Advice and

information for
employers of nurses
and midwives

Advice for employers 1

Contents

Introduction 3
The role of the NMC... 3
Protecting the public. 4
Your responsibilities as an employer. 5
Revalidation......... 8
Internationally-trained nurses and midwives..... 9
Fitness to practise.... 11
Urgent referrals and interim order................... 12
Types of fitness to practise allegations.............. 13
Issues to consider before referral 16
Deciding whether to make a referral 18
Referral decision tree.. 18
Making a referral...... 20
Further advice and information. 23

Advice for employers 2

Introduction
This information is for anyone who employs nurses and midwives, including directors of nursing
and other managers, and those working in HR.

It will help you learn more about:

your responsibilities as an employer

how to use and check our register
what steps you should take during the recruitment process
what we mean by fitness to practise
how to proceed if you are considering making a fitness to practise referral to us

The role of the NMC

We protect the public by making sure all practising nurses and midwives have the skills,
knowledge, health and character to do their job safely and effectively.

To do this, we:

require all nurses and midwives who practise in the UK to be registered with us
set standards of education, training, conduct and performance so nurses and midwives can
deliver high-quality healthcare consistently throughout their careers
ensure that nurses and midwives keep their skills and knowledge up to date and uphold our
professional standards
have clear and transparent processes to investigate nurses and midwives who fall short of
our standards our fitness to practise work

Advice for employers 3

Protecting the public
Our register
Fundamental to our work protecting the public is keeping the register of nurses and midwives
who are legally allowed to practise in the UK. Only those who meet our standards can be on the
register. Registration provides assurance to patients, employers and the public that a person is
fully qualified, trained, capable of safe and effective practice and worthy of trust and confidence.

We consider whether applicants for initial registration are of sufficient health and character
to be capable of safe and effective practice using the principles outlined in NMC character and
health decision-making guidance. Universities can refer to this guidance in making their own
health and character assessments of students and prospective students, and it may also be
useful for employers.

Only we can stop a nurse or midwife from practising in the UK by removing them from the register
or taking action to suspend or restrict their practice.

On 1 January 2016, there were 690,000 nurses and midwives on our register. Anyone can check
whether a nurse or midwife is currently registered on our website.

The Code
All qualified nurses and midwives must read and adhere to The Code: Professional standards of
practice and behaviour for nurses and midwives (NMC, 2015). The Code contains the professional
standards that nurses and midwives must uphold. They are also the standards that patients and
members of the public tell us they expect from healthcare professionals.

Our Code revolves around four themes prioritise people, practise effectively, preserve safety
and promote professionalism and trust. Employers are responsible for the safety and quality
of the care provided by their staff, and The Code supports this by ensuring that every contact,
action and decision made by a nurse or midwife is governed by core professional standards and
principles. These standards are key to the quality of the services nurses and midwives provide.

Advice for employers 4

Your responsibilities as an employer

You should have robust procedures to make necessary checks during the recruitment process
and regularly throughout a nurses or midwifes employment with you.

Checking references
Always make sure that you receive at least two professional references from an applicants
last place of work as a nurse or midwife. You should ensure one referee is the most recent line
manager, and the second referee should be a suitably qualified senior nurse or midwife, not a
personal friend. If the nurse or midwife is newly registered, you should ask for a reference from a
tutor and practice mentor. References should be sufficiently detailed to confirm that someone
is competent to do the role you are asking them to undertake.

Be sure to follow up on references too always contact referees yourself rather than relying on
any written statements supplied to you by the applicant.

You should also verify any gaps in a nurses or midwifes employment history. Periods of time out
of the workplace may have come about because someone took maternity leave or went travelling,
but you should assure yourself that the reason for the gap is not problematic. Its important to
consider whether any gaps in employment may be due to concerns about practice.

You should not let a person start work until you have verified their references. If you really
cannot afford to wait for references to be confirmed in writing, at least obtain verbal
assurances over the phone until the paperwork is received and reviewed.

