000 days

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

the FtP process – Step 1 of 7

Navigating FtP: the screening process explained

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.

This video explains the role of the screening team. You will be assigned an NMC case officer at an early stage. During the screening stage the NMC determine if the allegations are

a) something that is of regulatory concern and if so

b) does it fulfilled their requirements to continue to examine.

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

This is a short overview of the FtP process from defence barrister, Stephen McCaffrey.

Determining the seriousness of the concern

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
  • The referral must also be accompanied by supporting evidence – if there is no supporting evidence they will not take the case further. We are waiting for confirmation from the NMC as to the timeline they have set for closure. If you have not received a copy of any supporting evidence then challenge your screening officer for a timeframe and for case to be closed if this is not received. You can read more about this on the NMC’s own site.

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 the investigations team for a full investigation if the employer has not finished theirs yet. The aim of the NMC’s new approach is to only investigate if there is an ongoing concern once the employer has completed their investigation. If you leave employment it is an automatic referral to NMC, so stay put and cooperate with the investigation if you can.

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.

How can I show I have remedied any issues?

Even if the case meets the threshold for moving forward, a nurse can impact this by showing they have taken action to prevent the issues being considered from happening again. If evidence is submitted of having personally reflected on the issues, or undertaking extra training, the NMC may consider there to be no ongoing risk to the public and close the case.
Engaging with the process is key for nurses to get the best and quickest outcome. Ms Siegel from the Royal College of Nursing has been quoted in a recent article as saying:
“The worst thing that nurses can do, and what can happen if they don’t have legal representation, is bury their heads in the sand.
The best way is to engage with the process and provide evidence of fitness to practice.”
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. So, in essence, you can show good remediation but if the NMC feel that the case still needs pursuing from a public interest point of view they will still do so.
To find out more about the role of the case examiner and how they determine if there is a case to answer,  you can read more here.
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First - I've just been referred - Help!

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02 - Navigating FtP: Interim Orders