Fitness to practise procedures do not exits as a general complaints resolution procedure. The scope of what regulators can consider relevant is usually set out in statutory Regulations. In the case of the Nursing and Midwifery Council (NMC), its statutory powers to carry out investigations are limited to two kinds of allegation:
Allegations about fitness to practise can be based on:
If a nurse, midwife or nursing associate falls short of the Code, what they did or failed to do may be serious professional misconduct. It is this “misconduct” that the NMC investigates.
It is important to make a distinction between poor clinical practice and serious professional misconduct. On the whole, the NMC will not consider one-off clinical incidents as serious professional misconduct.
The NMC has set criteria for determining how serious clinical practise might be and therefore what action to take. In cases deemed serious, the NMC will usually only need to take action if it's clear that the nurse, midwife or nursing associate deliberately chose to take an unreasonable risk with the safety of patients or service users in their care.
It is important to also note that “serious harm to a patient” does not automatically mean the NMC will take action. The NMC is looking for honesty, reflection and remedial action in these cases. It said:
“Even where there has been serious harm to a patient or service-user, provided there is no longer a risk to patient safety, and the nurse, midwife or nursing associate has been open about what went wrong and can demonstrate that they have learned from it, we will not usually need to take action.”
Substandard care can call into question a nurse, midwife or nursing associate’s competence criminal convictions and cautions. Generally speaking, unless it was exceptionally serious, a single clinical incident would not indicate a general lack of competence on the part of a nurse, midwife or nursing associate.
Substandard care is care that usually involve an unacceptably low standard of professional performance, judged on a fair sample of their work, which could put patients at risk.
Criminal offences are normally viewed with particular seriousness by the NMC. Nurses, midwives and nursing associates are under an obligation to declare any cautions or convictions (unless these are for a protected) both when they apply to join the register and/or if they become involved in criminal offending while they’re on the register.
The NMC takes a particularly serious view of fraudulent register entries where a nurse, midwife or nursing associate failed to declare criminal convictions.
Whilst each case will be determined on its individual facts, certain convictions are deemed “the most serious cases of criminal offending” and these types of offences are referred straight to the Fitness to Practise Committee. These are:
Certain criminal conviction and cautions are not within the NMC’s jurisdiction to act on. These include:
The NMC will not need to intervene in a nurse, midwife or nursing associate’s practice due to ill health unless there is a risk of harm to patients or a related risk to public confidence in the profession.
As mentioned above, the NMC will not need to intervene unless there is a public safety risk.
The following is what a nurse, midwife or nursing associate can do to avoid regulatory action:
English language proficiency is likely to become a fitness to practise issue when it presents a public safety risk.
Examples of language concerns that could place the public at risk of harm include:
Cases about determinations of other regulators will generally lead to regulatory action by the NMC. The only exceptions to this are:
In cases relating to other health or social care organisations, the NMC’s approach is to “consider the scope and nature of the other organisation’s determination and the factual background.” The NMC will also “assess how closely the issues relate to the practice of nursing or midwifery in the UK and the underlying facts or issues.”