The Nursing and Midwifery Council (NMC) must improve its fitness to practise (FtP) screening and work closer with chief nurses and NHS organisations to successfully tackle its referral backlog, a council meeting has heard.
Speaking at an NMC meeting earlier today, Anthony Omo, general counsel and director of FtP at the General Medical Council (GMC), said that the NMC’s thresholds on FtP screening are ‘not quite at the right place’ and warned that this was driving delays in dealing with cases at the regulator.
It comes as the NMC council papers highlighted that the regulator was ‘continuing to receive a sustained high level of referrals’.
The NMC’s FtP caseload stood at 6,581 cases in October this year – up from 6,502 cases the month before.
In September 2024, the NMC received 611 referrals – the highest number in one month in the last five years.
The regulator said it was currently seeing 531 referrals on average per month, above the 430 that was originally forecast.
During the meeting, Mr Omo, who is currently advising the regulator on its FtP backlog, said it would ‘inevitably take time’ to address the situation.
‘Let’s be frank, the scale and breadth of issues and change needed, it will inevitably take time for the fixes to be applied, for the systems to be updated, for people to get up to speed with what they need to and for this to show results,’ he said.
‘So, you’ve got early glimmers, but it’s going to take some time, because this is not an issue that arose over a short period.’
According to the NMC’s council papers, the majority of its FtP caseload is at the screening stage (47%) – where it is ‘currently receiving more referrals than we are resourced to keep pace with’.
The papers added that around 75% of the cases received by the NMC require no further investigation and conclude at screening.
‘Notwithstanding the impact of higher than planned referral numbers, we made 580 decisions in September and 609 decisions in October (the highest monthly number of decisions in recent years),’ the papers said.
The NMC said it was ‘expecting to maintain this higher level of screening outcomes, with the decision making capacity further boosted by five experienced case examiners who are now temporarily working in the team to assist with case reviews and decisions’.
Mr Omo told council that the volume of complaints received by the regulator demands better early-stage assessment of which referrals are best considered by the NMC, versus those that could be ‘taken elsewhere’, such as to NHS trusts.
He said he had reached a view that the NMC’s ‘thresholds around screening are not quite in the right place’ and added: ‘I think that’s driving a lot of the problems.’
‘If you think about the volume of complaints coming through screening, it needs to be as slick and quick as possible.’
The regulator is ‘one of a number of players’ responsible for protecting the public in the healthcare environment, he said.
‘You’re trying to get to a place of zero-sum risk, where the registrant is absolutely no risk to anybody, which is not a place you can ever quite get to,’ added Mr Omo.
‘Healthcare is dangerous, inherently, medicine is risky. And so there is a level of risk you need to live with which I don’t quite see through your guidance and your thresholds at the moment.’
Mr Omo encouraged the NMC to improve its ‘connectivity’ with chief nurses and others working locally to help resolve FtP cases, to avoid the backlog increasing and causing further delays to referral outcomes.
Looking ahead, he urged council members to focus on priority cases to help ease the backlog and improve case-progression overall.
‘You really need to just hone your focus on that and hold your nerve, because trying to push the entire plan at the same pace will put such a strain on the organisation that I don’t think it will succeed,’ he warned.
Earlier this month, the NMC announced Paul Rees, chief executive of the National Pharmacy Association (NPA), as its interim chief executive.
The appointment follows an independent culture review into the NMC earlier this year which exposed a ‘toxic culture’ of bullying, racism and harassment at the regulator.
During the meeting, the NMC stressed that Mr Rees is ‘excited’ to work with the NMC but understands the ‘significant issues’ the regulator faces.
