Information about cases considered by Case Examiners

Information about cases considered by Case Examiners
Information for nurses and midwives who have been referred to the Nursing
and Midwifery Council’s (NMC’s) Case Examiners
This means someone has made an allegation against you which may question
your fitness to practice. It is our duty to investigate this matter and, if the allegation
is proved, to take appropriate action.
This leaflet will help you understand:
The processes we follow to investigate the allegation.
How you can respond to the allegation.
What will happen next.
The decisions that the Case Examiners might make.
It does not cover the specifics of your case. You will have received a letter telling
you that we have referred your case to the Case Examiners, together with copies
of the evidence we have received at this stage. These give details of the allegation
made against you.
Fitness to practise cases follow an established process, which is set out in our
rules. This ensures that we deal with all allegations effectively, consistently and
transparently. Dealing with a case can be time-consuming, so it is important that
you help us deal with your case quickly, by responding to requests for information
by the deadlines given for example.
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Referral to the NMC
We are required to investigate two types of allegation:
Allegations that a nurse or midwife’s fitness to practise is impaired by
reason of misconduct, lack of competence, a conviction or caution for a
criminal offence, physical or mental health, or a decision of impairment by
another health or social care regulator.
Allegations that a nurse or midwife’s entry in the register has been
fraudulently obtained or incorrectly made.
For information regarding the investigation of allegations that a nurse or midwife’s
entry in the register has been fraudulently obtained or incorrectly made see:
‘Investigating the allegation: Information about cases considered by the
Investigating Committee.’
Allegations are referred to us from many different sources, including members of
the public, employers, colleagues and the police. We may also become aware of
an allegation through other means, such as the media or the publication of a
report. Regardless of how we hear about an allegation, we have a duty to
investigate it.
We appreciate that being referred to us may be a worrying experience and that, if
you are given a sanction, it may feel like a punishment. However, our fitness to
practise proceedings are not intended to punish the nurses and midwives
concerned; they are designed to protect patients and the wider public. We believe
you will find it easier to deal with the experience of being referred if you have clear
information about the process and what might happen.
Once we start to investigate an allegation, the law states that we must follow this
process to its conclusion. Even if you believe the allegation is unwarranted, you
have a duty to cooperate with us under The code: Professional standards of
practice and behaviour for nurses and midwives (NMC, 2015) so that your case
can be resolved.
We would encourage you to submit an early response to the allegations. This is
entirely your decision, however any information you provide will help us in
considering what, if any, further enquiries we need to undertake and the extent of
those enquiries. If you have a representative, please contact them to discuss the
referral and the content of any response you may choose to submit.
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What happens next?
We will investigate the allegation so that the Case Examiners can decide whether
there is a case to answer.
You will be assigned an NMC case officer who will prepare the case. This will
involve obtaining written statements and evidence only at this stage.
Investigating the allegation
The purpose of the investigation is to ensure we have the clearest picture possible
of what took place.
This may involve taking witness statements and seeking documentary evidence
from different people. We will also seek information from your current employer, if
you have one, about your current practice. Your case officer will send you a copy
of the evidence obtained and invite you to send your comments for the panel’s
Health issues
If the allegation suggests that your fitness to practise may be impaired for health
reasons, we may ask you to provide medical information so the panel can decide
how to proceed with your case.
If we have included a consent form for a medical investigation with your notice of
referral, it is important that you return it to us straight away.
There are three types of medical investigations that we might ask for at this stage:
obtaining a report, medical testing and medical examination. All medical
information is treated in the strictest of confidence.
Obtaining a report from your GP, occupational health department or other
healthcare professional: Your case officer will send you a consent form so we
can ask for a report from a particular person. We will pay for the cost of the report.
Medical testing: In this case, we ask you to provide samples (for example, blood
or hair samples) for testing. The tests will be carried out by a specialist laboratory
on our behalf. We will pay for the tests.
Your case officer will send you a consent form indicating the tests to be carried
out. The consent form allows you to:
Agree to provide the samples.
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Agree to the laboratory sending us the test results.
The laboratory will contact you directly to arrange an appointment for the samples
to be taken.
Medical examination: In this case, we ask you to undergo examination by a
doctor appointed by us. We will pay for the examination and any additional tests.
The examination will be arranged by a specialist service company on our
behalf. The medical examiner will need to see your GP and other
healthcare records.
Your case officer will send you a consent form so you can:
Agree to undergo an examination.
Agree that the service company can get your records from your GP and
other healthcare professionals, and send them to the medical examiner.
Agree to the medical examiner sending us the report.
When they have obtained the necessary information, the service company will
contact you directly to arrange an appointment with the examiner.
You can get your own medical report to give to the panel yourself if you wish, but
you will have to pay for this yourself.
Your case officer will send you copies of all the information we receive and invite
you to submit your written comments for the panel’s consideration.
