the interests of the registrant and the public interest, which includes public protection and public confidence. There is also a public interest in nurses and midwifes being allowed to practise their profession in a safe manner.

Workable means that it must be possible for the nurse or midwife to comply with the conditions. Any conditions imposed should not be wholly impracticable, or have the effect of amounting to a complete restriction on the nurse or midwife’s ability to practise. It is inevitable that conditions may have the effect of making it more difficult to obtain employment, but this does not mean that the conditions are unworkable.1

Measurable means that it must be possible to assess objectively whether or not the nurse or midwife has complied with each condition. The condition must be clear and unambiguous. The question of whether the nurse or midwife has complied with the condition should be capable of being answered ‘yes’ or ‘no’. If the question is capable of being answered ‘It depends…’, the condition is not measurable because it is not specific enough. The conditions should also ensure that, where necessary, the nurse or midwife is under an obligation to provide the NMC with sufficient information, in sufficient time, to enable the panel at a review hearing to assess whether the nurse or midwife has complied with the condition.

Use of language in conditions

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A conditions of practice order should be capable of being read and understood as a stand-alone document, without reference to any other document. When drafting conditions, panels should:

Use plain English: Avoid complicated words when simple ones are available. For example, use ‘before’, not ‘prior to’, ‘start’, not ‘commence’.

Avoid jargon or technical terms: If it is necessary to use clinical terms, these should be defined clearly in a way that can be understood by a lay person.

Use unambiguous language: If a term is used that is capable of being interpreted in different ways by different panels, the panel must provide a clear definition of what it means by that term. For example, ‘supervision’ is a term that is capable of being interpreted differently by different people. Among other things, it could mean:

  • having regular meetings with a supervisor to discuss clinical issues
  • working with a supervisor at the other end of a telephone if required
  • working with a supervisor who is physically present some, but not all of the time
  • being observed at all times by a supervisor.

Accordingly, if a panel considers that there should be a degree of supervision or oversight of the nurse or midwife’s work, it must specify precisely the extent of that oversight. Examples are included in the Conditions of practice library.

Be consistent: A conditions of practice library has been prepared to help panels to achieve consistency in the conditions of practice that are imposed. Where the wording of a library condition meets the requirements of the panel, that wording should be used. Where there is no condition in the library that meets the requirements of the panel, the panel must create its own condition. To help panels to ensure that no conditions are published that should not be, the conditions in the library are divided into public and confidential conditions.

Conditions of practice and timing

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It is important that panels understand when conditions take effect, and that this is reflected in the order.

Interim conditions of practice orders take effect immediately.

Conditions of practice made after a finding of impairment of fitness to practise take effect on the expiry of the period the nurse or midwife has to appeal against the order (28 days after service of the decision notice) or where an appeal is made, when the appeal is withdrawn or otherwise finally disposed of.

Conditions of practice made on a standard review before the expiry of an order2 take effect immediately on the expiry of the original order

Conditions of practice made on a review at the request of one of the parties during the life of an order3 take effect either:

  • immediately as the review takes place, if it is a decision to replace the original order with conditions of practice order, or
  • from the expiry date of the original order, if it is a decision to extend a conditions of practice order.

Times and periods of the order must be specified, for example ‘weekly’, ‘on the first day of each month’, or ‘once every three months’ instead of ‘regularly’, and ‘within x days’ instead of ‘promptly’.

Engagement of nurses, midwives and others

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There is no requirement for the nurse or midwife, or any third party affected by the conditions of practice order, to give express consent to the terms of the order.4

However, panels need to satisfy themselves that conditions are workable. If a nurse or midwife refuses to comply with conditions, such an order will not be workable.

In some circumstances, conditions will be workable even where there is no current or prospective employer. For instance, a condition requiring a nurse or midwife not to work in a particular environment or role, or not to carry out a particular procedure, is workable, even where there is no known employer, because it does not require support or any other input from a third party. In these circumstances, it is not necessary to give anyone an opportunity to comment before the order is made.

In other circumstances, where the panel considers that a particular level or type of support or input from a third party is necessary in order to protect the public interest, the panel should give the parties, and any third party affected by the order, an opportunity to comment on the workability of the proposed conditions of practice. This will enable panels to make decisions from an informed position, and will avoid the need for early reviews. Where possible, the NMC will seek to arrange for any such third party to be available to comment before any order is made. Where this has not been possible (for example, because the identity of the third party was not known to the NMC before the hearing) the panel may put the case back for a limited period (ordinarily no more than one hour) to enable contact to be made and comments sought.

Where the panel considers that support or other input from a specific third party is necessary in order to protect the public, it may conclude that, in the absence of evidence showing that the specific third party is available and willing to provide the necessary support, a conditions of practice order is unworkable. In these circumstances, the panel will need to move on to consider suspension. If it does so, it should set out in its decision the nature and extent of support or other input it considered necessary to protect the public, and why it considered a conditions of practice order to that effect to be unworkable on the evidence before it. This will enable the nurse or midwife to understand what is required before a conditions of practice order can be imposed, and will enable him or her to gather the necessary evidence before a review hearing.

A case where the panel considers an order is required should never be adjourned to another day simply because it has not been possible to obtain the comments of a third party. This would leave the public unprotected in the meantime. Instead, the panel must make an order that is relevant, proportionate, workable and measurable based on the evidence it has. Either party can seek an early review of the order should further evidence become available.

Where the panel is satisfied that it is possible to create conditions that ensure public protection, but which require some degree of third party support, it may impose such conditions, despite the absence of evidence identifying a third party who is available and willing to provide the necessary support. This will be appropriate where the conditions are generic in nature, and do not require the input of a specific third party. The practical effect of this will be that the nurse or midwife is unable to practise until finding a third party willing to support them. If no setting is prepared to employ the nurse or midwife on these conditions, then the effect will be that the nurse or midwife will not be able to practise. There will be no risk to the public. Should a setting be willing to engage the nurse or midwife on the basis of the conditions, the public have the benefit of a nurse or midwife in practice, but with strict limits.5

It should be noted from this that an employer or other third party cannot be placed under an obligation to support the conditions.

Conditions should always put the obligation on the nurse or midwife, not a third party. For instance, instead of saying “Your GP must provide a report to the NMC….” the condition should say “You must provide the NMC with a report from your GP”.

Return to practice courses

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Return to practice courses are designed to enable nurses and midwives who have not completed the required practice hours to eventually re-join the register. Return to practice are not designed to remedy concerns about a nurse or midwife’s fitness to practise. For this reason, it will generally be inappropriate for a panel to rely on a return to practice course in place of a conditions of practice order or direct that a nurse or midwife should complete a return to practice course.

1 Daraghmeh v General Medical Council [2011] EWHC 2080 (Admin)
2 Article 30 of the Nursing and Midwifery Order 2001 ('the Order')
3 Article 30(2) and (4) of the Order
4 Whitehead v General Medical Council [2003] HRLR 9
5 Perry v Nursing and Midwifery Council [2012] EWHC 2275 (Admin)