Annon v The Nursing And Midwifery Council

A striking-off sanction may be disproportionate where a practitioner has been repeatedly required to complete a return-to-practice course as a condition precedent to returning to practice, has made genuine efforts to secure a place, and has failed to complete the course through no fault of her own. The regulator should impose a realistic time limit for completion. A further conditions of practice order may then be the proper and proportionate sanction, particularly where the practitioner’s incompetence remains capable of remediation and public protection can be maintained by conditions.

The claimant, a midwife, appealed against a Conduct and Competence Committee decision striking her off the Nursing and Midwifery Council’s Register. Her fitness to practise had previously been managed through conditions of practice, repeatedly requiring completion of an approved return-to-practice course. She had made more than 30 applications for a suitable course but had not secured a place. The Committee found continuing impairment, lack of insight and concern arising from her lengthy absence from practice, and concluded that striking off was necessary to protect the public and maintain confidence in the profession.

The central issue was whether striking off was proportionate when the claimant had not breached the conditions and had been unable, through no fault of her own, to complete the required course.

1. Appeal allowed. The striking-off order was quashed and replaced by a Conditions of Practice Order requiring completion of a return-to-practice course within two years, together with such earlier requirements as remained appropriate.
2. The court gave appropriate respect to the Committee’s professional assessment and its findings concerning impairment, insight and the claimant’s lengthy absence from practice. Those findings did not, however, justify striking off where the claimant had been repeatedly told that completion of the course was the condition precedent to her return to practice and had made genuine efforts to comply.
3. Where failure to complete the required course resulted from the unavailability of a course place rather than from the practitioner’s fault, striking off at that stage was unjustifiable. The continuing protection of the public and maintenance of confidence in the profession could be achieved through conditions of practice.
4. A realistic time limit should have been imposed earlier. Continuing professional limbo and repeated review hearings reaching the same outcome were contrary to the wider public interest and the claimant’s interests.
5. The court observed that consideration of realistic completion periods in comparable cases might avoid a repetition of the appeal.

1. Nursing and Midwifery Council Conduct and Competence Committee: On 7 February 2017, imposed a striking-off order at a review hearing.
2. High Court (Administrative Court): Allowed the appeal and substituted a Conditions of Practice Order requiring completion of a return-to-practice course within two years.