NMC pilots employer guidance to tackle time-wasting referrals

The Nursing and Midwifery Council is piloting the new support tool for healthcare organisationss as part of an overhaul of its fitness to practise processes.

“We wanted to work much more closely with employers and support them to take responsibility for the quality of referrals that come to us”

Matthew McClelland

Directors from NMC gave an update about the new strategy, which it has been trialling for the last six months, to delegates during a breakout session at the chief nursing officer for England’s summit in Birmingham yesterday.

Lucy Dennett, assistant director of fitness to practise at the NMC, revealed that 50% of cases that were referred to the regulator currently were squashed in the first stage – “which tells us the wrong the things are coming to us”.

Matthew McClelland, director of fitness to practise, said under the different approach, the regulator wanted to “prioritise local action by employers” so that more issues were dealt with in-house.

“There’s something going on in the way referrals are coming to us, so we wanted to work much more closely with employers and support them to take responsibility for the quality of referrals that come to us,” he said.

To achieve this, the NMC is piloting new guidance that employers can use to help them make the decision about whether they need to refer a nurse to fitness to practise or whether they could deal with the issue themselves.

matthew mc clelland

matthew mc clelland

Matthew McClelland

“This is all about making sure we only get things come to us when there’s risk an employer can’t manage on their own,” he told the room of senior nurses.

Mr McClelland said the NMC was “absolutely clear” that employers were “primarily responsible” for the conduct and professionalism of their staff and needed to hold them to account when things went wrong.

During a question and answer session after the presentation, Gail Adams, head of professional services at Unison who leads on the union’s work on fitness to practise, said she supported the introduction of guidance for employers.

Ms Adams said some of the referrals to the NMC that she dealt with were “ridiculous” and she questioned why they were put forward.

She also highlighted learning from the way that cases had been handled after the care failings at the former Mid Staffordshire NHS Foundation Trust.

“In the wake of Mid Staffordshire, although the pendulum had to swing this far, we need to get back to neutrality where people can manager their own staff,” she added.

She added that the NMC’s new approach was the “titanic change that we needed to see”.

However, Sue Covill, director of development and employment at NHS Employers, said she “struggles slightly” with the guidance idea, because “action at local level is employment action, it relates to the employment relationship, regulation is different”.

She added: “When we talk to employers very often they say to us we made this referral because we didn’t want this person to go to a different organisation and cause a problem there.”

Mr McClelland acknowledged that, in the scenario where potentially problematic staff were moving around, the system that would be a matter for the NMC.

He said: “We say the only things we need to see is where employers can’t manage risk on their own, but people moving around or in multiple settings or without an employer is a key risk.”

Gail Adams

Gail Adams

Gail Adams

Mr McClelland said the NMC would also be taking greater account of the context in which an incident happened.

“Things don’t go wrong in isolation, they go wrong in an environment so it’s really important for us to understand what that context has been like and whether it’s right that we should hold the individual to account or if there’s wider learning for the organisation or for the system that we should identify first or instead,” he added.

In addition, the fresh approach to fitness to practise would focus on remediation and only taking a case to a public hearing when absolutely necessary, Mr McClelland said.