Checking registration
Our register is a public record of all nurses and midwives who meet our registration
requirements and are entitled to practise.

You must ensure that the nurses and midwives you employ are registered before they begin
working for you, and you must regularly check their registration status throughout the time you
employ them. In addition, nurses and midwives may hold recordable qualifications (for example,
allowing them to prescribe) which you should also check on our register.

Registration is not a guarantee of fitness to practise. As an employer, you should ensure that
the people you employ are competent and have the skills required for their role.

Employer confirmation service

We issue nurses and midwives with a unique identifying number called their Pin. You should not
rely on a nurse or midwife providing a Pin, or any NMC paperwork bearing a Pin, as proof of
registration. This is because a Pin is only valid on the day it was issued and their status may have
changed since. You should always check the registration status of nurses and midwives directly
with us.

We offer a free registration confirmation service that allows employers to check a nurses or
midwifes qualifications and registration status.

Advice for employers 5

The employer confirmation service holds more information than the public register, including a
full registration history, registration renewal dates and details of any cautions or suspensions
we have issued.

To find out more about this service or to register as an employer, visit our website or call us.

Identity checks
You should make sure the person you are employing is who they claim to be. As part of your
background checks before employment, you should ask to see proof of identity and address.
Proof of identity should be photographic, for example, a passport, photo driving licence, or
European Union (EU) or European Economic Area (EEA) national identity card.

Proof of address might include a recent bank statement, utility bill or council tax bill. You should
not employ someone if you are uncertain of their identity. Contact us immediately if you believe
someone is fraudulently using a nurses or midwifes identity or registration details.

New employees
New employees should have:

a thorough induction into their area of work

training and supervision where necessary
appropriate support and mentoring for newly qualified staff
ongoing access to professional development
clinical supervision

Monitoring performance appraisals and management

As an employer you have a responsibility to recognise and reinforce good performance, and to
take steps to identify and deal with poor performance.

All employees should receive regular performance appraisals (at least annually). Appraisals are
the method by which a nurses or midwifes work performance is discussed and training needs are
identified, evaluated and formally documented. Appraisals link to the revalidation process and
form part of a career development pathway. They should normally be performed at six-monthly
intervals, incorporating short and long-term objectives.

Performance management involves the formal intervention of a manager in relation to a nurse

or midwife not achieving organisational and professional objectives. It also involves managing
performance or conduct issues. This process will involve HR policies and guidelines as well
as referring to our standards and the Code in determining the degree of competence and
compliance.

Advice for employers 6

Responsibility for your staff
If a nurse or midwife is given, and accepts, responsibility for practice which is beyond their
capability and which results in errors and concerns about their practice, both the employee and
employer are accountable: the employee for failing to acknowledge their limitations, and the
employer for failing to ensure that the employee has the appropriate skills and knowledge to
perform their role.

Collecting employer information

Please encourage the nurses and midwives you employ to provide us with information about
the organisation they work for, such as their employer name, address, phone number and email
address. This helps us communicate with those on our register and helps us reduce the number
of nurses and midwives practising with lapsed registration.

Raising concerns
In accordance with our guidance you should ensure that there is a mechanism available for
nurses and midwives to raise concerns about, for example, poor standards of care, or a
colleagues fitness to practise.

ELSEmployer Link Service

The new Employer Link Service (ELS) aims to develop more effective regulatory relationships with
employers and offers a variety of services.

ELS provides information about key NMC developments such as revalidation, along with
continuing to promote the Code and other guidance. We offer learning sessions for employers,
including induction for new Directors of Nursing.

The services Regulation Advisers will assist with queries and advice about making a fitness to
practise referral. This way we can ensure the right referrals are made so that we can protect
the public. The enhanced links formed by the service will enable us to share data and information
with employers and other regulators.

Employers needing guidance are encouraged to contact the ELS team on 020 7462 8850 or
[email protected].

