Karen Brown v The Nursing and Midwifery Council [2025] EWHC 1642 (Admin)

[2025] EWHC 1642 (Admin)

Case No AC-2025-LON-000572

IN THE HIGH COURT OF JUSTICE

KING'S BENCH DIVISION

ADMINISTRATIVE COURT

Venue Royal Courts of Justice, Strand, London, WC2A 2LL

Date 03/07/2025

Before

MR JUSTICE LINDEN

Between

KAREN BROWNAppellant

THE NURSING AND MIDWIFERY COUNCILRespondent

Angus Gloag instructed by Appellant by direct access

Leeann Mohamed (instructed by the Nursing and Midwifery Council) for Respondent

Hearing Hearing date: 19 June 2025

Approved Judgment

This judgment was handed down remotely at 10.30am on [date] by circulation to the parties or their representatives by e-mail and by release to the National Archives.

.............................

MR JUSTICE LINDEN

Introduction

[1]From November 2019 to June 2020 the Appellant, Ms Karen Brown, worked as a Community Psychiatric Nurse on an agency basis for North Tyneside East Community Treatment Team which is part of the Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust (“the Trust”). On 25 September 2020 she was referred to the Respondent (“the NMC”) by the Executive Director of Nursing and Chief Operating Officer of the Trust in relation to concerns about her record keeping and her relationships and communication with patients and others, including concerns that she had not sufficiently respected professional boundaries.

[2]This is Ms Brown’s appeal against the outcome of that referral which was that the Fitness to Practise Committee (“FPC”) of the Respondent upheld some of the charges against her and imposed a 12 month conditions of practice order. The terms of that Order are set out at Appendix 2 to this judgment.

[3]Ms Brown contends that that the FPC’s decision was wrong and/or the unjust result of serious procedural irregularity on eight Grounds. She developed these Grounds in a 30 page written submission which, I was told, was written by her representative for the second to fourth stages of the hearing before the FPC, Mr Hussain-Dupre.

[4]Mr Angus Gloag of Counsel then appeared at the hearing before me. Whilst not abandoning any of the Grounds of Appeal or the arguments in Ms Brown’s written submission, his oral submissions materially departed from these documents both in terms of content and emphasis. His particular focus was on the question whether there had been adequate cross examination of one of the witnesses called by the NMC – Ms Brown’s line manager, Ms Laura Jobson – and whether the FPC had adequately analysed the evidence in coming to its decision, and had given adequate Reasons. The other Grounds of Appeal were barely mentioned by him and in some cases were only mentioned when asked by the Court whether they were pursued. As will be seen below, this is likely to reflect good judgment on his part.

[5]On behalf of the NMC, Ms Leeann Mohamed provided a skeleton argument which I found helpful in bringing the appeal into focus. I am also grateful for her helpful oral submissions.

The charges which Ms Brown faced before the FPC

[6]In order to address some of Ms Brown’s complaints about the FPC’s decision, and to understand the context in which her arguments are put forward, it is important to begin by noting the nature of the allegations against her, and which allegations were upheld.

[7]Ms Brown faced 16 charges, a number of which included sub-charges. A full list is set out in the Table at Annex 1 to this Judgment. This Table also shows whether each charge was found proved (whether by formal admission or otherwise), if so whether it was found to amount to “misconduct” and, if so, whether Ms Brown’s fitness to practise was found to be impaired on the basis of that charge. It is important to note that, as will be apparent from the Table: i) A substantial majority of the factual allegations made against Ms Brown were found not to have been proved on the evidence by the NMC. ii) Of the factual allegations which were found to have been proved or admitted, some were found not to amount to misconduct. The charges which were found to amount to misconduct were: 5, 7, 9,14(a),14(b), 15(e), 15(f), 15(g) and 16. iii) Of the charges which were found to amount to misconduct Ms Brown formally admitted the facts alleged in 14(b), 15(e) and 15(g). And the finding on Charge 16 was based on 15(e) and (g). The FPC also found that she had in effect admitted the factual basis of Charge 7. iv) The FPC did not find that all of the charges which amounted to misconduct impaired Ms Brown’s fitness to practise. Her fitness to practise was only found to be impaired on the following charges: 5, 7, 9, 14(a), 14(b) and 15(f). v) The charges which led to findings that Ms Brown’s fitness to practise was impaired were principally concerned with her record keeping. Part of one of these charges was having insufficient contact with a patient (Charge 9 – Patient M) and one of these charges was ignoring an instruction which she had been given in relation to Patient D (Charge 14(a)). The allegation of breaching professional boundaries in relation to Patient A (Charge 16) was found to amount to misconduct but the FPC found that Ms Brown had taken significant steps to remedy this issue and her fitness to practise was not impaired in this regard.

The Hearing

[8]It will be necessary to come back to the detail of some aspects of the FPC hearing below but, in outline, it took place before a panel of three comprising a Chair, a registrant member and a lay member (“the Panel”). They were assisted by a legal assessor. The NMC was represented by Mr Yusuf Segovia, as case presenter.

[9]The hearing took place over the course of a number of sessions. On 13-17 and 20-24 May 2024, the Panel dealt with what was called “the facts stage” i.e. whether the primary facts alleged in the charges were or were not established on the evidence: for example, did Ms Brown fail to record that plans had been followed through in the case of patient G (Charge 5)? There was a wrinkle in relation to Charge 16, which involved an evaluative judgment as to whether, on the facts, professional boundaries had been observed, and therefore as to whether there had been a breach of professional standards. But the Panel decided (without objection) to determine whether this allegation amounted to misconduct at stage 1 of the hearing.

