NMC launches new fitness to practise resource for employers

Published on 02 February 2021

The NMC publishes Managing Concerns, an employers resource to support them when concerns are raised about a nurse, midwife or nursing associate's practise.

The Nursing and Midwifery Council has published a new resource to support employers of nurses, midwives and nursing associates to take effective action when concerns are raised about someone's practise.

The NMC's person-centred approach to fitness to practise focuses on promoting a just culture that's free from blame. It encourages health and social care professionals to be open and learn from mistakes.

The NMC wants people to be honest when things go wrong, so learning can make services better. Rather than punishing people for genuine mistakes, we want employers to encourage service improvement through an open culture that values equality, diversity and inclusion.

In line with this approach, the new resource supports employers to avoid fear and blame when looking at concerns and to help everyone feel confident that they can speak up. It also sets out when it is not appropriate to make referrals to us, and supports employers to act first, with fairness and kindness, so that regulatory involvement only occurs when necessary.

The NMC also hopes that it will help employers to address challenging findings from last year's Ambitious for Change report, which found that nurses and midwives from a Black, Asian and minority ethnic background were more likely to be referred to fitness to practise by employers.

The resource outlines best practice principles for employers to consider when they are investigating and managing concerns locally about a nursing or midwifery professional. It has been developed collaboratively with employers, other professionals, our regulatory partners and representatives of people who use services across the UK drawing on their views as well as our own regulatory experience. It has been informed by earlier learning from five pilots and workshops with employers. The resource is intended to be used alongside, and not replace, existing local guidance and policies.

Key highlights include:

  • Principles and questions for employers to consider when investigating and managing concerns about their staff.
  • Practical case scenarios to illustrate when to make a referral.
  • Updated webpage for completing online referrals, including questions asking about contextual factors to help the NMC understand what may have contributed to incidents and better consider whether we need to take action.

Andrea Sutcliffe, Chief Executive and Registrar of the NMC said,

"The NMC has a really important responsibility in acting on concerns about nurses, midwives and (in England) nursing associate's fitness to practise. We want to make sure we are focusing our work on referrals that are necessary to protect the public. Employers have a key role to play in making sure that happens and the resource we are publishing today is designed to support them in appropriately managing or escalating concerns about someone's fitness to practise."

"Our research has highlighted that a disproportionate number of nurses and midwives from Black, Asian and minority ethnic backgrounds are referred to fitness to practise. I hope using this resource will help employers to be proportionate and fair so we can work together to eradicate the inequalities we see."

“This resource will be valuable for employers across health and social care. It will support them to improve both the experience of staff and the quality of care for people using their services. Jacky and the team at Hertfordshire have already shown what fantastic progress can be made."

"I'd like to thank everyone who has collaborated with us on this. Through working together we can help reduce unnecessary fitness to practise referrals and embed a learning culture that helps professionals feel confident to speak up, knowing they'll be supported and treated fairly."

Jacky Vincent is Deputy Director of Nursing, Quality & Safety at the Hertfordshire Partnership University NHS Foundation Trust. The Trust participated in one of the five pilot programmes that informed the development of the employer resource. Jacky said:

"We were delighted to be involved in the pilot project that has informed this resource, as it enabled us to review our own processes as an organisation."

"As part of our own review of processes and in response to our concern regarding Black, Asian and minority ethnic staff members being disproportionately disciplined, we introduced a Decision Making Panel process. This ensures that all matters are dealt with fairly and with swift and proportionate action."

"This is an objective panel and all cases brought are anonymised. The panel is chaired by a member of the People and Organisational Development team, with representation from the Head of Profession, a Senior Manager and a member of our Equality and Inclusion Team. It has allowed us to address identified concerns in relation to a staff member/s alleged misconduct based on an assessment of the merits of the case."

"Overall, the outcome for us has been positive; we have ensured that our all of local procedures and actions taken are consistent across the organisation, that they are measured and that they foster a learning and just culture."

Rosalind Hooper, Head of Legal Services (Regulatory) at the Royal College of Nursing (RCN), said:

"Encouraging employers to deal with performance issues at a local level first can often mean they are dealt with more quickly and effectively."

"This new resource should help employers better understand the options available to them so that they are less likely to immediately make a referral to an NMC Fitness to Practise process when a concern is raised."

"We know that a referral to the NMC is hugely distressing for registrants and should not be used by employers unless it is the only way to protect the public"

"With the over-representation of BAME registrants within the fitness-to-practise process, it is vitally important that where there are concerns about performance those involved are properly supported through a just process that is applied fairly, whatever their background."

"If nurses, midwives and nursing associates, and their employers, can focus on learning from mistakes at an early stage, care will be provided even more safely."

Suzanne Miller, Regional Officer and lead on Fitness to Practise for the Royal College of Midwives (RCM) said:

"The RCM welcomes the publication of the new resource for Employers and having been involved in its development we are pleased with the clarity and support it will provide employers. The RCM is committed to equality and diversity and ensuring that midwives are treated fairly and equitably at work."

"Research has shown us that black, Asian and minority ethnic midwives are often disproportionately affected by workplace referrals to the NMC. So we hope that these guidelines will support maternity managers in their decisions on when issues should be managed by themselves or escalated to the NMC and in turn go towards reducing unnecessary fitness to practice referrals and ensure all midwives are treated fairly in any type of disciplinary process."

Juliette Cosgrove, Chief Nurse at NHS Professionals, said:

"As one of the largest providers of flexible nurses and midwives to the NHS, we welcome this new resource to help support us. We were grateful to have been part of the pilot and workshops that informed the development and launch of this new tool and we used the learnings from our involvement to look at ensuring that, when working with our registrants, the real focus is about a just approach and local resolution, leading to a fair outcome for all."

"This has led to us identifying that many concerns raised about the performance of our nurses and midwives were related to a training requirement and we have invested in our team to improve our education and training programme. We are confident that this collaborative framework will be a useful tool for when we investigate any issues related to the practice of our registrants. Our investigations can often include other parties and we know a consistent, partnership style approach will lead to parity of treatment for all registrants."

"We look forward to working together to ensure this new tool’s success."

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