The Nursing and Midwifery Council (NMC) has a well-publicised backlog of referrals and cases relating to concerns from employers, members of the public and others relating to nurses, midwives and nursing associates (Devereux, 2024). It is aiming to improve the handling and timing of these cases.
As part of the improvement work underway relating to the handling of concerns, I and my NMC colleagues have been looking at the information that we hold to consider where we can work with employers to improve handling, timeliness and experience.
Like most other professional regulators, members of the public have been the biggest source of fitness to practise (FTP) referrals to the NMC. Since 2019, our data show that referrals by members of the public amount to around 33% of referrals. In 2022/23 our data show that 71% of these referrals have resulted in a decision not to investigate as they do not meet the threshold for a regulatory investigation.
The public's concerns
When we have looked at the concerns raised by members of the public, the most common allegations relate to the following event allegations:
- Patient care: 22-23%
- Communication issues: 13-14%
- Behaviour and violence: 14%
- Dishonesty: 8-10%.
The NMC has undertaken work to understand the drivers for raising concerns and has found several reasons which we can break down. The first group is what I would describe as ‘for the greater good’-type reasons, such as to protect others, to raise standards or to help make improvements and make sure mistakes are not repeated.
The other group often relates to more individually driven motivations, such as seeking redress or closure via an apology, accountability, or compensation – often following a poor experience with how concerns have been handled by an employer.
From our work, we have seen that the public commonly follow three paths that lead them to progress to a referral with the NMC:
- Dissatisfaction with the employer's reply or attitude
- Following a pattern of employer-police-regulator escalation
- Looking for accountability: members of the public have often got lost in avenues and options when attempting to raise concerns.
The public's experience
The final area that we considered was the experience of members of the public, specifically when their concern, as indicated earlier in a high proportion of referrals, has resulted in a decision not to investigate. This experience largely falls into several themes as to why concerns are not a matter for the NMC:
- Lack of understanding of the role of the NMC
- Some incidents occur in a professional's private life
- People's expectations do not always align with the NMC remit
- People often will not progress concerns and engage in the NMC processes.
Because of these issues, people's experience of the NMC processes can be traumatic, unexpected and frustrating.
What FTP is and what it is not
With these interesting insights in mind, I believe that it is important for the NMC and professionals on the register to better explain to the public several areas to support understanding:
- The types of matters that are viewed as serious (for example, not custody battles, or neighbour disputes)
- What constitutes a regulatory concern
- What information and evidence is sufficiently credible to pursue an investigation
- When the NMC is required to limit its investigations if other organisations are involved, such as the police
- That the NMC will need ongoing communication and information from members of the public to progress consideration of concerns.
Supporting the public
The NMC has a primary role to protect the public. What is clear is that, despite our profession being one of the most trusted by the public, it is critical that we learn together, as employers and as the regulator, that whatever the driver, or path followed, we all have a role in supporting the right response when people feel that they need to raise a concern.
From the number of referrals by members of the public that are closed at the screening stage, for the reasons outlined above, there is an opportunity for us to locally resolve areas of concern and prevent a referral to the NMC – which as we know is a distressing experience for people, including for the registrant involved.
Supporting members of the public to understand how they can raise concerns is a key part of all our roles to improve trust and confidence in our profession.