[10]Throughout the hearing in May 2024, Ms Brown was represented by Mr Holborn of NMC Watch. The Panel heard the NMC’s witnesses, who were cross examined by Mr Holborn. He then made a submission of “no case to answer” in relation to all of the charges which Ms Brown faced. This was rejected by the Panel save in relation to Charge 13, which was dismissed. Ms Brown then gave evidence and was cross examined. There was then consideration, in the light of Ms Brown’s evidence, of which of the primary facts were formally admitted. Once this had been clarified by the Panel, the representatives made submissions on the disputed allegations. The Panel then handed down its decision on the facts on 24 May 2024.

[11]The hearing was then adjourned to 22 October 2024. By then, Mr Hussain-Dupre had been instructed by Ms Brown. At the outset of the hearing he said that he did not seek to reopen the Panel’s factual findings or apply for the charges to be amended or further particularised. But he wished to put on record that he was concerned that the charges had not been adequately particularised. He also indicated that he had concerns that the NMC had been permitted to rely on a supplemental statement of Ms Jobson. His concern appeared to be that she had conducted a retrospective investigation and that portions of her supplemental statement represented the findings of that investigation and ought to have been excluded. He asked that the issues of whether the allegations which had been admitted or found proved amounted to misconduct and, if so, whether such misconduct impaired Ms Brown’s fitness to practise, be considered in 2 stages in order to mitigate the concerns which he had expressed. There was no objection and the Panel agreed to this.

[12]The representatives then made submissions on whether the factual allegations which were well founded amounted to misconduct, and the Panel handed down its decision on 24 October 2024. There were then submissions on the issue of impairment.

[13]The proceedings were then adjourned to 21 January 2025 when the Panel announced its decision on impairment of fitness to practise. This was followed by submissions on sanction, and the Panel gave its decision on this question on 22 January 2025. An interim conditions of practice order was then imposed in the terms of the Order which the Panel had decided to impose as a sanction.

[14]Mr Hussain-Dupre did not seek to reopen any aspect of the proceedings prior to his involvement. Nor did he call Ms Brown to give further evidence at any of the three stages after the fact finding hearing in May 2024.

Overview of the Panel’s decision

[15]By way of overview, the Panel’s written decision runs to 82 pages. It is meticulous, clear, thorough, well reasoned and, on the face of it, fair. As has been noted above, the Panel accepted a good deal of Ms Brown’s case.

[16]Contrary to one of the themes of Ms Brown’s written submissions, the Panel rightly considered the evidence which was relevant at each stage of its deliberations. At the first stage it asked and answered the question whether the primary facts alleged in each charge had been admitted or proved on the balance of probabilities. In considering whether misconduct had been established it considered whether the facts which had been established amounted to a breach of any of Ms Brown’s professional obligations. In considering whether any misconduct which had been established impaired Ms Brown’s fitness to practise, the Panel considered the then current position and any steps which she had taken to remediate the concerns which had been identified. In relation to sanction, the Panel applied the relevant guidance as to approach and took into account exculpatory and mitigating factors.

[17]In approaching its decision making in this way, there were some aspects of the evidence which were relevant to more than one stage. But Ms Brown’s suggestion that failure by the Panel to refer to a given piece of evidence at a given stage meant that the Panel had ignored that evidence is misconceived: the reality is that the Panel referred, at each stage, the evidence which was most relevant to the issue for determination at that stage. The fact that it did not refer to a particular piece of evidence did not mean that it did not have that evidence in mind and take it into consideration. Legal Framework Relevant aspects of the procedure to be adopted by the FPC

Legal Framework

[18]The procedure to be adopted before the FPC was at all material times governed by the Nursing and Midwifery Council (Fitness to Practise) Rules 2004 (“the FTP Rules”). These envisage an investigatory stage, which is governed by Part 2, and which may lead to a referral to the FPC.

[19]The procedure at hearings before the FPC to consider an allegation that a registrant’s fitness to practice is impaired is governed by Part 5 of the FTP Rules. Rule 24 provides for the following stages “unless the Committee determines otherwise”: i) a preliminary stage during which any objections to the charges may be raised or considered and admissions may be made by the registrant (Rules 24(2)-(5)); ii) a fact finding stage during which the FPC determines disputed facts underpinning the charges and makes its findings of fact on the evidence. It is during this stage that the FPC can consider a submission of no case to answer in relation to any or all of the charges (Rule 24(6)-(11)); iii) in a case where it is alleged that the registrant’s fitness to practise is impaired by reason of misconduct, an impairment stage where the FPC considers that question (Rule 24(12)); iv) a sanction stage (Rule 24(13) and (14)).

[20]In Hindle v Nursing and Midwifery Council

[2025] EWHC 373 (Admin)

Mr Alan Bates, sitting as a Deputy High Court Judge, said this at [112]:

“The NMC's allegations against the Appellant were all of 'misconduct' by reason of which her FtP was impaired. Accordingly, insofar as any conduct charges were found 'proved' against her (whether by reason of their having been admitted by her, or otherwise), the next steps would then be to consider: (a) whether the proved conduct constituted 'misconduct'; and, if it did, (b) whether her FtP was currently impaired.”

[21]In the present case, as Ms Mohamed confirmed, the Panel therefore followed its standard approach save in relation to Charge 16, and save that it dealt with the issues of misconduct and impairment of fitness to practise in separately. This was at the request of Mr Hussain-Dupre and no complaint about it was made by Ms Brown or Mr Gloag.

The right of appeal in this case

[22]Article 38 of the Nursing and Midwifery Order 2001 provides that an appeal from the decision of the Panel in the present case lies to the High Court and, at Article 38(3), it sets out the disposals of such an appeal which are available.

[23]CPR Rule 52.21(3) governs the basis on which an appeal may be allowed. This provides as follows:

“The appeal court will allow an appeal where the decision of the lower court was: (a) wrong; or (b) unjust because of a serious procedural or other irregularity in the proceedings in the lower court.” (a) wrong; or (b) unjust because of a serious procedural or other irregularity in the proceedings in the lower court.”

