Will COVID Redeployment Lead To An Increase In Fitness To Practice Referrals?

Do Nurses redeployed due to COVID face a higher risk of referral because of Fitness to Practice (FtP) concerns? And can the NMC’s new approach cope with such an increase?

The Chief Nursing Officers (CNOs) from UK health authorities recently wrote to Nursing directors across the country.

In this letter, “fear of being referred” was highlighted as a common concern amongst Nurses.

The four CNOs acknowledged that staffing shortages, including absences related to Covid-19, were worsening the pressures already facing the Nursing workforce.

They recognized that directors of Nursing may have anxiety about possible ramifications for affected staff of ‘difficult decisions made in challenging circumstances’, particularly if there had been a poor outcome.

In response to this Nursing leaders said: “although referrals are still relatively rare, should this happen the NMC considers context in all of its fitness-to-practise decision making.”

Are you confident that any referral to the NMC as a result of COVID redeployment would take sufficient account of extenuating circumstances?

The difficulties in training reassigned staff were exacerbated by the sheer numbers being redeployed and the demands this placed on the permanent staff conducting the training.

Approximately a quarter of the 2,338 Nurses who responded to a Nursing Standard survey said they had been redeployed.

35% of those redeployed to new positions felt they had received sufficient training. 38% felt they had not.

Nurses who had not been on a ward for a number of years said they had to learn on the job, which left them feeling vulnerable and unsupported.

‘I had not worked on a ward for over five years so was deskilled. It was difficult to get upskilled due to so many redeployed staff on the same ward at the same time’ one Nurse related.

Another respondent to the survey recalled how they missed the training because they started in their new area later than the rest of the redeployed staff.

If there is an increase in referrals made to the NMC, should the health authorities dictating redeployment share any determined culpability?

For staff redeployed during the pandemic, the RCN produced guidance which said that all redeployed staff should receive an induction to their new clinical area and that the employer was responsible for ensuring staff had the requisite skills and knowledge to perform the role assigned to them.

The RCN did also reiterate to Nurses that they must work within the limits of their competence, as laid out in the Nursing and Midwifery Council code.

Given the demands on health services during the pandemic, do you think it was feasible for any Nurse to decline to be redeployed, even if the deployment was out of that Nurse’s area of expertise?

According to NMC figures, the number of reported Fitness to Practice concerns increased between 2018-19 and 2019-20, from 5373 (which was in itself a 2.5% decrease from the previous year) to 5704. In 2020-21, this figure fell to 5547. The figures for FtP referrals remain consistently around 8 referrals for every 1000 registrants or 0.8%.

Figures from a FtP Report for 2019-20 indicate 58% of cases referred to the regulator required no further action. The following year, 2020-21, this figure was 53%.

As a consequence, the NMC instituted a new approach into how it oversaw cases in early 2021.

“This new [approach] should help employers better understand the options available to them so that they are less likely to immediately make a referral to an NMC FtP process when a concern is raised” said Rosalind Hooper, head of legal services at the Royal College of Nursing.

Do you think the possible loss of 80,000 Nurses due to mandatory vaccination policy in the NHS will mean that a proportion of referrals that may have happened will not now occur, or will not be followed up if the subject of the referral has left the profession?

The NMC has also undertaken to reduce waiting times for fitness to practise proceedings. Under the current system, registrants can remain under investigation for up to three years.

In response to the Professional Standards Authority’s (PSA) finding that on average, cases ‘dragged on’ for just over two years, NMC chief executive Andrea Sutcliffe stated on 26th January 2022 that reducing caseloads and waiting times had become the Nursing regulator’s top priority.

The healthcare regulators’ regulator found the backlog of pending investigations had expanded, from 4,506 in April 2020 to 6,357 in March 2021. It said the NMC was ‘failing to complete cases in a timely way.’

The escalating caseload can be partly attributed to the first wave of the pandemic. In-person hearings were suspended, and only cases where there was judged to be an immediate potential public risk received a virtual hearing.

What other factors can be attributed to the increasing numbers of FtP cases pending? Was the regulatory system fit for purpose even before the pandemic?

Also, should the government and Nursing authorities temporarily raise the threshold for FtP referrals in response to COVID redeployment, so that only the most serious cases are investigated, and anything less severe dealt with through internal procedures?

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