More information we provide for employers can be found on our website.

Advice for employers 7

Revalidation

From 1 April 2016, nurses and midwives must meet our new revalidation requirements to maintain
their registration. The new process replaces Prep and will help nurses and midwives demonstrate
that they practise safely and effectively.

All nurses and midwives will have to revalidate every three years when they renew their place
on the register. Failure to comply with revalidation will result in their registration lapsing. If this
happens, the only way they can regain their registration would be by applying for readmission.
This process can take two to six weeks, depending on their circumstances; they would be unable
to practise during this period.

If a nurse or midwife applies for readmission within six months of having lapsed from the register
because they failed to revalidate, they will have to meet the revalidation requirements as well as
the usual readmission requirements (unless exceptional circumstances apply).

The requirements
In order to revalidate, nurses and midwives will need to have met the following requirements over
the three years since they last renewed their registration:

450 practice hours or 900 if revalidating as both a nurse and midwife

35 hours of continuing professional development, including 20 hours participatory learning
five pieces of practice-related feedback
five written reflective accounts
reflective discussion
health and character declaration
professional indemnity arrangements
confirmation by an appropriate person that they have met the revalidation requirements

Previous Prep requirements remain in place until 31 March 2016.

Revalidation has been developed to apply in all kinds of practice settings. We believe that
employers will benefit from positive engagement with the revalidation process and that those
who prepare for, invest in and support the process will get the most benefit from it. It also
provides an opportunity for employers and organisations to undertake a wider assessment of
the quality and assurance systems they have in place.

As an employer, you should support your staff through the revalidation process. More
information about revalidation can be found on our microsite. You can also view our Employers
guide to revalidation (2015) which shows how you can provide support to nurses and midwives as
they go through revalidation.

Advice for employers 8

Internationally-trained nurses and midwives

Depending on their country of training, nurses and midwives are admitted to our register via
different routes.

Nurses and midwives trained outside the EU or EEA

When nurses or midwives who trained outside the EU or EEA apply to join our register, we will
check their education and practice experience. We will also verify their good character, health
and language competence. We require an IELTS score of seven for all applicants who trained
outside the EU or EEA, regardless of which country they are from or whether that country is
majority English speaking.

We require all nurses and midwives from outside the EU or EEA to successfully complete our
overseas competency test before we can register them. This is a two part test consisting of a
theory based assessment and a further objective structured clinical examination (OSCE).

Nurses and midwives inside the EU or EEA

EEA countries include the 28 member states of the EU, as well as Iceland, Liechtenstein and
Norway. The same rules also apply to Switzerland. The process of recognising qualifications from
the EU and EEA is governed by legislation based on the principle of freedom of movement.

Language competence
As a result of recent changes to European legislation, we have introduced a new process to
check the language competence of EEA-trained nurses and midwives who apply to us for full
registration. Applicants will be asked to supply us with evidence that they have the necessary
knowledge of English to practise safely. If they cannot supply this evidence, we will require them
to successfully pass an IELTS test before we can register them.

These changes will enable us to make sure, on a case-by-case basis, that a nurse or midwife from
the EU has sufficient knowledge and command of English to practise safely and effectively.

However, all employers should ensure that any nurse and midwife is able to communicate
effectively at the interview stage before offering employment.

European Professional Card (EPC)

From January 2016, EEA-trained nurses responsible for general care (adult nurses in the UK)
will be able to apply for recognition of their qualifications in other EU countries via the digital
European Professional Card (EPC). The EPC is a form of electronic exchange between European
regulators and is aimed at facilitating the process of recognition of qualifications.

It is important however that employers are aware that the EPC only recognises qualifications
and does not constitute a right to practise in the UK. Nurses and midwives who hold an EPC will
still be required to apply for registration and meet our requirements before being accepted onto
the register.