[24]As to the approach of this Court to appeals in the present context, I gratefully adopt the following summary which was provided by the Divisional Court (Sharpe LJ and Dingemans J, as he then was) in General Medical Council v Jagivan

[2017] EWHC 1247 (Admin)

at [40]:

“i) Proceedings under section 40A of the 1983 Act are appeals and are governed by CPR Part 52. A court will allow an appeal under CPR Part 52.21(3) if it is 'wrong' or 'unjust because of a serious procedural or other irregularity in the proceedings in the lower court'. ii) It is not appropriate to add any qualification to the test in CPR Part 52 that decisions are 'clearly wrong'... iii) The court will correct material errors of fact and of law…. Any appeal court must however be extremely cautious about upsetting a conclusion of primary fact, particularly where the findings depend upon the assessment of the credibility of the witnesses, who the Tribunal, unlike the appellate court, has had the advantage of seeing and hearing…. iv) When the question is what inferences are to be drawn from specific facts, an appellate court is under less of a disadvantage. The court may draw any inferences of fact which it considers are justified on the evidence: see CPR Part 52.11(4). v) In regulatory proceedings the appellate court will not have the professional expertise of the Tribunal of fact. As a consequence, the appellate court will approach Tribunal determinations about whether conduct is serious misconduct or impairs a person's fitness to practise, and what is necessary to maintain public confidence and proper standards in the profession and sanctions, with diffidence… vi) However there may be matters, such as dishonesty or sexual misconduct, where the court "is likely to feel that it can assess what is needed to protect the public or maintain the reputation of the profession more easily for itself and thus attach less weight to the expertise of the Tribunal …"…: the appellate court "will afford an appropriate measure of respect of the judgment in the committee … but the [appellate court] will not defer to the committee's judgment more than is warranted by the circumstances". vii) Matters of mitigation are likely to be of considerably less significance in regulatory proceedings than to a court imposing retributive justice, because the overarching concern of the professional regulator is the protection of the public. viii) A failure to provide adequate reasons may constitute a serious procedural irregularity which renders the Tribunal's decision unjust...”

The Grounds of Appeal Preliminary observation

The Grounds of Appeal

[25]It is important to note at the outset that it is not asserted by or on behalf of Ms Brown that the Panel misdirected itself in law or failed to take into account relevant authority or guidance. That is no doubt because no such criticism could be levelled at the Panel. At each stage it directed itself correctly as to the law and referred to the relevant guidance. The discussion below proceeds on the basis that this is a given and therefore does not repeat the Panel’s references to these materials. Grounds 1-3

[26]It is convenient to deal with Grounds 1-3 together because they are interrelated, and in order to clear away certain “dead wood” and lay the foundations for the analysis of Ms Brown’s other Grounds of Appeal.

[27]Under Ground 1, at least as pleaded, Ms Brown contends that she was poorly represented by Mr Holborn at the fact finding hearing in May 2024, and that this had an adverse and determinative effect on the outcome. The specific failings which she alleged under this head were a failure to make applications: i) Under Rule 28 of the FTP Rules, for the charges to be amended so that they were particularised further; ii) Under Rule 31, to exclude the evidence of Ms Jobson in whole or in part.

[28]In her written submissions Ms Brown also says that Mr Holborn was not legally qualified. She was not happy about how the case had been prepared by him, about the lack of clarity over the charges and some points which, despite her instructions, were not made by him in cross examination. Although the alleged failure to make points in cross examination was mentioned in passing in Ms Brown’s written submission, and no particulars of any such point were given, this was a key focus of Mr Gloag’s oral submissions at the appeal hearing. I return to this issue below.

[29]Ms Brown also complains about admissions which were made on her behalf by Mr Holborn when she was not present at the hearing. She says that although she agreed to these admissions she did so on the basis of a lack of clarity and understanding of the charges. Although she then changed representation, the Panel’s findings of fact had been handed down and they stood for the rest of the process.

[30]Ground 2 is pleaded as a complaint that the charges were not properly particularised. In her written submissions, Ms Brown referred to Shrimpton v General Council of the Bar

[2005] EWHC 844 (Admin)

at [16] where Lindsay J accepted that the case against a defendant in disciplinary proceedings should be made clear in good time before the hearing. She also referred to R (Johnson and Maggs) v Professional Conduct Committee of the Nursing and Midwifery Council

[2008] EWHC 885

which related to a complaint of inadequate particularisation of charges by the Professional Conduct Committee of the NMC.

[31]Under Ground 3 Ms Brown argued in writing that the evidence of Ms Jobson ought to have been excluded on the basis that it amounted to the outcome or findings of a previous disciplinary investigation. In this connection she relied on the decision of Holman J in Enemuwe v Nursing and Midwifery Council

[2015] EWHC 2081

Ground 2: were the charges inadequately and unfairly particularised?

[32]Starting with the complaint that the charges were insufficiently particularised and unfair, I reject this. Unsurprisingly, Mr Gloag did not dwell on this point.

[33]In the Johnson and Maggs case referred to by Ms Brown in her written submissions, Beatson J (as he then was) said this at [102]:

“The test to be applied in these cases is a two-stage test. Firstly, whether the challenges in the circumstances of the case provided sufficient information to enable those charged to know, with reasonable clarity, the case they have to meet. Secondly, whether they know enough about the charges to enable them to prepare their defences…”

[34]Ms Brown plainly was provided sufficient information to enable her to know, with reasonable clarity, the case she had to meet. She also knew enough about the charges to enable her to prepare her defence. In the present case she had advance notice of the nature of the concerns about her when she was provided with the Case Examiner’s Draft Report for her comments in March 2022 and the final version of that Report on 10 May 2022. On or before 5 April 2023 – i.e. more than a year before the first hearing before the Panel – she was then provided with the list of the charges which she faced and the supporting materials relied on by the NMC in relation to those charges, including the supplemental witness statement of Ms Jobson which was dated 27 March 2023. Albeit the number of charges against her had increased, at least partly on the basis of the supplemental statement of Ms Jobson, she had ample notice of this and ample opportunity to object or to seek clarification if there was anything she did not understand.

