Background

Although it is nurses' responsibility to maintain their registration with the NMC and ensure that they have appropriate indemnity for their role, there can be consequences for practices if a nurse is found to be treating patients without current registration. It is against the law to practice as a nurse without current NMC registration.

Audit and analysis

We reviewed cases reported to the MDU for the ten years between 2007 and 2016 concerning nurses and a lapse in NMC registration.

Over three quarters (77%) of the 39 cases were incidents reported by practice managers. Of the remaining cases, 17.5% were reported directly by nurses and the remainder by a doctor and a medical director.

Of the doctors' surgeries involved in the cases, only 7.5% of these had regular precautionary checks in place for confirming NMC registration statuses. As a result, these practices were able to detect the lapse within a year, limiting the potential damage done.

Lapsed registrations were usually identified locally within the practices; in 87% of the cases the lapses were discovered by the nurses themselves or their employing practices. The other lapses were uncovered following a complaint (2.5%), an inspection by the CQC (2.5%) or following NMC investigations (5%).

There were numerous reasons cited for the lapsed registrations. It was common for nurses to not receive renewal reminders after not notifying the NMC following a change of address. Many nurses incorrectly believed that they had set up annual direct debits with the NMC. Other reasons included periods of personal sick leave, leave to care for poorly relatives and other administrative errors.

The length of the registration lapses varied considerably - in one case the lapse was only for one day. The average period of time for a lapsed registration in the sample of cases we reviewed was two and a half years, with the two longest lapses in excess of 20 years.

Consequences

The NMC refused re-registration in just over a fifth (20.5%) of cases. Of the cases we reviewed, three of the nurses had previously allowed their NMC registrations to lapse; two of those cases eventually resulted in the nurses' registrations being refused. A lapse in NMC registration may have an impact on a nurse's indemnity.

The lapse in NMC registrations resulted in disciplinary action in over a third (36%) of cases; of those, five nurses were suspended and two had their contracts terminated. Nurses were referred to the NMC in 5% of cases. In at least one case, a doctor was referred to the GMC for employing a nurse who had not been registered with the NMC for over 10 years.

Some practices (36% of the cases) chose to allow the nurses to work as health care assistants while their registrations were lapsed. Practices and nurses should take extra care to ensure that nurses only undertake HCA duties during this time; in one case a nurse carried out nurse duties in a HCA role, which resulted in the NMC refusing re-registration and specifying that further retraining was required.

MDU advice

If a practice discovers that a nurse is employed without current NMC registration, it is important to act immediately.

• The practice should stop the nurse working and inform any patients treated by them that they were working without current NMC registration.
• Give those patients contact details for the practice if they have any concerns.
• An appropriately registered healthcare professional should check the records of the patients that the nurse has seen while practising without registration to check for any potential harm to patients.
• Doctors should arrange to meet any patients who may have suffered any adverse effects as a result of any treatment by the nurse.
• Both the practice and the nurse should inform their indemnifiers of the lapse, as well as the NHSE.

Summary

It can be easy for a nurse's NMC registration to lapse, and for many reasons, but the consequences can be serious. Nurses may find that their indemnity may not cover them, and doctors have been referred to the GMC for employing a nurse without knowing that their registrations have lapsed.

Practices could also find themselves in breach of contract if they are discovered to have been employing a nurse without valid NMC registration and may wish to seek employment advice.

Lapsed registrations can result in disciplinary proceedings between the nurse and their employer, and our analysis shows that re-registration is not always a straightforward process and a resumption of registration is not certain.

Our analysis suggests that prevention is better than cure, and we would recommend regular checks of all registration statuses in general practice.