Advice for employers 9

Temporary and occasional service provision workers
Under European law, nurses and midwives who are registered in their home countries are able
to apply to practise for short periods in other member states. When the NMC assesses such a
request it will measure the application against a number of criteria including duration, frequency,
regularity and continuity. Where a nurse or midwife meets the requirements for temporary and
occasional registration we will show their name on the NMC website for potential employers to
check.

In relation to temporary and occasional service providers, employers, recruiters and agencies
should be aware of the following:

Nurses and midwives wishing to provide temporary and occasional services are not permitted
to practise on a full-time or permanent basis. Such nurses and midwives should therefore
not be offered full-time or permanent employment contracts.
Employers and service users should ensure that nurses and midwives they employ or
contract can speak English and communicate effectively, and hold an appropriate indemnity
arrangement or insurance.
Nurses and midwives practising in the UK on a temporary and occasional basis are subject to
the requirements of the NMCs Code.

What we cannot do as a regulator

By law we cannot:

Check whether a nurse or midwife who meets the EU requirements for direct entry to the
register has undertaken professional experience since they originally qualified, regardless of
how long ago they qualified.
Check whether a nurse or midwife who trained before their country joined the EU or EEA has
met the standards of knowledge and competence expected of UK and internationally-trained
nurses and midwives.
Check whether a nurse or midwife employed on a temporary or occasional work basis meets
the necessary language requirements (please see the sub-section Temporary and occasional
service provision workers on page 10 for more information).

What you can do as an employer

EU legislation does not prevent you as the employer from checking that the nurse or midwife you
recruit is competent, safe to practise, has up-to-date and contemporary knowledge, and has the
necessary language and communication skills.

You have a responsibility to ensure that your recruitment systems are robust, and it is good
practice to:

request and follow up references and verify any gaps in employment

Advice for employers 10

 be assured that the nurse or midwife has the appropriate skills and knowledge to carry out
their role
be satisfied that the nurse or midwife can communicate effectively in English, both verbally
and in writing (for example, by requiring applicants for patient-facing roles to write a care
plan against a clinical scenario and then discussing it with them)
carefully manage the induction and support of new employees
regularly monitor and appraise your employees performance
maintain a reminder system to regularly check the registration status of your employees
using our employer confirmation service
support your staff in achieving the revalidation requirements and do all you can to help them
maintain their fitness to practise
not offer a full time role or permanent contract to a nurse or midwife undertaking temporary
and occasional service provision in the UK

If you are concerned that a nurse or midwife does not have the necessary knowledge of English
to practise safely, you can make a referral to us. Please refer to the sub-section Necessary
knowledge of English on page 14 for further information.

Fitness to practise

Being fit to practise means a nurse or midwife has the skills, knowledge, health and character to
do their job safely and effectively.

When someone considers that a nurses or midwifes fitness to practise is impaired, they can
bring these concerns to us.

We investigate various allegations including:

misconduct
lack of competence
criminal behaviour
serious ill health
not having the necessary knowledge of English

If a nurse or midwife fails to comply with our standards, this does not automatically mean that
their fitness to practise is impaired we have to look at all the circumstances involved. We
have clear and transparent processes to investigate nurses and midwives who fall short of
our standards. We also investigate cases where it appears that someone is on our register
fraudulently.

In 2014-2015, only 0.7 percent of the 687,000 nurses and midwives on our register were
considered under our fitness to practise procedures. The vast majority practise safely in line
with the Code and consistently meet the high standards expected by the public.

Advice for employers 11

As a requirement of new EU legislation, an alerts mechanism will enable the electronic sharing
of fitness to practise information between regulators across the EEA, enhancing our ability to
protect the public.

You can find out more about our investigation work in our annual fitness to practise reports.

Urgent referrals and interim orders

As an employer you have the power to suspend or dismiss a member of staff, but this may not
prevent them from working elsewhere. Since 2010, employers have been the biggest source of
referrals to us. In 2014-2015, 40 percent of referrals were by employers.