[35]In fact, the charges and the supporting materials made clear what case she was required to meet and what primary facts were being said to amount to misconduct which impaired her fitness to practise. The charges did not specify the professional standards which she was alleged to have breached but there was no real mystery about this, and it did not prevent her from putting forward her evidence in response. If she was uncertain about this, she could have asked.

[36]That Ms Brown was perfectly able to prepare her case in response to the charges is confirmed by the fact that she provided a detailed witness statement prior to the hearing before the Panel. This did not indicate any inability to understand the case against her or any impairment to her ability to respond to it. On the contrary, she set out a detailed account of the context and the exculpatory and mitigating factors which she relied on. She also included a Table which went charge by charge, stating whether she accepted or did not accept the factual allegation contained in the charge, and her account in relation to that particular charge. It was partly on the basis of this Table that the Panel was able to record that certain factual allegations were formally admitted.

[37]It was therefore with good reason that Mr Holborn did not apply for further particulars of the charges. No such particulars were needed or, insofar as they were, no order was required. He could ask his opponent what his case was on a given point. Indeed, it appears that he took a tactical decision not to seek any order and, instead, as part of his submission that there was no case to answer, to argue that the charges were vague and should be dismissed. That decision was perfectly understandable and does not undermine the fairness of the proceedings before the Panel.

Was it unfair to rely on Ms Brown’s admissions?

[38]Mr Gloag did not refer to this complaint but I will deal with it for completeness. Again, the argument has no merit.

[39]So as to get this complaint in perspective, I note that the only charge which was formally admitted and was subsequently found to amount to misconduct giving rise to impairment of Ms Brown’s fitness to practise was 14(b). Charges 15(e) and 15(g) were admissions of the facts which were found to give rise to misconduct. And there was a finding of misconduct on allegation 16 which was based on 15(e) and (g). However, the Panel did not find impairment of fitness to practise in relation to these charges.

[40]As to what happened, at the end of the evidence and before closing submissions, on 22 May 2024, Mr Segovia drew attention to the fact that Ms Brown had admitted the primary facts alleged in certain of the charges. He also reminded the Panel that Rule 24(5) of the FTP Rules provides that where facts have been admitted by the registrant, the Chair shall announce that such facts have been found proved. And he identified, with the Chair of the Panel, the charges which he said were admitted by Ms Brown either in writing or orally, or both.

[41]Ms Brown had not attended that day and, erring on the side of caution, Mr Holborn was therefore given time to contact her to take instructions as to whether she did indeed admit the charges which had been identified. When he returned, he confirmed that he had spoken to Ms Brown and had taken her instructions. He and the Chair then went through each of the charges where admissions were said to have been made and he indicated where it was accepted that an admission had been made and where it was not. He also made clear (for the avoidance of doubt) that any admission was purely as to the facts alleged: no admission of misconduct or impairment was made. No one disagreed that this was the (limited) effect of any admissions at that stage. The Chair then declared the charges which were agreed to have proved by admission as required by Rule 24(5).

[42]These facts were therefore admitted by Ms Brown and she confirmed to the Panel, via Mr Holborn, that they were admitted. To her credit, she did not suggest before me that they she had not authorised Mr Holborn to confirm that they were admitted. For the reasons I have given, however, I reject the suggestion that any of her admissions is undermined or unfair by reason of any lack of clarity in the charges: see Ground 2 above.

Ground 3: should Ms Jobson’s evidence have been excluded?

[43]Again, this is not a Ground which Mr Gloag developed, for good reason. But I deal with it for completeness.

[44]In Enemuwe Holman J held that there had been a serious procedural irregularity. This was that the report of the supervisory investigation which led to the proceedings before the Conduct and Competence Committee of the NMC had been taken into account by that Committee in coming to its decision. The normal practice of the NMC was that findings and opinions of a previous panel or investigation were not generally admissible and were not put before the Committee. At [38] Holman J said this:

“…. in this sort of situation where there has been a prior investigation and prior findings by a local disciplinary or investigatory person or body, the findings of that person or body are not, and should not be, normally admissible in proceedings before the NMC, nor put before the Committee, although Miss Marsh says that the Committee does sometimes receive a redacted version of such a report or findings.”

[45]At [78] Holman J said that there was “a world of difference” between the Committee “knowing that there has been some investigation, and their actually paying regard to the factual outcome of the investigation in reaching their own findings and conclusions on disputed issues of fact”. On this basis he found that the decision of the Committee was unjust and he allowed the appeal.

[46]However, I agree with Ms Mohamed that Enemuwe does not apply in the present case. That decision does not even preclude the calling of a witness who carried out, or was involved in, a prior investigation. Insofar as it gives rise to any rule, which is debatable, it precludes reliance on the findings of such an investigation on the basis that the FPC must reach its decision for itself on the evidence of primary fact which it receives and uninfluenced by the opinions and findings of the earlier disciplinary investigator(s). In the present case Ms Jobson was Ms Brown’s line manager at the Trust at all material times and had direct knowledge of the concerns about her. She gave evidence of fact as to what, to her knowledge, had happened in relation to aspects of certain charges, and what she had become aware of on considering the records and other documents, and she produced documentary evidence. There is no suggestion in her evidence that she carried out a disciplinary investigation and her evidence did not include the findings of any such investigation. The fact that Ground 3 is misconceived was underlined when it was confirmed by Ms Brown, during the hearing before me, that Ms Jobson had not in fact carried out any disciplinary investigation.

