NMC’s ‘Agreed Removal’ Explained

The NMC is “taking a different approach” to requests from nurses to be removed from the register when they are subject to fitness to practise concerns – ‘agreed removal’.

What is agreed removal?

Under the Nursing & Midwifery Council’s (NMC) statutory rules, if a nurse, midwife or nursing associate is subject to fitness to practise proceedings, they can apply to be removed from the NMC’s register.  A nurse can submit a removal application to us at any time during the Fitness to Practise process, including during a substantive (final) hearing.

An agreed removal, by NMC Registrars, will conclude the proceedings without consideration by the Fitness to Practise Committee.  According to the NMC’s guidance, “in most cases” the Assistant Registrar is likely to agree to removal from the register provided:

• they’re satisfied that the regulatory concerns raised aren’t so serious that they’re fundamentally incompatible with being a registered professional (the kinds of concerns that are likely to result in the Fitness to Practise Committee making a striking-off order)
• where we haven’t completed our investigation, they’re satisfied that there’s enough information to make a decision about the seriousness of the concerns and the public interest in removing the professional from our register without completing our investigation.

If the application is successful, the NMC will amend the register so that ‘removed by agreement – outstanding fitness to practise question’ is displayed against the nurse.  When removal is agreed during a hearing, the NMC will publish the removal decision as part of the panel’s reasons.

Nurses should note that the NMC will request and consider comments from the maker of the allegation, but the Assistant Registrar will make the final decision.

How the NMC will consider removal applications

Public Interest Test

When a nurse is removed from the register, there is an immediate public protection benefit.  The NMC’s guidance goes on to say that:

“In many cases allowing someone to leave the register quickly, without full consideration by a fitness to practise panel, will be the best way to meet the public interest. 

“However, more serious concerns where the nurse, midwife, or nursing associate’s conduct is fundamentally incompatible with continued registration aren’t usually suitable for agreed removal. This is because there’s a public interest in these concerns being investigated and considered by the Fitness to Practise Committee. The Assistant Registrar is unlikely to agree removal where there is likely to be a finely balanced decision about whether the professional should receive a striking-off order. It’s usually in the public interest for those kinds of decisions to be made by the Fitness to Practise Committee, and for the full reasoning to be published.”

Particular cases

The NMC’s guidance states that “removal is likely to be appropriate where”:

• there are concerns about a nurse, midwife, or nursing associate’s health; and/or
• the regulatory concern relates to lack of competence or not having the necessary knowledge of English

Conversely:

• cases where the concerns relate to convictions or determinations from another regulatory body are less likely to be appropriate candidates
• where the misconduct is so serious that it’s fundamentally incompatible with being a registered professional, the Assistant Registrar is unlikely to agree removal.

NMC Readmission Applications

Agreed removal is “not necessarily” permanent, as the nurse may seek to be readmitted to the NMC’s register at some point in the future.  It is important to note that this is referring to the NMC’s readmission process, which is different to applying for restoration.

Part of the NMC’s consideration, it will ask the nurse whether they intend to reapply to join the register within the next five years. The new guidance states:

“If the nurse, midwife, or nursing associate demonstrates a committed intention to leave the profession then this will be a factor in favour of agreeing removal. For example, a nurse, midwife, or nursing associate may express their intention to follow an alternative career path, be suffering from long term ill health, or have taken steps to leave the profession before we raised concerns with them. They may wish to submit a statement and / or provide evidence of this in support of their application, and we will usually ask them whether they plan on reapplying to join the register within the next five years.”

Insight and Remediation

As mentioned above, agreed removal is “not necessarily” permanent.  The guidance recognises that a nurse, who is subject to fitness to practise proceedings, may want to be removed from the register for a period of time with a view to returning in the future, once the issues with their ability to practise safely have been resolved. The NMC does caution though that:

“This will usually only apply in cases of lack of necessary knowledge of English, where the nurse, midwife, or nursing associate’s skill may improve over time; or health, where their health might improve or be better managed in the future.”

For readmission to the register, the nurse will need to make an application for readmission supported by appropriate evidence. The Assistant Registrar will consider the application alongside the details of any concern that was unresolved at the time removal was agreed and any new information the nurse, midwife or nursing associate provides about this.

Interim order, suspensions and conditions

If a nurse is subject to an interim suspension order or interim conditions of practice order, this will need to be revoked by an interim order panel before an application for agreed removal can take effect.

Similarly, where a nurse is subject to a final conditions of practice or suspension order and no longer wants to be on the register, they can apply for the final order to be lifted by a fitness to practise panel so that they can be removed.