NMC updates on fitness to practise plan

We aim to conclude 80 percent of our cases within 15 months of the initial referral being made. We are seeing meaningful progress towards this target; between December 2023 and December 2024, 65.5 percent of cases were closed within 15 months.

We are also making progress at the initial assessment stage (screening) where most of the caseload is held. In December 2024, 25 percent of our cases at this earliest point in our process were resolved within our two-month target. Additionally, the number of screening decisions we have been making in recent months has been exceeding the number of new referrals being made.

While it’s welcome to see some early green shoots of progress, there is still a long way to go, with the total caseload increasing from 5,778 in January 2024 to 6,633 by December 2024 – in part driven by high volumes of referrals. The next step is the publication of our realigned FtP plan.

We’re taking a step-by-step approach, with it being a long-term effort to make real improvements for everyone involved – our colleagues, the professionals on our register, and the public.

• We are currently prioritising the stabilisation of our processes, with a focus on eliminating the backlog of cases at screening while also working to resolve older cases more swiftly.
• We will then aim to conclude cases faster and ensure fewer cases require high court extensions.
• Our long-term goal is to run a sustainable service, built on fairer and faster processes so that we can deliver swift and safe decisions, improving experiences for everyone involved.

Since we originally launched the plan in April 2024, the context has changed. Our screening teams are receiving higher than expected volumes of referrals, and the independent review of our culture highlighted areas of our operational performance that required immediate action to resolve, including within safeguarding. We subsequently committed to reviewing the plan and, as recommended, have introduced a safeguarding hub to improve the safety and experience of people involved in our process.

As we launch our realigned plan, we are acutely aware of the significant pressures across the entirety of our FtP process and the real impact this has on people. Which is why the plan will remain responsive to a changing environment and continue to seek both internal and external views on further improvements that we can make.

We are currently finalising further external specialist support to reinforce the plan. This will focus on relieving pressure at screening, and recommending further improvements to regulatory processes across the NMC.

Listening to the views of professionals and stakeholders about their FtP experiences has also been critical to shaping the plan’s development. This is in addition to the support and advice from our external advisers, Anthony Omo from the General Medical Council, and former Professional Regulatory Adviser at the Scottish Government Professor Donna O’Boyle.

Following advice from Anthony Omo, we are adjusting how we assess referrals at the screening stage to enable a more proportionate and robust approach. This includes resetting the screening threshold to close concerns that are not for the NMC quicker while promptly promoting those requiring further consideration. We will also be strengthening our approach to supporting local resolutions with employers and be clearer in our information about what types of concerns we can and can’t consider. So, where appropriate, avoid people unnecessarily being involved in our processes and ease the pressure on our screening teams.

Meanwhile, with the support of Professor Donna O’Boyle, we are beginning to look at how we can enhance clinical input into our processes. This aims to strengthen decision-making by incorporating expert advice where needed.

The realigned plan will build on other recent progress.

• Decisions have been made for our lowest-risk cases (979), with 65 percent either closed or progressed, reducing cases at screening.
• The number of hearings with allocated dates has risen from 412 to 604, providing greater certainty for all those involved.
• New case-weighting tools are now in place, ensuring that cases are assessed based on their complexity and risk. This helps us handle each case appropriately while providing a fairer distribution of work for our teams.
• We’ve implemented a pre-equality impact assessment scoping tool to ensure fairness in all areas of our work, with equity considerations at the heart of the process.

Lesley Maslen, Executive Director of Professional Regulation at the NMC, said:

“Thanks to colleagues’ hard work, we’re starting to see some green shoots of progress from our fitness to practise plan. Recent months show early signs of improvement in our decision-making rates across several stages of the FtP process - one of the keys to a better experience for everyone involved.

“However, we’re under no illusion about the long journey ahead. The range of improvements we want to deliver are complex and will take time to embed. This means that many of the people involved in our processes will have yet to feel the positive impact of the operational changes we’re making.

“We need to keep investing in our people and in the tools they need to do their jobs well. We must also keep working to better understand people’s lived experiences of our processes. This is how we’ll achieve the step change in the experience of FtP that people inside and outside the NMC deserve.”

Further information

Referral: This is what we call a new concern raised with us about a nursing or midwifery professional on our register.

Screening: This is the initial assessment stage when we receive a new concern about a professional on our register and decide whether it should go to a full investigation.

Investigations: If we've decided that a concern needs further investigation, the screening team will pass it onto the investigation team. The investigation team will then gather evidence and continually assess all the information they receive to decide what the next steps in the investigation should be. At the end of the investigation, the team will put together a report for our case examiners to look at.

Case examiners: If a referral has been made about a professional and we have investigated the case, our case examiners will decide whether there is a ‘case to answer’.

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