000 days

since the NMC committed to investigate its ‘established procedures’. We’re still watching!

Navigating FtP: Screening

Stephen McCaffrey is a private barrister specialising in Fitness to Practice cases. He is producing a series of information leaflets to help understand different aspects of the process and is happy for us to share them.
Here he explains the first stage of the process – the screening process. A short video is also available here
The NMC’s first stage in their fitness to practise process is screening complaints. This is necessary for the NMC to decide whether they can investigate the complaint or not. The screening process is also important for the NMC to undertake an initial risk assessment of the complaint to determine if it meets the threshold for consideration of any interim steps.
The NMC’s approach to screening can be divided into four stages:
  1. Determining the seriousness of the concern relevant to fitness to practise
  2. Checking if it meets the NMC’s formal requirements
  3. Checking whether the NMC can obtain credible evidence
  4. Checking for evidence of remediation
1. Determining the seriousness of the concern
2. NMC’s formal requirements
This is a technical matter, but for information, the NMC requires the following for all complaints made to it:
  • Must be written in a letter or an email
  • Must provide sufficient detail about the individual nurse, midwife or nursing associate so that the NMC are able to identify them
  • Must come from an identifiable person or organisation with agreement to us disclosing their referral to the nurse
  • Must set out the nature of the concern, the events and circumstances giving rise to it complaint
3. Credible evidence
If the NMC’s initial assessment of a complaint leads it to believe that concerns are sufficiently serious to be treated as an allegation of impaired fitness to practise or of incorrect or fraudulent entry, it will move on to consider the evidence to assess if there’s enough evidence that’s likely to be credible and admissible.
There is no exhaustive list of evidence the NMC will consider but it gives the following as “Examples of useful supporting evidence”:
  • a clear and logical narrative explaining the conduct which is being alleged
  • dates of the incident(s) (including exact time and dates if possible)
  • locations where the incident(s) took place (including name and address of the organisation, and specific wards or departments where possible)
  • details of who was present (including patients, colleagues or any other witnesses)
  • copies of contemporaneous notes and statements of anyone who witnessed the events alleged
  • copies of medical records, MAR charts, prescriptions, which should be provided with the informed consent of the patients concerned if possible, or a clear indication as to why this has not been possible
  • local policies
  • details or documentary records of any admissions made by the nurse, midwife or nursing associate
  • details of other sources of evidence in support of the allegation, where the evidence that can be provided by the referrer is limited.
It is worth noting that the NMC will not, generally, refer a case to our investigations team for a full investigation if the employer has not finished theirs yet.
4. Evidence of remediation
Remediation must not be underestimated. Steps that have been taken by a nurse, midwife or nursing associate to alleviate any concerns about their fitness to practise concerns since an incident can carry a lot of weight.
The NMC’s own guidance states in cases where all the formal requirements are met, it will “gather information to determine whether the nurse, midwife or nursing associate has taken appropriate steps to mitigate the risks presented by the case.
In the same guidance, the NMC says it expects a nurse, midwife or nursing associate to have reflected on the issues raised in the case and there is evidence of relevant retraining or learning.
Where there is clear evidence of the above, the NMC may decide that they no longer present any risk to patients or members of the public.
However, risk to patients or members of the public is only one aspect of the NMC’s considerations. Promotion and maintaining public confidence in nursing is another aspect to consider and for this remediation in itself is not sufficient. Notwithstanding an assessment of public or patient risk, if the NMC thinks an allegation might damage public confidence in nursing, it could still act by Fitness to Practise Committee.