Whoever I speak to professionally since joining the Nursing and Midwifery Council (NMC), despite the many areas that I want to share with colleagues – such as plans to scope whether or not advanced practice should be regulated – the focus of discussions typically circles back to a concern about a fitness to practise (FTP) case.
This discussion comes from one of two angles: either that an employer has made a referral and is keen to understand where the case is sitting in terms of progressing towards a decision-making point, or that a member of the public has raised a concern and employers are also keen to understand when the case is likely to reach a decision point. With both scenarios, there is a significant personal impact on registrants and members of the public.
This month, at the NMC Council meeting in public, the latest annual report on FTP (NMC, 2023) was presented in advance of being laid before parliament, which is the formal process that must be followed.
The report highlighted that FTP is when a nurse, midwife or nursing associate has the skills, knowledge and good health and character to deliver safe, effective, and kind care for their patients and people who need or use health and social care services.
It was reiterated that the overwhelming majority of over 788 000 registered professionals do practise safely and effectively and, proportionately, a very small number of registrants are removed from the register (191 people in 2022–23).
Anyone can make a referral to the NMC, and it was made clear at the public meeting that reducing the NMC FTP caseload swiftly and safely is the top priority. The FTP annual report shares details about the process and, although the NMC has not met its planned reduction in the current caseload this year, there are a range of improvements in progress that are detailed in the report.
For 2022–23 there were a total of 3348 new referrals made to the NMC. Of real interest to me in my new role at the NMC is that in 2022-23, the decision not to investigate 4639 cases was made at the screening stage, either because it was concluded that the concerns did not require regulatory action, or because it was not possible to identify the individual as being on the NMC register (NB there were 473 concerns referred to another regulatory body). This equated to 76% of decisions made at this initial stage being to close the case with no further action to be taken.
The NMC team has made changes to support the public in the referral processes by introducing a new helpline as well as the design of a new form to guide the public through the FTP process. It is hoped that, in doing this, the appropriateness of FTP referrals will increase and there will be an overall decrease in public referrals. Examples that I have looked at include low-level concerns, for example, a community nurse parking badly at a patient's house, or issues that should have been addressed at a local level via a complaints route.
There is also a strong focus at the NMC on tackling discrimination and promoting diversity and inclusion, via the ‘Ambitious for Change’ programme (NMC, 2022). The NMC is undertaking work to understand why some people are disproportionally referred or receive different outcomes from NMC processes
During my first few weeks I have received some training that I wish I had known when I was a chief nurse, which leads me to the opinion that there is more that can be understood in practice to reduce inappropriate FTP referrals.
I am convinced that there is an opportunity for the NMC to work closely with senior nursing and midwifery leaders to support the aim of reducing the current caseload that is in the screening phase (which is currently at around 2300 cases) by supporting information requests, alongside having conversations to support the risk assessment of the referral once the facts are established to close cases swiftly and safely. I also believe that senior nursing and midwifery leaders have a role to play in influencing the public that use their services, in terms of how to raise concerns about care and for local resolutions to take place. Only if FTP is likely to be impaired should a referral to the NMC arise from this.
I am looking forward to working with my colleagues, particularly within my team in the employer link service (ELS) who reported their activity in the FTP annual report. This included delivery of webinars to share NMC processes with employers, regular engagement with employers and advice and guidance through the employer advice line that is led by the ELS team.
I look forward to a different caseload profile next year with the work that the NMC plans to deliver and look forward to working with colleagues to jointly support the improvement required to reduce the overall caseload and support the wellbeing of registrants at all stages of the process – while ensuring that public protection drives what we do and how we do it.