[47]This did not lead Mr Gloag formally to abandon the contention that Ms Jobson’s evidence ought to have been excluded or, at least, that there should have been an application to exclude it. When asked what the basis for such an application would have been, he said that it could have been argued that Ms Jobson had trawled the notes and records to find evidence against Ms Brown and that her supplementary statement, amongst other things, produced the results of that trawl. That does not seem to me to be a fair characterisation of Ms Jobson or her supplementary witness statement. But even if it was, that would not have provided a basis on which to exclude her evidence, which was central to the issues which the Panel had to decide. Not only was Ms Jobson’s evidence (highly) relevant and therefore admissible: it had been served more than a year before the hearing. Ms Brown therefore had plenty of time to prepare to challenge that evidence in the course of the hearing and there was no unfairness to her in admitting it.

[48]It was therefore with good reason that Mr Holborn did not apply to exclude the supplementary statement of Ms Jobson. Such an application would inevitably have failed. Ground 1: was the standard of representation by Mr Holborn such as to amount to a serous procedural irregularity?

[49]As for the test to be applied in relation to this type of ground of challenge, in Nicholas Pillai v General Medical Council

[2015] EWHC 305 (Admin)

Laing J (as she then was) said this at [74]:

“A ground of appeal relying on the incompetence of counsel involves an undesirable form of satellite litigation which is to be discouraged... It is no doubt for this reason that the test is a strict one: was the incompetence of such degree that no reasonable advocate would have acted in that way and did any such incompetence cause the hearing to be unjust?....”

[50]It follows from what I have said that Ground 1 fails in respect of Mr Holborn’s failure to seek an order for further particularisation of the charges and to apply to exclude the evidence of Ms Jobson. Both applications would inevitably have failed. Nor can any issue sensibly be taken in relation to Ms Brown’s admissions of the primary facts relating to certain of the charges against her.

[51]The remaining issue under this head is Mr Gloag’s argument that Mr Holborn’s cross examination was so deficient as to amount to a serious procedural irregularity which rendered the decision of the Panel unjust for the purposes of CPR Rule 52.23(3). His argument focussed on the cross examination of Ms Jobson, who was the principal witness for the NMC. He submitted that this was inadequate in that Mr Holborn did not go through each of the charges in turn with her as he should have, and did not put various medical notes and records and other evidence to her in relation to each charge. Mr Gloag took me to the materials in question, at least so far as related to the charges which resulted in findings of misconduct. His submission was that Mr Holborn’s cross examination did not subject Ms Jobson’s evidence to a forensic analysis in the light of these materials.

[52]Having read the transcript of Mr Holborn’s cross examination of Ms Jobson it seems to me that the approach which he adopted was well within the range of approaches which a reasonable advocate could have taken in the circumstances of this case, particularly given what the issues actually were. For ease of reference the charges which were found to amount to misconduct and/or to give rise to an impairment of Ms Brown’s fitness to practise are set out below with the latter emboldened: i) Charge 5 was:

“Between 27 December 2019 and 30 June 2020, on one or more occasions, in relation to patient G did not record that plans had been followed through.” ii) Charge 7 was that: “Despite being allocated patient J on or around 29 November 2019 did not ensure that their formulation was added to their record prior to June 2020.” iii) Charge 9 was: “Between 1 April and 30 June 2020 had minimal contact with patient M and/or did not record that plans had been carried through.” iv) Charge 14(a) was: “on 28 May 2020, despite being asked to no longer work with patient D, left a voicemail on their phone and/or attended their home address.”. v) Charge 14(b) was: “on 28 May 2020, having been informed of a concern relating to patient D’s dog did not inform your manager and/or make an incident report.”

This was admitted. vi) Charge 15 alleged that, in relation to Patient A, Ms Brown: a) “(e) Agreed to be their birthing partner and/or attended the birth of their child;” This was admitted. b) “(f) Did not record any conversations with Patient A and/or social services about being the birthing partner of A”. c) “(g) On one or more occasion looked after their child/children at your house.” This was admitted. vii) Charge 16 was that Ms Brown had breached professional boundaries by reason of the matters charged in Charge 15. This was upheld on the admitted facts of 15(e) and (g).

[53]The reality of this case was that these charges made a series of specific criticisms: mostly that a particular thing or things were not recorded but also that there had been minimal contact with Patient M, that there had been a failure to comply with an instruction in relation to Patient D and that there had been dealings with Patient A which were inappropriate. What the records showed to have been recorded or not recorded was not capable of serious dispute, Ms Jobson’s specific criticisms were based on them and, unsurprisingly, they generally supported the NMC’s factual case. Mr Gloag showed me documents which provided mitigating evidence but he did not show me any note or record which actually contradicted the specific allegation which was made by the NMC. Some of the factual allegations were admitted and others were not within Ms Jobson’s knowledge: on either basis cross examination on such points would be inappropriate. There were areas of interpretation – what is “minimal contact”, for example, or whether Ms Brown’s admitted dealings with Patient A went beyond professional boundaries. There was a difference of emphasis as to what had been said to Ms Brown about not contacting Patient D but, overall, this was not a case where the credibility of Ms Jobson was in issue: such disputes as there were were mainly in relation to the interpretation of the facts, whether they amounted to misconduct and whether there were mitigating factors.

[54]Unsurprisingly, Mr Holborn’s cross examination reflected these considerations. He challenged some factual assertions by Ms Jobson but largely concentrated on putting points to Ms Jobson which challenged the suggestion that there had been any misconduct on Ms Brown’s part arising out of acts or omissions which were largely not in dispute. He also emphasised the difficulty of the circumstances in which she was working given for example the Covid-19 pandemic, an alleged lack of training support and supervision, being overworked, and so on, as explanations for any failings by Ms Brown in terms of, for example, record keeping. As will be seen below, the Panel took these points on board in coming to its decision.