In very serious cases, it will be appropriate to refer a nurse or midwife to us at an early stage,
even before you conduct your own internal investigation. This allows for the possibility of
imposing an interim suspension or conditions which restrict the practice of the nurse or midwife
until the case has been investigated.

Although concerns about a nurses or midwifes practice can often be addressed under an
employers own processes, if you believe that patients may be at immediate and serious risk from
the nurse or midwife, you should contact us straight away. You may not have a lot of information,
but you should tell us as much as you can.

Hearings to consider an interim order take place in public. A panel will consider whether the
interim order is:

necessary to protect the public

in the publics interest
in the nurses or midwifes interest

If you have already involved the police or safeguarding authorities, you should let us know. Please
contact the Employer Link Service if you need to discuss a potential referral on 020 7462 8850
or [email protected].

Student nurses and midwives

If there are fitness to practise concerns raised about a student nurse or midwife, you should
immediately contact the university to make them aware of the details.

Advice for employers 12

Types of fitness to practise allegations

Misconduct
Misconduct is behaviour which falls short of that which can be reasonably expected of a nurse or
midwife.

The Code is the foundation of good nursing and midwifery practice, and is a key tool in protecting
the health and wellbeing of the public. Not every departure from the Code will raise a fitness to
practise issue, but if nurses and midwives do not follow the Code it may give rise to an allegation
of misconduct and impaired fitness to practise.

Examples of misconduct
Common examples of misconduct referrals include:

physical or verbal abuse of patients or colleagues

dishonesty, including theft of medication
significant failure to deliver adequate care
significant failure to keep proper records
an uncaring attitude it is possible to deliver care that is clinically competent but uncaring;
attitude and character are as important as competence

More examples of recent case outcomes can be found on our website.

Case study: Misconduct

Allegations of misconduct can include physically or verbally abusing patients. A nurse was
struck off the register for treating care home residents in an aggressive and inappropriate
manner. Charges included knowingly feeding two residents with dementia contrary to their
requirements, pushing a resident forcefully, shouting aggressively at residents and colleagues,
and grabbing residents hands hard enough to cause the skin to redden.

The fitness to practise panel ruled that this behaviour was unacceptable, falling far short of
the behaviour expected from someone in the nursing profession. In order to protect patients
and maintain public confidence in nurses, the panel decided to strike the nurse off the register.

Advice for employers 13

Lack of competence
Lack of competence is a lack of knowledge, skill or judgement that makes the nurse or midwife
not fit to practise safely.

Nurses or midwives who are competent and fit to practise should:

have the skills, experience and qualifications relevant to their part of the register
demonstrate a commitment to keeping those skills up to date
deliver a service that is capable, safe, knowledgeable, understanding and completely focused
on the needs of the people in their care

Examples of lack of competence

Lack of competence may be an issue if over a prolonged period of time a nurse or midwife makes
continual errors or demonstrates poor practice.

This could involve:

a lack of skill or knowledge

poor judgement
an inability to work as part of a team
difficulty in communicating with colleagues or people in their care

You might identify a training need and set up a supervised support programme for a nurse or
midwife, but their work may only show a temporary improvement which slips back when the
programme is completed.

Also, the nurse or midwife might demonstrate a persistent lack of ability in correctly dealing with
medicines. Or they may demonstrate a persistent lack of ability in identifying care needs and
subsequently planning or delivering appropriate care.

It is important to consider whether the nurse or midwife shows insight into their lack of
competence.

Necessary knowledge of English

We can investigate concerns that a nurse or midwife does not have the necessary knowledge
of English to practise safely. When assessing referrals relating to English language, we will only
consider that a nurse or midwifes fitness to practise could be impaired if the referral is serious
and if their lack of knowledge of English could place patients at potential or actual risk of harm.