We will not normally pay for your travel or other expenses for a medical
examination. However, we may make an exception in cases of hardship to cover
the cost of travel, meals and overnight accommodation when necessary. If you
have a disability and need a companion to travel with you, we can pay that
person’s travel expenses. You should raise this with your case officer as soon as
If you think you might qualify for financial assistance, please read the Criteria for
ex gratia payments of expenses we have sent you, and return the application form.
We will tell you whether your claim is successful.
You should return your consent form for a medical examination straight away,
even if you are still waiting to hear from us about financial assistance.
Interim orders
You may be referred for an interim orders hearing at any point while your case is
under consideration. At the hearing, a panel will decide whether to suspend your
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registration or place interim conditions on your practice while we investigate the
We will send you notice of the date, time and place of the hearing, and any other
information you will need about the process. You will have the right to attend the
hearing, with or without representation. You will also be allowed to give evidence
and make your arguments to the panel.
The hearing will decide whether an interim order is necessary for the protection of
the public, and also in your own interest or that of the wider public.
If an interim order is not considered necessary, you can continue to practise as
normal while you are under investigation.
Your role during the investigation
We strongly recommend that you seek advice from your professional organisation,
trade union or lawyer as soon as possible, as the NMC cannot represent you. A
Citizens Advice Bureau or Law Centre may also be able to advise you. There are
some helpful contact details at the end of this leaflet. The NMC cannot represent
You should provide us with the contact details of your lawyer or representative.
Responding to the referral
You may send us a written response to the allegation made against you as soon
as we notify you of it. You will also be able to respond to the material we obtain
during our investigation. If you choose to do this, you must do so by the response
deadline in your notice of referral letter. You should seek advice from your
representative before sending any response and after considering the information
As part of your response, a reference from your most recent or current employer
regarding your current (not past) fitness to practise could help the panel come to
an early decision on whether or not there is a case to answer. You should tell your
employer why you need a reference, and ask them to send it directly to your case
References should be on headed paper and be signed and dated.
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Allegations involving drugs or alcohol
39 If your case is about a first and single offence involving the use of drugs or alcohol
(such as a drink driving conviction), the panel will find it helpful to have a report
from your GP or occupational health department commenting on your fitness to
practise in the light of the offence. Again, you should tell your health professional
why you are asking for the report, and ask them to send it directly to your case
Response deadlines
It is your responsibility to ensure we receive your response, and any references or
reports, by the response deadline. This will allow the Case Examiners to consider
it alongside any other information received.
Sharing your response with the referrer
We will share your response with the person who referred you to us if there is a
significant difference between the two versions of events. We will tell you if we are
sharing your response with the referrer. We will ask the referrer to comment on
your response. We will then send you their comments so you can make a final
We will not share with the referrer any personal confidential information you have
given us – such as details about your health. We will leave out or conceal any
personal confidential information about third parties that you may have provided.
Information you must give the NMC
Even if you choose not to submit a response to the Case Examiners, you must
provide certain information, including details of your employer. We may need to
contact them for more information about your fitness to practise.
You should provide these details using the employment form enclosed with your
notice of referral letter and return it to your case officer. You can send this
information separately, or with your response to the allegation.
Whether or not you choose to respond to the allegation, you must return your
employment form by the response deadline in your notice of referral letter.
If the allegation is a second or subsequent offence involving the use of drugs or
alcohol, you must complete a consent form for medical investigations by an
independent service provider. This is to help the panel to establish whether you
are currently fit to practise. Forms for this will be enclosed with your notice of
referral. If you do not provide this consent, it will take longer to investigate and
resolve the matter.
You should also keep us informed of any changes to your contact details, such as
if you move house. If you do not do this, you may not receive the information we
send you and your case could proceed without your knowledge or ability to
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respond. It may also mean that we send confidential information about your case
to the wrong address.
Continuing to practise
Unless a Practice Committee has made an interim order to suspend you or restrict
your practice, you can continue to practise as normal while you are under
Telling your employer
You must inform your employer and anyone else you work for that you are under
investigation by the NMC. This is set out in The code: Professional standards of
practice and behaviour for nurses and midwives (NMC, 2015). We may have to
contact your employer during our investigation to ask for information about your
fitness to practise.
Practising overseas
If you decide to practise overseas while you are being investigated, the
investigation will continue. The regulator in the country where you are seeking
work will ask us for your registration details and we will let them know the status of
your investigation.
Staying registered with the NMC
You should stay registered with us while your case is being investigated. If your
registration is due for renewal during this period, you should renew as usual.
Your registration will not lapse while your case is still open but, if you stop paying
your fees or do not renew your registration, the register will show that your
registration has passed its expiry date. Many employers will not allow you to work
while your registration is in this position.
Even if your employer does allow you to work after your registration has expired,
your registration will lapse as soon as your case has finished. You will then have
to stop working and will need to apply to be readmitted. You will also have to pay
readmission fees.