[55]I therefore do not accept that there can be significant criticism of Mr Holborn’s approach to the cross examination of Ms Jobson. Still less do I accept that his approach amounted to a procedural irregularity, whether serious or otherwise, which rendered the decision of the Panel unjust. Here, the important point is that the process has to be looked at as a whole. As I have said, this was not a case in which the cross examination of Ms Jobson was crucial but, even if it was, the real question is whether Ms Brown had a fair opportunity to put her case before the Panel and I have no hesitation in finding that she did. Her case was fully set out in her witness statement, to which I have referred above. She then gave oral evidence and was cross examined by Mr Segovia. His cross examination of her was not hostile, and rightly so. He took her through each of the charges in turn and put the NMC’s case to her, largely by asking her non-leading questions. She had a full opportunity to respond to each of his questions and to put her side of the story in relation to each of the charges. She was also questioned by each of the members of the Panel. At the end of the evidence, submissions were made on her behalf which highlighted the strengths in her case and the weaknesses in the NMC’s. As I explain below, the Panel then carried out a thorough analysis of the evidence in making its findings. There were then further submissions as to misconduct and impairment by Mr Hussain-Dupre whom Ms Brown has not criticised. She could also have given further evidence at either of these stages if she had chosen to.

[56]In short, the overall procedure which the Panel followed ensured that Ms Brown received a fair hearing in which she had a fair opportunity to respond to the charges against her and to put her side of the case, much of which was accepted by the Panel. Mr Holborn’s approach to the cross examination of Ms Jobson did not begin to render the decision of the Panel unjust.

[57]Finally, and for completeness, Mr Gloag drew attention to the fact that Patient A had expressed favourable views about Ms Brown in email correspondence with the NMC in early December 2021. He said that this correspondence had not been put before the Panel. This specific point was not taken by Ms Brown in writing. What Mr Gloag did not say is that the correspondence had been provided to Ms Brown when the draft Case Examiner’s Report had been sent to her in March 2022. Ms Brown was therefore able to put it before the Panel if she wished to. In any event, whilst Patient A expressed appreciation of the help which Ms Brown had given her, she did not contradict the NMC’s case on the relevant charges: what she did was confirm that they had a close relationship. The issue on Charge 15 was largely whether that relationship was closer than it should have been and Ms Brown had strayed beyond her professional boundaries in her dealings with Patient A. Nothing which Patient A said established that Charge 15 was unfounded: on the contrary, it tended to confirm that there was a close relationship between them. Moreover, with respect to her, it was for the Panel rather than Patient A to be the judge of what professional standards required of Ms Brown in relation to Patient A and, of course, ultimately the Panel did not find that her fitness was impaired in this regard. Conclusion on

Grounds 1-3

[58]These Grounds therefore fail.

Ground 4

[59]Under this Ground, Ms Brown argues that the Panel failed to take account of her evidence at the fact finding, misconduct, impairment and sanctions stages and that it failed to provide any or adequate reasons for its decision. She says that the Panel did not explain whether it had rejected her evidence or preferred other evidence which was before it. If it was the latter, the Panel ought to have explained why her defence had failed. She alleges that the Panel did not take account of the context, and that the Panel’s determination that her conduct had fallen short of required professional standards in certain respects was fundamentally flawed. Nor had it attached enough weight to evidence as to context when deciding whether her conduct would undermine public confidence in the nursing profession. Nor did it attach weight, when it considered the question of impairment of fitness to practise, to the fact that she had practised on an unrestricted basis for three years following the referral without incident or complaint, although the Panel had erroneously taken this consideration into account as a mitigating factor at the sanction stage.

[60]In her written submissions Ms Brown specifically challenges the Panel’s findings on Charges 7, 9, 14(a) and (b), 15(e) and 15(g) as well as Charge 15 as a whole, and the Panel’s findings of misconduct overall. Her submissions under these headings effectively seek to reargue the case which was argued before the Panel. Mr Gloag chose to focus on the charges which led to a finding that her fitness to practise was impaired, including 5 and 15(f), but he also made short submissions on 15(e) and (g). Importantly, to my mind, it was implicit that Ms Brown did not agree with the findings against her but Mr Gloag did not submit that any finding of the Panel was perverse or wrong or not open to the Panel on the evidence. His argument, which overlapped with his criticism of Mr Holborn’s approach to cross examination and was based on the same materials, was that there had not been a sufficiently forensic analysis by the Panel of each of the charges, and of the evidence in relation to each of the charges.

[61]I disagree. It is abundantly clear from the Panel’s Reasons that it took account of Ms Brown’s evidence, of the context and of the evidential features to which she refers. It also adopted a forensic approach, analysing each allegation in turn and the evidence relevant to that allegation. Moreover, it did so at each of the four stages of the process: primary fact finding, misconduct, impairment and sanction, having set out the submissions of the representatives at each stage. The notion that it did not take account of Ms Brown’s evidence at each stage and overall is substantially undermined by the fact that it accepted significant aspects of her case, and rejected the NMC’s case on these points as I have pointed out.

[62]I will trace the Panel’s reasons in relation to Charge 5 to illustrate how the Panel approached each charge but it is not necessary to undertake this exercise for all of the charges. The Panel’s decision can be referred to for further detail, but the pattern was the same for all of the charges.

[63]Having dealt, separately, with the question whether there was a case to answer in relation to each of the charges in turn, including Charge 5, the Panel said the following at the fact finding stage:

“Charge 5 “That you, a registered mental health nurse, between 27 December 2019 and 30 June 2020, on one or more occasion, in relation to Patient G did not record that plans had been followed through.”

