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Stage two: Check it meets our formal requirements

Reference: SCR-1b

Last Updated 24/05/2018

When is a referral in the form required?

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We are committed to operating a fair and transparent process. Before we can begin our initial consideration, any referral must:

  • Be written, in a letter or an email, even if it was initially made by phone. We can assist people to do this where this is needed.
  • Provide sufficient detail about the individual nurse or midwife so we are able to identify them on our register. We recognise that this is not always easy, but knowing a first name, the date and care setting in which the events took place is helpful;
  • Come from a person or organisation identifying themselves by name and address, with agreement to us disclosing their referral to the nurse or midwife concerned. This is because we believe the nurse or midwife has the right to know the details of the concern and the source of the complaint, so they have the opportunity to provide a full response. We may still have to act on the information provided if there is no agreement for us disclosing the referral. This would be where it is in accordance with our regulatory processes and there is a clear public interest in us pursuing the matter further.
  • Set out the nature of the concern and the events and circumstances giving rise to it, in enough detail for the nurse or midwife concerned to be able to understand and provide a response.

In writing

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In order for us to consider investigating the practice of a nurse or midwife, we need to be confident that we are dealing with a precise and clear expression of the concerns involved. This means that we need the concerns to be put in writing, so that we know clearly what they relate to, and there can be no confusion about what has been referred to us.

If we first receive contact by a different method, we will advise the person contacting us of our requirement that concerns should be expressed in writing, and where the person needs us to, we will provide assistance to ensure this can be done.

Agreement to disclose and anonymous referrers

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It can be difficult for us to investigate anonymous referrals. Generally, we would only do so if there would be a real risk of harm to patients if the nurse or midwife concerned was allowed to practise unrestricted.

We recognise, however, that our core function is to protect members of the public who rely on the services of nurses and midwives. For this reason, there will be cases which are so serious that it will be necessary for us to investigate, even when the person making the referral wishes to remain anonymous, does not agree that details should be disclosed to the nurse or midwife concerned, or is unknown.1

Identifying nurses or midwives on our register

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We can only investigate allegations against an identified nurse or midwife who is currently on our register2.  We must be confident that we have correctly identified the Personal Identification Number (‘PIN’) of the nurse or midwife who is the subject of a referral. We often receive complaints about care delivered to a particular patient, which tell us only that nurses on a certain ward, unit, or particular setting need to be investigated.

In cases where we need to investigate in order to identify any individual nurses or midwives concerned, we will usually ask employers or healthcare providers to supply us with documents and information (such as rotas or timesheets) from which we will be able to conclude that the referral relates to an identified nurse or midwife on our register, or more than one. We will treat cases involving a number of nurses or midwives from a particular healthcare setting (who we cannot immediately identify) as a single referral as we gather information to identify the individuals causing concern.

If after taking reasonable steps we cannot link the referral to an identified nurse or midwife on our register, we will not be able to investigate further.

Incidents before the nurse or midwife was registered with us

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We will usually not investigate concerns or incidents which took place before the nurse or midwife was registered with us, unless the concern is about criminal convictions which the nurse or midwife received before they came onto our register, but did not disclose to us when they applied for registration, meaning that the correctness of their entry on our register may have been affected. There may also be exceptional cases of conduct which occurred before a nurse or midwife registered with us which, on its later discovery, may be so serious as to appear to be incompatible with continued registration, where we would carry out an investigation.

Referrals to other regulators

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Where a referral does not relate to a nurse or midwife who is currently on the register, but the person concerned appears to be registered with another healthcare regulator, we will advise the person who referred the case to us that a referral to a different regulator may be appropriate. We will disclose the referral and any relevant documents to that regulator ourselves if we are asked to do so, or if we consider that this may be necessary to protect patients or others from harm.

Similarly, where a referral does not raise concerns about the fitness to practise of a nurse or midwife, but appears to raise serious issues of patient harm which should be investigated by another body (such as a systems regulator or ombudsman), we will provide that body with the appropriate information and advice. This may include disclosure of the referral and any documents to assist with consideration of the case.

1 Article 22(6) of the Nursing and Midwifery Order 2001 gives us the power to carry out an investigation into the fitness to practise, or entry in the register, of a nurse or midwife where an allegation is not made to us under article 22(1) but it appears to us that there should be such an investigation. Accordingly, we may decide to carry out an investigation in the absence of an identified referrer, or agreement to disclose the allegation to the nurse or midwife. 
2 Article 22(1) of the Nursing and Midwifery Order 2001 refers to allegations against ‘a registrant’, which is defined in Schedule 4 as ‘a member of the profession of nursing or midwifery who has been admitted to the register…’

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