Change of address or contact details
54 You must remember to notify us if you change your address or contact details,
such as your mobile, phone or email. If we are unable to contact you, the
investigation will continue, but you may miss the chance to defend yourself against
the allegations.
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The Case Examiners
When we have completed our investigation, the Case Examiners will consider all
the documents gathered about the allegation, including your response.
Your case officer will send you notice of that the Case Examiners will be
considering your case along with all the information put before them which, in most
cases, will include the charges set out in the details of the allegation. At this stage,
you will have another opportunity to provide a written response to the allegation
which the Case Examiners will also consider. We recommend you seek advice
from your representative before sending this.
Two Case Examiners will consider your case. One of them will be a nurse or
midwife. The other will be a lay Case Examiner meaning they are from outside the
profession and not on the NMC register.
The Case Examiners must decide whether there is a case to answer and whether
there is a real prospect of the allegation being proved if a hearing were to be held.
We have issued guidance for Case Examiners to help them decide whether there
is a case to answer. You can find this on our website at
Decisions that the Case Examiners might make
The investigation process can take some time, so it may be a while before the
Case Examiners make a decision about your case. You should keep all the
information about the case in a safe place until then.
Once the Case Examiners have reviewed your case, your case officer will send
you a letter informing you of its decision within one week of the decision.
Case examiner decisions should be unanimous. If case examiners are unable to
agree, the Registrar must refer the matter to a panel of the Investigating
Committee for a fresh decision, applying the same test.
The Case Examiners can decide on one (or more) of the following outcomes:
there is no case to answer and close the case;
there is a case to answer and refer the allegation to the CCC or HC;
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to recommend that further investigations are carried out to enable them to
reach a decision on whether there is a case to answer; and
to direct the Registrar to refer the matter for interim order consideration.
No case to answer
The Case Examiners may decide there is no case to answer. Your case will be
closed and, if you have been subject to an interim order, this will automatically be
We will keep a record of your case and if we receive a further allegation regarding
your fitness to practise within three years, the previous allegation may be taken
into account.
Cases closed by case examiners can be reviewed and re-opened by the Registrar
in certain limited situations, where new information becomes available or the
original decision is materially flawed, and it is in the public interest for the case to
be re-opened.
Some people may find it difficult to settle back into their careers after being
referred to the NMC. If you are having difficulties regaining your confidence at
work, you may wish to seek support from your professional organisation or trade
union. You should also consider discussing these issues with your manager. If
your employer offers a confidential counselling service, you should consider using
this source of support.
Case to answer – conduct and competence or health cases
67 The Case Examiners might decide that there is a case to answer. You will then be
referred to the Conduct and Competence Committee or to the Health Committee
depending on the nature of the allegation. These committees are made up of
nurses and midwives and people outside the profession. Both committees have
the power to make the final decision about the case.
If this happens, we will send you a notice of referral, and our standard directions
form which requires you to provide certain information to us. Your trade union,
professional body or lawyer can help you with this. We will also send you further
information about how we deal with conduct and competence cases or health
Further investigation
If the Case Examiners need more information to help it decide whether or not
there is a case to answer, they may ask the NMC to carry out further
The Case Examiners will again consider this, and the previous information
gathered, to decide whether there is a case to answer. Before this happens, you
will be given the opportunity to respond to the new information.
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Voluntary removal
While your case is being investigated, you will not be able to remove yourself from
the register unless you go through our voluntary removal process. You will only be
allowed to remove yourself from the register if you meet our criteria. For more
information about the process of voluntary removal, and to find out if you might be
eligible, please go to our website at
Contacts and further help
If you have any more queries about your case, you should contact your case
officer. You will find their details on your notification letter. Our office hours are
Monday to Friday from 9.00am to 5.00pm.
What to do if you have concerns about how your case is being
You should let your case officer know if you have concerns about the way your
case is being handled. If you are unhappy with their response, ask them for their
manager’s name so you can contact that person directly.
Trade unions and professional organisations
The Royal College of Nursing (RCN) is a trade union for nurses.
The Royal College of Midwifery (RCM) is a trade union for midwives.
UNISON is a public sector trade union representing the public services, private
contractors providing public services and the essential utilities.
The Community Practitioners’ and Health Visitors’ Association (CPHVA)
represents registered nurses, health visitors, school nurses, nursery nurses and
community nurses who work in a primary care or community health setting.
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Other sources of advice
Citizens Advice Bureau and Citizens Advice Scotland offer free, confidential and
independent advice, face to face and over the phone. You can find your local
advice service through their website.
Law Centres provide an independent legal advice and representation service.
They employ solicitors and specialists in social welfare law to help individuals and
About this leaflet
This leaflet has been written as a helpful and simplified guide to our fitness to
practise processes. It is based on our rules, but does not cover every situation that
may arise. You can find our full fitness to practise rules on our website at and you should seek trade union or independent legal advice
before acting on the contents of this leaflet.
Effective from 9.3.15
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