Are overseas nurses and midwives being given a fair assessment to register in the UK, or is there racial bias at the NMC?

James qualified as an RN in Nigeria in 2020. He had studied hard and gained exceptional grades and many awards at school and during his training.

He decided to come to the UK as he felt opportunities were better here with a wider scope of gaining experience and developing his career. Like many overseas nurses, he attended a local test centre to take his initial tests so that he could start the process. He passed, finding the test easy, and began his transfer to the UK. He was sponsored by a large teaching hospital in the South of England which supported his visa and gave him employment whilst he took the necessary tests to gain his UK PIN. In 2021 he undertook the OSCE evaluation for overseas nurses. This is a series of knowledge and clinical skills tests which involve written and practical skills-based scenarios.

As expected he passed and was granted his PIN from the NMC. He then began working and quickly progressed to a higher band and started a self-funded degree in his chosen specialism.

Test centre concerns

In May 2022 news articles were published stating concerns raised on the legitimacy of entrance exams at one Nigerian test centre. Unfortunately, it was the test centre where James had taken his OSCE test. He immediately spoke to UK colleagues who had tested at the same training centre and understood how these matters were being processed. He also spoke to his manager who was extremely supportive and felt everything would be ok. Finally, he spoke to the RCN but because he was not a member at the time of taking the test they could not support him. Five days later he found the news article in an email sent to him.

James carried on working and continued to receive high praise from the surgeons he worked for, his managers and colleagues. He was a highly skilled theatre nurse and everyone expected the matter to be sorted. 

NMC investigation

In Sept 2022 the NMC first got in touch with James, they explained that they were basing their investigation of him on the length of time it took him to take the OSCE test, saying he was one of 48 who had passed the test too quickly. The NMC arranged for him to take another test – this time in the UK – which he passed in a similar time and continued to work without any restrictions. Since starting work in the UK James has passed all mandatory training and started a peri-operative practices degree in May 2024 with good results so far.

James continued to work despite the pressure of an ongoing investigation. In February 2024, his manager found NMCWatch and contacted us to see if we could assist and support him. We had an online meeting and discussed the case history. We then gathered evidence of James’s high level of clinical practice, his academic achievements, and testimonials from colleagues. 

Test too easy

It is safe to say he was very confused by the allegations and was adamant that he had done the test himself in Nigeria, and had not used a proxy tester or any other methods to defraud. He says that he has always passed exams with high grades. He also prepared for the exams by studying the many practice exam questions via the online portal. James stated that many of these questions then appeared in the actual OSCE exam as well as the second exam he did for the NMC. So he was familiar with the questions beforehand. But we found the questions extremely easy when we had a go at the test, as any registered nurse should. However, we did explain that it was the speed of the test that the NMC was questioning and not his clinical ability. 

In March 2024 there was a 2-day hearing and then in early July, the panel returned with their decision. The panel decided the facts were proven and removed the registrant from the register.

Whilst we understand that if someone fraudulently procures their ability to be on the register, this case is not so straightforward. 

We found that:

1. The nurse’s ability to work in the UK was not solely based on the initial test taken in Nigeria
2. The nurse took further examinations in the UK under the supervision of the Nursing and Midwifery Council to qualify to work in the UK
3. The nurse then took a further initial test under the supervision of the Nursing and Midwifery Council which he passed in a similar time
4. This nurse has given 2 years of exemplary service to the NHS, has been promoted and is considered a senior, reliable member of his team
5. This nurse has established his life here in the UK, his partner is here and he has grown his life here but now without registration faces potential deportation as his visa may no longer be valid.
6. He will have to abandon the degree that he is halfway through – the funds he has paid out of his earnings will also be lost
7. He continues to assert that his initial test result was nothing but honest 

James has the option to appeal this decision within 28 days. But currently, considering his treatment, he no longer wants to be part of the nursing profession.

Bias repeated?

Five other registrants who came through the Yunnic Test centre (paywall) have been removed from the register. So were the hearings really necessary – was this an automatic and unavoidable outcome that could not have been changed in any way? Are the NMC assuming that ALL nurses who have taken their initial test at this centre have done so fraudulently? In which case why a hearing? Why not just remove them anyway?

Can there not be another way – surely maintaining the register is about ensuring ALL registrants on it are CURRENTLY fit to practice? It is true to say that if someone fraudulently had gained the initial test then this will invalidate any ongoing assessments – or will it?

This raises more questions about why it took the NMC over two years to look into these allegations with no interim orders imposed in the meantime. 

It also raises issues around the governance responsibilities that Pearson Vue (who run overseas test centres) and the NMC have, and that if the process was robust we would not be here. How can we be confident that other overseas test centres have appropriate governance?

Rules are strict but the impact on someone’s professional career can not be ignored – everyone has a responsibility to do better. 

The elephant in the room is whether there is a wider issue here around racial bias in the NMC’s treatment and expectation of overseas registrants.

Let us know your thoughts and experiences. Please leave a comment or email us in private, via nmcwatch.org.uk/contact.

UPDATE: 5 August 2024

Now that his appeal period is over, James has applied for re-entry onto the register. We were informed by NMC “If someone is removed under Fraudulent Entry (FE) or Incorrect Entry (IE) (for example the recent CBT cases), they can reapply to the register straight away. What will happen is that one of the Assistant Registrars (AR) (we have 4) will consider the application and the FE/IE case and make a decision.”

James awaits the decision. 

We have six other members who joined us with a similar story. They insisted they did the original test properly, were told they did it too quickly and offered to take a new test but had that test ignored in the decision-making. Some registrants have asked for the retest centre’s CCTV, but have been told this can’t be used and has not been made available. But it would show they did not use a proxy. 

Some have already been deported and others face it. Only a few have had employers find them alternative roles – most are without work and destitute despite coming to this country in good faith.