Review into disparities in NMC fitness to practise outcomes

The NMC said it wanted to understand whether bias or discrimination contribute to the disparities that it is seeing across the FtP process.

“Every nurse, midwife and nursing associate needs to feel respected, valued and supported so they can deliver the best care possible for people"

Matthew McClelland

It comes as previous research conducted by the regulator found that nurses and midwives have different FtP outcomes based on their protected characteristics and where they trained, live and work.

The NMC launched its ‘ambitious for change’ programme of research in 2019, which assessed the impact its regulatory processes have on different groups of nurses, midwives and nursing associates.

The first phase of the research found that professionals who are male, transgender, bisexual, Black or have a disability that the NMC does not know about were more likely to be referred to the regulator compared to others.

The NMC also found that employers referred higher proportions of minority ethnic nurses and midwives, while the public and service users referred higher proportions of White nurses and midwives.

However, it noted that cases referred to by the public or service users are more likely to be closed at screening compared to those referred to by employers, which are more likely to progress to the adjudication stage.

The NMC is now seeking to understand why these differences exist so that it can plan ways to make the FtP process more equitable.

The NMC announced this week that it had commissioned the University of Greenwich to review a sample of FtP cases that closed between September 2019 and September 2023.

The regulator said it wanted to better understand why these differences exist and whether bias or discrimination contribute to the disparities it is seeing.

It comes as improving the timeliness and quality of FtP decision making is now the regulator’s top priority over the next two years.

Last month, the NMC signed off a £30m investment in FtP to try and tackle the growing backlog, which reached a record number in February.

The new review will examine the NMC’s current policies and guidance and assess whether they effectively promote equality in the FtP processes.

Meanwhile, the NMC has also asked its own Employer Link Service to work with health and care employers to better understand why employer refer higher proportions of minority ethnic nurses and midwives to FtP.

It also wants to understand what is being implemented across healthcare organisations to reduce bias and ensure fairness in referrals.

The NMC said it would analyse the outcomes of those discussions later this year.

Matthew McClelland, NMC executive director of strategy and insight, said: “Every nurse, midwife and nursing associate needs to feel respected, valued and supported so they can deliver the best care possible for people.

“That includes every aspect of their working lives, including on those occasions when professionals are referred to our fitness to practise process.

“We’re speaking to employers to understand why there can be disparities in some groups of professionals who are referred to us as well as looking at why those groups experience our regulatory processes differently.

“This work will help us work towards being a fairer, more inclusive regulator.”

A spokesperson for NMC Watch, a group which works to support registrants going through the FtP process, told Nursing Times that the NMC must be “very careful not to be caught in the game played by disingenuous employers”.

“Some will refer a registrant to avoid the spotlight being shone on the trusts failings as we have seen many times with whistleblowers on our group,” they warned.

The spokesperson added: “The NMC must get better at assessing the whole context around the case history in order to ensure they are not complicit in unknowingly hiding the true issues around patient safety and joining the  noise to try to blame one individual.”