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Blog: Defining our new approach to fitness to practise

NMC Director of Fitness to Practise, Matthew McClelland talks through what's new about the new approach and what's still in process.

Last summer we launched our new approach to fitness to practise – focussed on how we can move away from a culture of blame when things go wrong in health and social care – and instead develop other ways of working that better support the safety of people using services.

Why? People are at the heart of what we do. And when something goes wrong, we know that for many people and their families, ensuring that doesn’t happen again to someone else is really important.

Our new approach to fitness to practise is committed to enabling a culture of openness and learning for nurses, midwives and nursing associates so that we – working together with employers, our partners and other regulatory bodies – can ask the right questions when mistakes do happen and truly understand the context and the impact of the working environment where those mistakes have occurred.

There will always be times when things go wrong that can’t be put right – for example, if someone has been reckless or has done something deliberately. In those cases, we will always take appropriate regulatory action.

But in many cases, people can put things right by being open and honest about what happened, showing insight into what went wrong, and taking steps to improve their practice. In these sorts of situations where someone can demonstrate they’re safe to practice, we think they should have the opportunity to continue with their professional career.


Over the past nine months, as well as setting up our person-centred Public Support Service, we’ve been busy doing lots more engagement with a wide range of health and care stakeholders across England, Scotland, Wales and Northern Ireland to find out what people think.

There is lots of support for our new approach – people particularly feel that our new direction will help support learning, promote public trust and enable better, safer care.

Importantly, there is also a recognition that it’s going to take much collaboration, commitment and a real shift in mind-set by everyone involved in order to deliver the practical actions that people have told us they want to see.


Between September last year and March this year we piloted new ways of working in some parts of fitness to practise, aimed at putting our new approach to fitness to practise into action.

Specific areas include encouraging employers to look at things locally before referring to us, taking account of the context in which mistakes happen, enabling remediation and making the best use of hearings.
Overall, the pilots were a success, demonstrating that we’re on the right path and heading in the right direction. The main highlights are:

  • Employers really welcomed extra support and advice to help them to better understand and resolve concerns locally.
  • Members of the public found support from our specially trained screening team very valuable.
  • We’ve developed an approach which will help us better capture evidence about the context in which incidents occur and decide what action, if any, we need to take.

While the pilot work highlighted there’s much to be positive about, other themes included the need for continued engagement with our partners and more training for our people and decision makers. In nearly every area it was clear that more guidance, and better supporting information for employers on what, when and how to make referrals, will be really beneficial.

Here’s what one of our partners have to say about it too:

We have been impressed watching the NMC wrestle with very new approaches while piloting the new strategy, and we have been very glad to be involved and updated. The use of external agencies has brought a different tone to the debate. It has created some challenges for the NMC. How, for example, can all the different contextual factors be properly weighted and evaluated in an FtP case? We like person-centred policies, but realise how hard it can be to balance the requirements of fairness to the registrant in the legal process with giving a voice to patients and families, for example. In July we are planning some joint training with the NMC and we look forward to learning more.

Roz Hooper, Head of Regulatory Legal Services at the Royal College of Nursing.

Next steps

I’m grateful to everyone who has been involved in our development work so far and helped ensure the pilots gave us lots of food for thought. Undoubtedly, there’s lots we can learn from, and crucially, there’s lots more that we now need the time to plan and do.

We’re committed to making our fitness to practise ambitions a reality for the benefit of people, patients, professionals, partners, employers and everyone else involved.

Going forwards, we’ll now be turning the evaluation of our pilot work into further actions in order to strengthen the process and our supporting materials – while at the same time – continuing to listen to our stakeholders as we roll out our new approach more widely over the next 12 months. Watch this space.

Read more about the progress we've made on our new strategic direction for fitness to practise.

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