Raise a concern as an employer or manager

Before you can make a referral using our online form you need to set up an account with us. 

Once you’ve set up an account and are ready to proceed with raising a concern, you’ll need to provide information about you and your organisation.

Authorised person

We require referrals made by employers to be submitted by a person authorised by the organisation to make referrals to us.

If you're unsure, you’ll first need to confirm with your organisation that you’re a person authorised to raise a concern on behalf of them.

In many organisations it's the Director of Nursing or Midwifery or a member of the senior management team who will make a referral to us. We need to know that the organisation considers that a referral to us is necessary and that prior to the referral being made to us, it has gone through a quality assurance process locally.

Reasonable adjustments

We’re committed to making our fitness to practise process accessible. If you need us to make any adjustments to support you to make a referral to us or to the way we communicate with you once we have your referral, please tell us in this section.

Alternative contact

We’ll ask for details of an alternative point of contact in case you’re not available and we need to urgently discuss the referral. Please make sure you’ve discussed the referral with them and they’re able to gain access to the information or documents we might need.

We’ll ask you to tell us about the person the referral is about. We’ll need their name and NMC PIN, date of birth and at least two of the following: postal address, email address, telephone number.

We ask for this to help us to quickly carry out identify checks to make sure we correctly identify the person you're referring. This helps to safeguard against the potential for information security breaches.

Take care when providing us with this information and carry out checks to verify that all of the information is correct and cross checked for accuracy.

It’s really important this information is complete and accurate as we use it to make sure we’ve identified the right person on our register.

Whistleblowing

We’ll ask you to tell us whether, to the best of your knowledge, the person you’re referring to us has ever raised concerns about patient safety or the wider healthcare system with you, a colleague or another organisation. This information helps us decide whether a concern raised to us constitutes whistleblowing, and to take appropriate action.

Find out more information about whistleblowing.

Employment information

To help assess the immediate risk, we’ll need to know whether:

• the nurse, midwife or nursing associate remains employed with you
• you’ve placed any restrictions on their practice within the workplace
• they’re working elsewhere; either with another employer or agency - if they are, we’ll ask you to provide the details of any known agencies or employers so we can contact them if we need to.

In this section we’ll ask you to provide details of what happened to cause you or your organisation to be concerned about the nurse, midwife or nursing associate’s fitness to practise.

We’ll need a clear summary about the incident to help us understand the cause of the concern. If there was more than one incident, we’ll ask you to enter these separately so we have enough information individually and collectively to assess the risk.

The information you enter in this section should focus on what happened to cause you to be concerned.

We’ll need the information in this section to be factual, keeping to what was seen and heard and avoiding opinion.

Later in the form, we’ll ask you to tell us how you’ve responded to the concerns and the actions that have been taken to manage them.

The information you enter should clearly explain what the nurse, midwife or nursing associate did, what they should have done in the circumstances and why this is of concern.

It should include any other relevant factors that may have contributed to why the incident happened such as the levels of staffing, distraction, devices and equipment, workload, relationships between professional groups, existing custom or practice, tiredness, physical or mental health or any other personal issues that may have played a part.

Death and serious harm

We’ll need to know whether any of the incidents resulted in death or serious harm or had the potential for serious harm. This will help us to understand what could happen to patients if the poor practice was repeated and decide whether we need to take immediate action to address the risk.

Witness details

If there were any witnesses to the incident, we ask that you tell us about them in the witness details section. We’ll ask you to tell us about their role as well as contact information so we have a way of contacting them should this be necessary. If the witness is a nurse, midwife or nursing associate, please also tell us their NMC PIN.

We’ll also ask whether they need any reasonable adjustments, whether you’ve taken a statement from them and whether you’ve told them you’re passing their details to us and that we might contact them.

In this section we’ll ask you to give us information about how your organisation has responded to the concerns. This may include carrying out an investigation, redeployment or providing supportive measures such as supervision or additional training.

It’s important for us to have an understanding of your attempts to work with the nurse, midwife or nursing associate to put the problems right. We think employers should act first to deal with concerns about a nurse, midwife or nursing associate’s practice, unless the risk to patients or the public is so serious that we need to take immediate action. So we’ll need to see details of the different steps you took, why those steps weren’t successful and why the nurse, midwife or nursing associate wasn’t able to put things right.

Their response

As our process is about managing the risk that someone poses in the future, it’s really important that we have a good understanding of how the nurse, midwife or nursing associate responded to the incidents or concerns.

