Referral to the Nursing & Midwifery Council (NMC)
Being referred to the NMC is one of the most worrying and stressful things that can happen to a midwife and, unfortunately, the process is not a quick one. Once a referral has happened, the wheels of the NMC grind slowly and, whatever the final outcome, referral involves you in a considerable amount of paperwork, writing, and emailing/telephone calls for a period of at least 15 months but sometimes, even longer.
First of all, there are plenty of midwives out there setting off on the same journey as you. The NMC receives a midwifery referral approximately each working day of the week. Here are some figures to try to help put your referral in perspective…..
Outcomes of NMC Case Examinations (2019-20)
- 20 midwives were referred for a FtP hearing
- 2 midwives were given “advice”
- 5 midwives were offered “undertakings”
- 55 had no further action (NMC-speak for “no case to answer”)
(The disparity in numbers is due to the time delay between referral and outcome of the investigation/case examiner stage.)
FtP hearings (2019-20)
28 midwives had FtP panel hearings, of whom:
- 4 received no sanction (facts not proved or fitness to practise not found to be impaired).
- 24 were found to have their fitness to practice impaired, of which
- 3 received a caution
- 7 had Conditions of Practice (CoP) imposed
- 10 were suspended from the register
- 4 were struck off the register
1Get some understanding of the FtP process
2Link in to support networks and peer expertise
NMCWatch: Registrant Care Facebook Group
The group was established in 2017 by Cathryn Watters, an oncology nurse who managed to get her striking off overturned on appeal to the High Court and who has worked and campaigned ever since to help others referred to the NMC.
In this group you will find nurses and midwives who have been through FtP referrals or who, like you, are currently referred. There is usually someone who can answer your question or point you in the right direction. NMCWatch also has a repository of useful documents and templates, and runs online webinars.
Midwives NMC Defence Research Group Facebook Group
This group was set up in 2019 to help independent midwives referred to the NMC (IMs are referred disproportionally) but also has a number of employed midwives in the group. It helps midwives find the research and evidence they need to defend themselves, especially with regard to supporting women to make autonomous decisions surrounding care in childbirth.
“The careline counsellors are experienced working with sensitive and personal information. They can also signpost you towards specialist organisations to help with specific issues.”
You can contact the CiC Careline free on 0800 587 7396
3Keep a diary and acquire a couple of big arch-lever files and some Post-it notes
If you haven’t already done so, start your own diary. You’ll need at least to record all communications, meetings and events – personnel, dates and times, and any verbal communication. You also need to record any meetings which you had prior to and which led to your being referred.
When you send an email, put a “delivery receipt” and a “read receipt” on it so that you know it has reached its destination and not been ignored. You should also save to drive delivery and read receipts for important emails you send. Mark anything confidential as “CONFIDENTIAL” in the subject line. These things can help you stay a little in charge of the time-frame and conduct of the process.
Make a note of all the documents you may need to address the allegations made against you and start collecting them together in a separate electronic file and a hard copy “evidence” ring binder again in strict date order oldest at the front. That can help you and your representative to identify gaps in the documentation which you still need to get hold of.
Unlike in internal disciplinary procedures there’s nothing to stop you trying to contact witnesses if you have their contact details and believe they can help your case; many may say they cannot help but sometimes colleagues may be willing to speak up for you, and sometimes patients may have complaints about matters of which you have been held responsible by the employer but the patient’s complaint was not directed at you.
It will aid you greatly if you are able to scan, photocopy and print documents (such copying for the purpose of legal proceedings [and whistleblowing] is expressly permitted) and the ownership of or access to a good printer can prove invaluable and reduce stress at key times.
4Getting legal representation (or not…)
The union stance above suggests that it is the union and not you who instructs the lawyer. This is incorrect – the lawyer is there to represent YOU and it is YOU who needs to instruct her or him. This means that after considering the legal advice you are given, either confirm you agree with it or, if you do not agree with it, that you make that clear and state clearly what you would prefer to happen. Follow any verbal discussion up with an email to confirm mutual understanding of the position. It is very important that you do not allow the process to take a course you are unhappy with or your instructions to be disregarded. You may end up disappointed about how your case was conducted yet have little comeback unless you can show that your instructions were disregarded.
5The NMC FtP Process
6How long does it all take?
The NMC aims to complete 80% of cases within 15 months and, in 2019 – 20, it met this target. However many cases are rejected at the screening stage or found to be “no case to answer” and conclude at Case Examiner stage. As only 10% of cases proceed to a full hearing, this means that a small but significant number of cases take longer to complete the Case examiner stage than 15 months without ever proceeding to a FtP hearing. In our experience it generally takes 15 months for a case to reach the conclusion of the Case Examiner stage.
Once a substantive hearing has taken place If you then appeal the outcome of a FtP hearing (see the section on Appeals), you can expect this to be heard about 4 to 6 months later.
It is not uncommon for the core incidents of interest to the NMC being considered at hearings about 3 to up to 5 years after they happened.
8Writing a reflective piece
What the NMC are looking for and what they mention time and time again are INSIGHT and REMEDIATION.
Many registrants use Gibb’s reflective cycle as the basis for their reflection and find that helpful – it seems to go down quite well with the NMC. But there is no such things as a one version fits all reflection – each reflection has to reflect on its registrant’s circumstances and the facts of that case.
A reflective piece can be useful evidence of your insight and remediation at Interim Order hearings, Case examiners’ review and at a FtP meeting or hearing. Even if you are disputing the facts of a case, it is still possible to write a reflective piece that shows insight and even, to a degree, remediation but do ask your legal representative for advice.
Make sure you download, print off and save all certificates as soon as you have completed each course (or stage of a course). RCM i-Learn, for example, dates the certificate with the date you print it out and FtP panels may think, despite being told otherwise, that you have simply swotted up in the couple of days before a hearing. Being able to produce evidence that you are regularly and continuously staying up-to-date may be very important at Interim Order or Substantive Order hearings if you are seeking to get a suspension lifted or to argue against the imposition of one.
The below is the guidance to FtP panel members about what to consider regarding CPD during the FtP process:
“Evidence of training courses should be carefully considered. Decision makers should look at the duration of the course and the amount of time or focus placed on topics which address the relevant concerns. Courses with a practical element and formal assessment (with results available), can carry more weight than courses completed online or those without any means for the nurse, midwife or nursing associate to demonstrate understanding.”
10Fitness to practise meetings and hearings
11The Professional Standards Authority (PSA)
Trauma Resolution Therapy
Trauma Resolution Therapy
for midwives traumatised by the NMC process
I qualified as a Birth Trauma Resolution (BTR) therapist in 2019. I am employed for two days a month to offer BTR to women. The results have been so positive that I now also work one day a week for staff to receive trauma resolution therapy. Most midwives are carrying the effects of trauma whether directly or vicariously as a result of working within maternity services.
In 2020, following a call out from Midwives Haven for midwives to attend NMC hearings to offer support, I attended a case and found the whole thing quite distressing to watch and it wasn’t even me answering to the NMC! Because of that I want to offer BTR free to any midwife who feels traumatised by their experiences with the NMC process. If you would like more information please email me: firstname.lastname@example.org