Insight into Fitness to Practise

Nursing and midwifery are among the UK’s most trusted professions, and they make such a profound impact on people’s lives every day. They’re integral to providing the safe and effective care the public has the right to receive – but we know there are occasions when things go wrong.

While concerns affect a tiny proportion of professionals on the register each year, we know the FtP process can be difficult, stressful and time-consuming.

The insights set out in this publication, have already helped to lay the foundations for a comprehensive programme of work – the FtP plan, that we launched in April 2024 – which focuses on protecting the public by ensuring faster and fairer outcomes for everyone, supported by significant investment in additional people, legal expertise and technology.

What the data shows

The inaugural Insight into Fitness to Practise report reveals that both patients and employers most commonly raise certain patient care concerns relating to diagnosis, observation, or assessment of patients. They can also involve delayed or inappropriate responses to patient deterioration.

Patients and employers are also similarly concerned with record keeping and dishonesty. The former relates mainly to patient records, care plans, or drug and medication records. The latter tends to involve misrepresentations or omissions related to patient care or employment.

However, there is then divergence, with the public more often concerned by their nurse, midwife or nursing associate’s communication. This is usually when professionals are felt to be unfriendly, uncaring, or rude. Most of these public referrals highlight a lack of compassion or kindness, or a failure to provide sufficient or accurate information about care.

In contrast, employers more commonly refer prescribing and medicines management issues, which typically involve errors in medication administration, breaches of local policies, or incorrect dosages.

The NMC analysis makes other key findings

• Members of the public are more likely to raise concerns about midwives than employers. Conversely, employers are more likely to raise concerns about nurses and nursing associates than the public.
• There was a 14 percent increase in new concerns from 5,058 in 2022/23, to 5,774 in 2023/24. The public have consistently raised more concerns than employers over the past few years, although there was a significant proportional increase in employer referrals in 2023/24.
• There is overrepresentation of certain groups in the FtP process with male professionals, working in mental health and learning disabilities settings being particularly affected. Male professionals account for 40 percent of FtP referrals of professionals with a mental health qualification, despite comprising only 26 percent of those professionals on the register.
• Professionals who have representation, actively engage in reflection, and take steps to strengthen their practice, are less likely to receive FtP outcomes that restrict their practice.

Read Insight into Fitness to practise 2024

Interactive data dashboard (2019-2024)

We are also providing an accompanying dashboard to demonstrate trends in our data over the last five years. This will help to highlight the types of concerns reported to us as well as the decisions we have made.

View the dashboard