In this section we want you to tell us whether they cooperated with you or engaged with supportive measures.

We want to know if they accept the concerns you’ve raised with their practise, whether they’ve shown understanding of the seriousness or impact of those concerns, whether they expressed a willingness to engage with supportive measures and whether they’ve done anything to put any problems in their practice right.

Supporting information

At this point in the form we need you to attach supporting information.

The type and form of information will vary depending on the concerns but as a general guide we require you to provide the following information where it exists:

• incident investigation reports, any HR investigation reports or a written record of the outcome your HR investigation
• any root cause analysis reports, expert reports or the outcomes of any Just Culture based investigations
• witness statements from people who saw the events taking place or can explain directly what happened (whether staff, patients or relatives), without having to repeat someone else’s account - any witness statements should be signed, dated, and include a statement of truth
• clear copies of the relevant records - this could include nursing notes, care plans, administration of medicines records; we need to know how any patients presented and what the plan for their care was
• evidence of staffing levels, at the relevant time, and what the expected staffing level was, rotas, details of handovers - evidence of how busy the setting was, whether this was normal, and whether there were any patients or service users with unusually challenging or complex needs at the time.
• where possible, any evidence from the nurse, midwife or nursing associate themselves, including any statements or reflective pieces they produced.
• evidence of supervision or guidance given, how this compared to supervision or guidance you’d normally expect to be given to nurses, midwives and nursing associates with comparable experience and qualifications, and details of who provided any relevant training.
• relevant policies or standards in place at the time and, as part of the statements, a clear explanation of which sections are relevant, how these were brought to the nurse or midwife’s attention and whether they were being used routinely by those with comparable experience and qualifications.
• evidence explaining what a nurse or midwife or nursing associate with comparable experience and qualifications should have done in the circumstances - this will help us to assess how far the person you’re referring fell below the standards
• details of the nurse, midwife or nursing associate’s employment history, copies of the their training record and job description
• the records you kept of your attempts to work with the nurse, midwife or nursing associate to put the problems right.

We ask that you also tell us about any previous concerns that you’ve not already told us about and that are relevant to the issues you’re raising.

We’ll need you to tell us what it is the nurse, midwife or nursing associate did or didn’t do, when this happened, what the impact was or could have been and what your organisation did to manage the concern or concerns.

We’ll need you to provide us with the evidence relevant to the previous concerns by attaching them to the form.

If there’s been more than one previous concern the form allows you to add another concern once you’ve saved your progressed and moved to the next screen.

We need to know about any organisations or individuals who are involved in the concerns and may also need to take action.

This may include the police, local authorities or other organisations with safeguarding powers such as the Disclosure and Barring Service and Disclosure Scotland, other professional or health and care regulators, agencies such as NHS Counter Fraud, or any external authorities also investigating or involved in the concerns.

If more than one third party organisation is involved, the form will allow you to add multiple contacts.

We want to know about any factors that might have impacted the nurse, midwife or nursing associate you're referring to us or the incident. We call these context factors. You might know them as 'human factors' or 'just culture' considerations.

We're committed to enabling a culture of openness and learning. Context factors help us think about whether any changes or regulatory action would help ensure effective and kind care to keep people safe.

Giving us this information will help improve our decision making and reduce the impact of the process on everyone involved.

The final section of the form asks you, on behalf of your organisation, to declare that the referral is made in good faith and that reasonable steps have been taken to ensure the referral is fair and accurate.

We need to be assured that we only receive appropriate referrals. Your decision to refer should not be based on bias or discrimination against individuals or groups on the basis of ethnicity, gender, age, disability, sexual orientation, religion or belief, gender identity or pregnancy/maternity.

Research and reports commissioned by us and other regulatory bodies have shown that nurses and midwives from ethnic minority groups have in the past been disproportionately over-referred to fitness to practise processes.

As the referrer you should recognise where bias or discrimination may have had an impact on any actions taken and the decision to refer to us.

Before submitting the referral you should be confident that another nurse, midwife or nursing associate from the same peer group, with comparable experience and qualifications wouldn’t have acted in the same way in similar circumstances.

By submitting the form, you’ll be giving us agreement to disclose the referral, any supporting information and any other information you provide during the course of our investigation with those who we think can help us reach a decision on what action to take. While we won’t share the personal contact details of witnesses we will share the content of the referral and your details as the person making the referral with the nurse, midwife or nursing associate and their nominated representative.

More information about how we use the information you provide can be found in our privacy notice and our fitness to practise information handling guidance which are available on our website.