This charge is found proved. In reaching this decision, the panel took into account the evidence of [Ms Jobson] provided in her oral evidence, written statement, supplementary statement and supervision records. The panel had specific regard to paragraph 5iii in [Ms Jobson’s] supplementary statement in which it is stated that for Patient G there was ‘no evidence of plans being followed through’. The panel took into consideration your oral evidence, written statement and documentary evidence provided. The panel noted that you ‘raised concerns with her psychiatrist…arranged for her to have appointments’ but that once the COVID-19 pandemic started Patient G ‘did not want me [you] to visit, she told me [you] she was managing’. Further the panel noted that you stated you signposted Patient G’s daughter on how to apply for a carers assessment but that it was not for you to follow up on this. The panel took into account Patient G’s RiO notes from 27 December 2019 to 17 June 2020. The panel noted your entry on 19 March 2020, when you stated, ‘referral for daughter re carers (sic) assessment’. The panel noted your entry on 9 June 2020, when you recorded ‘send information for her daughter to claim carers (sic) allowance’. The panel was of the view that this indicated that you had not followed up regarding the daughter undertaking a carer’s assessment in the intervening 3-month period and that there is nothing contained in Patient G’s notes to evidence that this matter has been concluded. Further the panel noted that on 3 March 2020 it is stated that Patient G would undertake ‘work with Karen on anxiety management, sleep hygiene’. However, the panel determined that there are no entries in the contemporaneous supervision records or notes for Patient G to evidence that you followed up on this plan. The panel was of the view that even if it was not your responsibility to follow up on a carer’s assessment it was clearly your responsibility to follow up on the plan to undertake work with Patient G on anxiety management and sleep hygiene. The panel noted that the contemporaneous documentary evidence provided did not contain any entries from you that this had been undertaken. The panel therefore found on the balance of probabilities, charge 5 proved.”

[64]At the misconduct stage the Panel found as follows:

“In respect of charge 5, the panel noted that you did not record that plans had been followed through in respect of sleep hygiene and anxiety management. The panel acknowledged that you may have engaged with these two plans but there is nothing recorded in Patient G’s notes. The panel determined that your failure to record that the plans had been followed through in Patient G’s notes constitutes a breach of the Code, particularly concerning the requirement to maintain clear and accurate records relevant to one’s practice as outlined in Paragraph 10.1 of the Code ‘complete all records at the time or as soon as possible after an event, recording if the notes are written some time after the event’. The panel was of the view that given that the patient in question was a vulnerable individual with mental health challenges, the recording in relation to these plans was essential to ensure continuity of care. The panel determined that your failure to document relevant information in relation to the plans could have exposed Patient G to a potential risk of harm. The panel determined that your failure to record that the plans had been followed through was a serious departure from the standards expected of a registered nurse and amounted to misconduct.”

[65]At the impairment stage the Panel said this in relation to record keeping:

“The panel carefully considered your misconduct in relation to working cooperatively with your colleagues, in particular in relation to your poor record-keeping. It concluded that your failure to document critical information involving vulnerable patients was a serious failing that put vulnerable individuals at unwarranted risk of harm. The panel was of the view that the absence of relevant and important information in the patients’ records could have prevented other healthcare professionals from making informed, timely decisions regarding patient care and, therefore, potentially compromised patient safety.”

[66]It went on to say:

“The panel noted its finding that you had breached a number of paragraphs of the Code, specifically paragraphs 8.2, 8.3, 10.1, 10.2, 20.3, and 20.6 and, in particular, that there were repeated breaches in respect of your failure to work cooperatively with colleagues by not recording important information in patients’ records. It was of the view that these breaches signified a substantial departure from the Code, which sets out the standards required for registered nurses. The panel was, therefore, satisfied that you had, in the past, breached fundamental tenets of the nursing profession.”

[67]It found that Ms Brown’s poor record keeping was more easily remediable than other aspects of her conduct and it went on to conclude:

“The panel was of the view, however, that in relation to your failure to work cooperatively with colleagues, in particular your poor record keeping, and your failure to act upon instructions not to contact a patient, there is a risk of repetition in the future. This is based upon the fact that there is insufficient evidence before the panel of insight and strengthened practice in relation to these areas of your misconduct. The panel therefore decided that a finding of current impairment is necessary on the grounds of public protection.”

[68]Ms Brown’s repeated refrain that no account was taken of the fact that there had been no incident or complaint about her in the three years after the referral to the NMC is also incorrect. The matter was specifically referred to on more than one occasion in the Panel’s Reasons including, contrary to her assertion, in relation to the issue of impairment of fitness to practise, when the Panel said this:

“The panel also took into account that following the last breach of professional boundaries you continued to work as a registered nurse for a further period of three years without any further breaches of professional boundaries occurring. Taking all of this into account, the panel was satisfied that you have strengthened your practice sufficiently and that your misconduct in relation to the breaches of professional boundaries have been remedied. The panel was satisfied that it is highly unlikely that this area of your misconduct would be repeated in the future.”

[69]As Ms Brown points out, the Panel also referred to the point as a mitigating feature when considering sanction. It is difficult to see why this should be regarded as “erroneous” and surprising that she should complain about it given that it was taken into account in her favour.

[70]As far as failure to take account of the context is concerned, it will already be clear from the Panel’s dealings with Charge 5 that the Panel had the evidence as to context well in mind at all stages of its decision making. However, I also note that in the section on sanction the Panel said this:

“The panel had regard to the contextual circumstances of your case. The panel noted that you were employed as a mental health agency nurse for 8-months by the Trust when the concerns arose. The panel took into account that, during this period of your employment with the Trust, COVID-19 restrictions were in place, you were provided with limited induction, and in practice support appeared to be very limited. This resulted in a difficult working environment for you. Additionally, the panel noted that in relation to your record keeping failings, you were only made aware of these failings when your line manager undertook a retrospective audit of your record keeping. No formal concerns, regarding your record keeping, were raised with you at the relevant time whilst you were under supervision.”