Advice for employers 14

Examples of language concerns that may come to your attention and which could place the public
at risk of harm include:

Poor handover of essential information about patient treatment or care to other health
professionals because of an inability to speak English.
Serious record keeping errors or patterns of poor record keeping because of an inability to
write English.
Serious failure(s) to provide appropriate care to patients because of an inability to
understand verbal or written communications from other health professionals (or patients
themselves).
Evidence of drug error(s) caused by a failure to understand or inability to read prescriptions.
When investigating a nurses or midwifes knowledge of English we will usually direct them to
take the International English Testing System which assesses an individuals abilities in reading,
writing, listening and speaking.

Character issues criminal behaviour

Cases concerning character usually involve some form of criminal behaviour that has resulted in
a serious conviction or caution.

On some occasions, you will need to consider whether to discipline or educate a nurse or midwife
whose behaviour has brought the profession into disrepute, even if their actions have not
resulted in legal proceedings. For example, a nurses or midwifes behaviour outside work may
cause you or a patient to question whether they are the right sort of person to be giving people
care.

If you are ever unsure whether to make a referral, dont hesitate to contact us for advice.
Examples of behaviour that indicate questions about character include:

a caution or conviction for example, theft, fraud, violence, sexual offences or drug dealing
dishonesty
accessing illegal material from the internet of a serious nature

Case study: Character issues

A nurse was found guilty of making indecent photographs of a child by a Crown Court and
sentenced by the court to two years community punishment and rehabilitation, and disqualified
from working with children.
The Nursing and Midwifery Order 2001 requires us to investigate allegations that an individuals
fitness to practise is impaired because of a criminal conviction. In this case, the fitness to
practise panel recognised that the behaviour was fundamentally incompatible with being a
nurse and was in very serious conflict with the Code.
The nurse broke the trust and confidence of the public, threatened the good reputation of the
profession and broke UK laws. They were struck off our register.

Advice for employers 15

Serious ill health
Good health means a person must be capable of safe and effective practice without supervision.
It does not mean the absence of any disability or health condition. Many disabled people and
those with long-term health conditions are able to practise with or without adjustments to
support their practice.

We are particularly concerned about long-term, untreated or unacknowledged physical or mental

health conditions that impair someones ability to practise without supervision. To be considered
fit to practise, nurses and midwives should also demonstrate suitable attention to their personal
needs and should not, for example, abuse or be dependent on alcohol or drugs.

Issues to consider before referral

Using local procedures
Every day, employers, managers and supervisors deal with situations concerning the misconduct,
lack of competence, bad character or serious ill health of nurses and midwives.

We recognise that many of these incidents involving minor wrongdoing are better dealt with
by employers at a local level. You might need to discipline a nurse or midwife through your own
employment procedures or provide them with further training. However, the incident may not
be so serious that we need to consider whether they should remain on our register without
restriction.

Evidence of insight into the concerns and a willingness to take steps to address the issues are
important factors to consider. If there are no patient safety issues and you know you can help
the individual to improve and practise safely, take all steps to do so.

If you do manage a concern locally, you should monitor the situation and review the position if
there is a change in circumstances. For example, if you manage a case of poor performance or
ill health, and the concerns cannot adequately be dealt with under your own procedures, or the
situation deteriorates and there are fitness to practise or patient-safety issues, you should
make a referral to us. It is helpful if the referral includes any evidence and information collected
for your investigation.

It is up to you as the employer to decide whether you refer a case to us. So, as well as keeping a
record of evidence for making a referral, you should also record your evidence and reasoning for
those concerns or incidents where you decide not to make a referral. You can contact the ELS
for advice on making a referral.

Ill health cases

Cases of ill health can probably be managed locally if:
the nurse or midwife acknowledges their condition and is complying with recommended
treatment
necessary steps are taken to manage the condition following a doctors advice or your own
requirements
there is no risk to patient safety

Advice for employers 16

Lack of competence procedures
Lack of competence cases are usually referred to us after the employer has tried to address
the problems with someones practice, and they have not taken advantage of opportunities to
improve.

