During our fitness to practise process, you might need to give us more details in writing, talk through your self-referral with us or receive written information from us.

We know that these things can be difficult for some people, and we want to provide you with the best support possible. For example, we can send information in a different language or format.

And if you have a disability, long-term injury or health condition, please let us know and we’ll talk through about any adjustments we can make to support you through the process.

If you are currently employed or have been previously, please let us know your current or last employer’s details (including agency or bank arrangements).

Cautions, criminal offences and conditional discharges

Section 23.2 of our Code requires you to tell both us and any employers as soon as you can about any caution or charge against you, or if you have received a conditional discharge in relation to, or have been found guilty of, a criminal offence (other than a protected caution or conviction).

Please note you don’t need to tell us about protected cautions or convictions, parking offences, fixed penalty notices or penalty fares imposed under a public transport penalty fare scheme.

Disciplined by another regulatory or licensing body

Section 23.4 of the Code requires you to tell us and your employers at the first reasonable opportunity if you are or have been disciplined by any regulatory or licensing organisation, including those who operate outside of the professional health and care environment.

You have an unmanaged health condition and/or disability which presents a risk to the public

Section 20.9 of the Code requires you to maintain the level of health you need to carry out your professional role.

When we talk about ‘level of health’ we mean that you are capable of safe and effective practice as a nurse, midwife or nursing associate either with or without reasonable adjustments and adjustments which your employer has made.

We appreciate that you may have sought medical advice and treatment from Occupational Health, a GP or other medical professional or specialist and where appropriate support, to manage your practice safely and effectively. Or you may have taken steps to adapt, limit or stop your practice if your health and/or disability does affect you. In these circumstances, as you are appropriately managing your health condition and/or disability you do not need to self-refer to us.

Other circumstances

There are some circumstances where you may choose to self-refer other concerns about your practice to us.

Apart from in the above situations where you must refer yourself to us, employers should take action locally before we become involved. If you are employed, you should tell your employer about any concerns relating to your practice before coming to us so that these can be dealt with locally.

If your employer is already taking action, then you don’t need to self-refer unless your employer asks you to. Our Regulation Advisers and Employer Link Service can provide advice to employers to help support this.

If you are self-employed or a bank worker and a serious concern is raised about your practice that cannot be dealt with by an employer, please tell us about the details.

Please provide further information below, for example:

- Details of the offence(s) committed (and the circumstances around the offence(s)), including relevant dates

- The investigating police force

- If you have been charged, whether you are on bail and if so, what the bail conditions are

- If you have received a conditional discharge, the name of the Court and the date you were discharged

- If you have been found guilty, the name of the Court, the date of the conviction and your sentence

Please provide any relevant documents

For example, conviction or caution certificate or documents received from the police or the courts. 

Any supporting evidence you include will be handled in line with our information handling guidance.

Please provide further information below, for example:

- Details of the disciplinary action/finding

- The name and contact details of the person you have been in contact with at the other regulatory or licensing organisation

- If you have appealed a finding, the details of that appeal and outcome

Please also provide any relevant documents.

For example, copies of the documents received from the other regulatory or licensing organisation.

If you have been suspended or dismissed from work for any issue related to your fitness to practice, please provide a copy of the written communication making you aware of this, and any relevant disciplinary documents.

Any supporting evidence you include will be handled in line with our information handling guidance.

Please provide further information in the box below: 

For example, this could include:

- Nature and seriousness of the health condition and/or disability.

- Pattern of condition (is it active or relapsing).

- Management of your health condition and/or disability.

- An explanation of why you feel that your health condition and/or disability is not currently being managed appropriately or won’t be managed appropriately in the future.

- Whether or not you have informed your employer about the health condition and/or disability.

- Medical or other supporting information (for example, therapeutic interventions) commenting on how your health condition and/or disability does or could affect your ability to practise safely and effectively and what steps you (or your employer, if applicable) can take to enable you to practise safely.

- Your level of insight and understanding into your health condition and/or    disability and how it could affect your ability to practise safely.

Please also provide any relevant documents, for example, medical reports.

Where did the incident take place?

If the incident is related to professional practice, please include:

- The name and  address of the hospital or nursing home or the address where the incident or incidents occurred

- The name of the specific ward, department or unit.

If there wasn’t one incident but smaller incidents over time, please provide the name and address, or location where each incident took place.

If the incident occurred outside of your workplace, please state the location.

What happened?

Please describe what happened in as much detail as possible.

If there wasn’t one incident but smaller incidents over time, please describe all these incidents in as much detail as possible.

Is there or has there been, an internal investigation by your employer?

If so, please provide us with the details and outcome.

Please provide any relevant documents.

We’ll use the information you’ve provided in this form in accordance with our privacy notice and our Fitness to Practise information handling guidance.

It might be necessary for us to share the information you have provided with your employer and any other relevant party we identify if it is necessary for us to carry out our investigation into your fitness to practise.