New data reveals areas of nursing and midwifery practice of most concern to public and employers

The public are more likely to raise concerns about nursing and midwifery professionals’ communication and manner, while employers tend to focus on performance-related issues and competence, according to new analysis of fitness to practise (FtP) data by the Nursing and Midwifery Council (NMC).

As part of the health and care safety system, the NMC investigates concerns that could amount to an impairment of someone’s fitness to practise as a nurse, midwife or nursing associate. A small minority of the 853,707 professionals on the NMC register are referred to the fitness to practise process each year. But the data show that on those occasions, there are common themes of concern to the public and employers.

Published today, the first Insight into Fitness to Practise reveals that both patients and employers most commonly raise certain patient care concerns relating to diagnosis, observation, or assessment of patients. They can also involve delayed or inappropriate responses to patient deterioration.

Patients and employers are also similarly concerned with record keeping and dishonesty. The former relates mainly to patient records, care plans, or drug and medication records. The latter tends to involve misrepresentations or omissions related to patient care or employment.

However, there is then divergence, with the public more often concerned by their nurse, midwife or nursing associate’s communication. This is usually when professionals are felt to be unfriendly, uncaring, or rude. Most of these public referrals highlight a lack of compassion or kindness, or a failure to provide sufficient or accurate information about care.

In contrast, employers more commonly refer prescribing and medicines management issues, which typically involve errors in medication administration, breaches of local policies, or incorrect dosages. 

The NMC analysis makes other key findings:

• Members of the public are more likely to raise concerns about midwives than employers. Conversely, employers are more likely to raise concerns about nurses and nursing associates than the public.
• There was a 14 percent increase in new concerns from 5,058 in 2022/23, to 5,774 in 2023/24. The public have consistently raised more concerns than employers over the past few years, although there was a significant proportional increase in employer referrals in 2023/24.
• There is overrepresentation of certain groups in the FtP process with male professionals, working in mental health and learning disabilities settings being particularly affected. Male professionals account for 40 percent of FtP referrals of professionals with a mental health qualification, despite comprising only 26 percent of those professionals on the register.
• Professionals who have representation, actively engage in reflection, and take steps to strengthen their practice, are less likely to receive FtP outcomes that restrict their practice.

Read the Insight into Fitness to Practise report 2024

Fitness to Practise dashboard (2019-2024)

To support system-wide learning and improvement, the NMC has today launched a data dashboard displaying the last five years’ FtP data. It uses charts and infographics to explore trends in the concerns that are being raised with the NMC. The dashboard is freely available on the NMC website. 

Kuljit Dhillon, Interim Executive Director of Strategy and Insight, said: 

“The vast majority of nursing and midwifery professionals provide safe and effective care day in, day out. But on those occasions when concerns are raised, our data shows common themes.

“Compared to employers, the public are more often concerned by communication, and they refer more midwives. This chimes with recent findings from the Care Quality Commission that there’s been a decline in positive feedback from new mothers about communication during childbirth. If we’re going to uphold public confidence in the professions, then all parts of the patient safety system, including the NMC, must do better to support all professionals to communicate effectively with the people in their care. The data is clear that this is fundamental to a good care experience, ensuring patients feel informed, respected and cared for.

“We hope our insights can help our partners across the health and social care sector to better understand and address the issues of greatest concern to patients and employers. For our part, we’re committed to more timely decision making in our fitness to practise process, and we’re working to improve the quality, accessibility, and usability of our data for the sector."

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