If you are considering making a referral regarding lack of competence, we expect that you will
have:

gathered information to establish the facts about a nurses or midwifes lack of competence
and attempted to identify possible causes
raised any serious problems formally with the nurse or midwife concerned, identified their
training needs and provided them with adequate supervision to help them improve

If at any stage you think patient safety may be at risk, you must refer the matter to us.

Shared responsibility
The responsibility for dealing with lack of competence is shared between employers,
the NMC, and individual nurses and midwives. We each have a duty to ensure that
nurses and midwives are competent for their roles and are able to practise safely.

Be prepared to notify patients and the nurse or midwife concerned

We will notify nurses and midwives of the allegations and evidence we are considering and,
depending on the type of case being referred, we may need to see a patient or service users
healthcare records. Information and guidance about healthcare records and fitness to practise
proceedings can be found in our publication and disclosure policy.

If you have any concerns about us notifying the nurse or midwife of the allegations or concerns
about patient healthcare records, you should raise these concerns with us as soon as possible.

Personal lives
If a concern is raised with you about something that has happened outside work, and the incident
suggests that a nurses or midwifes fitness to practise may be impaired, you should make
further enquiries.

When considering whether behaviour outside of the workplace raises a fitness to practise
concern or is such that it may bring the nursing or midwifery profession into disrepute, you
should bear in mind that opinions about personal behaviour can be subjective and individual
perceptions differ.

If you are unsure

You can contact us at any stage, whether you have just learnt about an incident and are about to
embark on an internal investigation, or are considering making a referral. It is important that you
call us for advice if you are unsure whether to make a referral.

Advice for employers 17

Deciding whether to make a referral

You should make a judgement about whether to refer based on the individual circumstances of
the case.
You can use the decision tree below to help you decide whether a referral to us is necessary or
whether the issues can be managed at a local level. You can make a referral at any time, even if
your local investigation is not complete.
You must always report a case to us if you believe the conduct, competence, health or character
of a nurse or midwife presents a risk to patient safety.

Referral decision tree

What sort of concern are you investigating?
1) Misconduct or competence?
2) Serious ill health?
3) Character, criminal behaviour?

Advice for employers 18

Advice for employers 19
Making a referral

Any referral to us must:

identify the nurse or midwife concerned

clearly explain the complaint against the nurse or midwife
be supported by appropriate information and evidence

There is a form for employers on our website that you should use to make the referral.

What happens when you make a referral

Once we have received your referral, we will give you contact details of a staff member who will
deal with your initial enquiries. Theyll check that the person you are enquiring about is on our
register and that the nature of the complaint is something that we should be involved with.

We will keep you informed of your cases progress. If for some reason the nature of your
complaint is something we cant help with, we will tell you.

We may seek information about whether the incident forms part of a pattern of wider concerns.
We will also confirm whether there are any immediate concerns that might warrant imposing an
interim order.

Once we are satisfied that the case is one we can deal with, we will let you know what information
you need to supply us with and work with you to collect all the relevant paperwork. The more
information you can give us at these early stages, the quicker we can progress the case. Please
make sure any requests for further information are dealt with promptly.

As far as possible, referrals should be supported by any documentary evidence that is available,
for example, any statements or reports you have collected during your internal investigation.

Clinical referrals will be reviewed by a nursing adviser in the case-screening process.

More information about our fitness to practise processes can be found on our website.

Gathering evidence
Depending on the type of case you are referring, you should provide as much information as
possible. However, if information is unavailable, this should not prevent you making a referral if
you are concerned about patient safety. Limited information supplied at an early stage is better
than full information being provided late.

Advice for employers 20

Initially, we will ask you for all or some of the following information.

Your name.
Your job title.
Name and type of your organisation.
You:
Your correspondence address.
Your daytime telephone number.
Your email address.

