Stage Three: Is there clear evidence to show that the nurse, midwife or nursing associate is currently fit to practise?
Where stages one and two of our screening process are met, we’ll consider the nurse, midwife or nursing associate’s current practice.1 Sometimes we receive evidence about the nurse, midwife or nursing associate’s current practice which indicates that steps have already been taken to address any concerns about their fitness to practise since the incidents which led to the referral.
We always encourage nurses, midwives and nursing associates who have been the subject of concerns to consider what lessons they can learn from the incident and to strengthen their practice as a result. Full information about our approach to issues of strengthened practice, reflection and insight can be found here.
We’ll consider whether the steps the nurse, midwife or nursing associate has taken to strengthen their practice satisfy us that there is no longer any risk to the public and the concern has been fully addressed.
For example, if there’s clear evidence that the nurse, midwife or nursing associate has appropriately reflected on the issues raised in the concern, or, where appropriate, provided evidence of relevant retraining, we may decide that the case does not need to be referred to the Case Examiners or the Fitness to Practise Committee.
Where we receive information that health or personal circumstances may have played a part in the concern, we’ll look for evidence from the nurse, midwife or nursing associate to demonstrate they’ve reflected on and addressed the issues they were experiencing at the time. Where we receive evidence that lack of training or support may have played a part in the concern, we’ll need to be satisfied the gap in training or knowledge has been addressed. We’ll also consider whether we need to share any information we receive about failures by employers to support nurses, midwives and nursing associates to stop similar concerns arising again, in line with our Information Handling Guidance on sharing information with outside agencies.
In some cases, the nature of the alleged conduct may be so serious that further investigation is required to promote and maintain public confidence in nurses, midwives and nursing associates generally, or to promote and maintain proper professional standards and conduct. In these circumstances, evidence about the nurse, midwife or nursing associate’s current practice will be less relevant to our decision.
1 Sometimes nurses, midwives or nursing associates may provide us with reflective material in relation to an incident that isn’t serious enough to require our involvement. While this won’t usually be relevant to our screening decision, we encourage nurses, midwives and nursing associates to reflect on their practice and their reflections may be helpful when they go through Revalidation.
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- Last Updated: 10/05/2021
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.
FtP library
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Understanding Fitness to Practise
- Aims and principles for fitness to practise
- Allegations we consider
- How we determine seriousness
- Why we screen cases
- When we use interim orders
- Investigations
- Examining cases
- How we manage cases
- Meetings and hearings
- Resolving cases by agreement
- What sanctions are and when we might use them
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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
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Screening
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Our overall approach
- Our overall approach - overview
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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
- Whistleblowing
- If we don't refer a case
- Determining the regulatory concern
- Screening incorrect or fraudulent entry cases
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Our overall approach
- Interim Orders
- Investigations
- Case Examiners
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Preparing for the FtP Committee
- Reviewing cases after they get referred to the FtPC
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Drafting charges
- 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
- Disclosure
- Notice of our hearings and meetings
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Case management
- 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
- FtP Committee decision making
- Sanctions
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Reviews
- Reviewing case examiner decisions
- Interim order reviews
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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