The full name, Pin and address of each person being referred
The part of the register they belong to.
The nurse or The area of practice in which they are employed.
midwife being Their jobat the time of the allegations and key aspects of thepostthat are
referred: relevantwhen consideringthe complaint.
Details of any previous disciplinary or other action taken relating to the
case including competence or health procedures.

The
Aclear summary and detailed account of the complaint.
complaint:

Please provide clear details about any incidents relating to your referral, being
sure to include:
when the incident(s) took place (including exact time and dates if possible)
where the incident(s) took place (including the name and address of the
Incidents organisation, and specific wards or departments where possible)
relating
to the the type of place where the nurse or midwife was employed at the time of
complaint: any incident (for example, hospital, nursing home or GP practice)
who was there (including patients, colleagues or any other witnesses), and
the context and circumstances of any incident(s) (for example, the number
and types of patients the nurse or midwife was responsible for and who else
was on duty at the time).

Details of any witnesses and copies of witness statements.

Any Confirmation that you have told the witnesses you have passed on their
witnesses: information to us. They may be required to give evidence in person to a
fitness to practise committee.

Details of any other agency you may have contactedabout this matter (for
example, a systems regulator or the police).
Previous
Notes, reports and transcripts of any internal investigations.
action:
Clear details of any actions you have already taken regarding this case (for
example, any disciplinary action or periods of supported practiceaction).

Advice for employers 21

 Depending on the nature of the referral, wemay also need:
an internal investigation report
copies of the relevant patients medical records and consent from other
Other patients or relatives to disclose relevant medical records
supporting if reporting a conviction or caution, as much information as is available, such
evidence: as a criminal records check orcertificate of conviction
if reporting a case of serious ill health, details of the nurses or midwifes
sickness record and copies of any medical reports and notes of any
meetings where the nurses or midwifes health has been discussed.

Confidential information and data protection

Initially, we will only need to see copies of any documentation supplied as evidence. However, if the
case progresses to an adjudication committee, originals may be required.

We always hold paperwork securely. When sending information to the nurse or midwife concerned,
they are warned that the documentation they receive is only to be used to defend themselves
against any allegations.

More information about our fitness to practise processes

Details of how decisions are taken on fitness to practise cases, our committees, processes
and the sanctions panels can impose on a nurses or midwifes registration are explained on our
website.

Advice for employers 22

Further advice and information

You can call us on 020 7333 9333, email us on [email protected] or visit

www.nmc.org.uk for more information.

Employers can also contact our Employer Link Service directly for advice on fitness to practise
issues and potential referrals on 020 7462 8850 or [email protected].

Attend a hearing
You and your colleagues are welcome to observe fitness to practise hearings. This will give you
valuable insight into the process. Contact us for further details on how to attend or visit our
website.

Sign up to our employers email newsletter

Sent once a month, our employers email newsletter contains all the information you need to keep
up to date with our work and important changes. It also includes details of outcomes of recent
fitness to practise cases. You can sign up to receive the newsletter on our website.

This publication is available to download from our website.

This edition was initially published in September 2014 and updated in January 2016.

This information and advice was originally published in March 2010. It replaced Reporting
unfitness to practise: A Guide for employers and managers (2004) and Reporting lack of
competence: A Guide for employers and managers (2004).

Contact us
Whether you require information about our register, making a referral, or want to make an
enquiry, please dont hesitate to contact us.

Nursing and Midwifery Council

23 Portland Place, London, W1B 1PZ
020 7333 9333
www.nmc.org.uk
This document is also available in large print, audio or Braille on request.

Advice for employers 23

23 Portland Place, London W1B 1PZ
T +44 20 7637 7181 F +44 20 7436 2924
www.nmc.org.uk
www.nmc-uk.org
The nursing and midwifery regulator for England,
Wales, Scotland, Northern Ireland and the Islands
Registered charity in England and Wales (1091434) and in Scotland (SC038362)

Advice for employers 24