[71]As far as the adequacy of the Panel’s reasons is concerned in Shabir v General Medical Council

[2023] EWHC 1772 (Admin)

at [18] Hill J said this:

“As to the duty to give reasons: i) The purpose of a duty to give reasons is to enable the losing party to know why they have lost and to allow them to consider whether to appeal...; ii) It will be satisfied if, having regard to the issues and the nature and content of the evidence, reasons for the decision are apparent, either because they are set out in terms or because they can readily be inferred from the overall form and content of the decision..; iii) There is no duty on a tribunal, in giving reasons, to deal with every argument made in submissions..; iv) In a straightforward case, setting out the facts to be proved and finding them proved or not will generally be sufficient both to demonstrate to the parties why they have won or lost and to explain to any appellate tribunal the facts found..; v)Where the case is not straightforward and can properly be described as "exceptional", the position will be different: a few sentences dealing with "salient issues" may be essential..; vi) Specific reasons for disbelieving a practitioner are not required in every case that is not straightforward..; and vii) Where a Tribunal's stated reasons are not clear, the court should look at the underlying materials to seek to understand its reasoning and to identify reasons which cogently justify the decision. An appeal should not be allowed on grounds of inadequacy of reasons unless, even with the benefit of knowledge of the evidence and submissions made below, it is not possible for the appeal court to understand why the tribunal reach the decision it did...”

[72]I am more than satisfied that the Panel’s Reasons met this standard in the present case.

[73]Ground 4 therefore fails.

Ground 5

[74]Under this Ground Ms Brown asserts in writing that the Panel’s findings in terms of facts, then misconduct and then impairment were contradictory. She does not give any instances of this in her Grounds of Appeal or her written submissions.

[75]At the hearing I asked Mr Gloag whether he proposed to identify any inconsistencies and he said that he did not. No doubt that is because there were none.

[76]This Ground therefore fails.

Ground 6

[77]Again, Ground 6 was not developed by Mr Gloag.

[78]Under this Ground, Ms Brown asserts in writing that the Panel’s reasons in relation to sanction contradicted its earlier findings and reasons on the facts, misconduct and impairment. She cites the passage which I have quoted at [70] above and she says that it was only at the sanction stage that the Panel finally lent weight to the contextual factors on which she relied from the outset. Mr Brown refers to this as a “capitulation” by the Panel which, she says, only took place because her representative insisted that these matters be taken into account. She says that it was “erroneous” to take these factors into account as mitigation and that this led to an order which was wholly at odds with the Panel’s earlier reasons.

[79]This argument is misconceived. The Panel clearly had the exculpatory factors in mind at each stage of the analysis insofar as they were relevant, and referred to them where appropriate. They clearly were mitigating factors (as well) and there was no inconsistency in taking them into account in the context of sanction. Nor was the Panel’s decision as to sanction inconsistent with its earlier reasons. The Panel’s view was that there were significant failings on the part of Ms Brown but that she had addressed some of them and, taking into account the mitigating features of the case, the Order which it made was an appropriate sanction. This was a perfectly coherent position for it to take.

[80]Ground 6 therefore fails.

Ground 7

[81]Again, Ground 7 was not developed by Mr Gloag.

[82]Under Ground 7 Ms Brown argues that “it was not appropriate for the Panel to mitigate its finding on impairment and its reasoning for the necessity of an order by imposing a lesser sanction than a suspension order”. She says that whilst she does not suggest that a suspension order was appropriate, the lesser order which was imposed was at odds with the Panel’s reasoning and earlier findings.

[83]I reject this argument, which is misconceived for the reasons I have given.

Ground 8

[84]Under this Ground it is contended that the conditions imposed by the Panel serve no useful purpose in addressing the question of public protection or the public interest. It is also suggested that, by implication, Conditions 1 and 2 require Ms Brown to be supervised at all times and that it is impossible to have the ability to follow instructions “signed off”. If the Panel really had the concerns about Ms Brown which it said it had, a conditions of practice order would be inappropriate. In her written submissions, Ms Brown expands on these points, describing the conditions imposed by the Panel as “unworkable” and amounting to a suspension order.

[85]Mr Gloag did not make any submissions in relation to this Ground until he was asked whether it was pursued. He said that it was but that the concerns about Condition 1 – the requirement of supervision – were greater than the concerns about Condition 2(b).

[86]When the interim order was made in these terms, even Mr Hussain-Dupre did not voice any concerns that it would be unworkable. I cannot see why it would be and, as Ms Mohamed points out, if there are any difficulties they can be raised at a review of the order and, indeed, I understand that Ms Brown has been offered an early review if she has concerns.

[87]As matters stand, Ms Brown’s own logic as reflected in Grounds 6 to 8 – where part of her argument is that the conditions of practice order was inconsistent with the Panel’s earlier findings because these suggested that a harsher penalty was appropriate - would indicate that she was fortunate that the Panel did not impose a more severe sanction. As for the suggestion that the order is unworkable, there has been no evidence of this and I can see no reason why this would be so. Condition 1 requires supervision in relation to the aspects of her practice which were found to be deficient, and for a senior registered nurse to confirm that she has addressed these issues. Condition 2 requires a monthly meeting to discuss the relevant issues and confirmation that she has addressed them.

Conclusion

[88]For all of these reasons the appeal is dismissed. APPENDIX 1: 89. TABLE OF CHARGES Charge Proven/not proven (+ if by admission) Appellant admitted facts? Misconduct found? Impairment found? 1. In relation to Patient B, on one or more occasions prior to 6 April 2020 did not:a. Set clear boundaries. Not proved No - -

b. Set specific times for appointments. Not proved No - -

c. Support them to be more self-reliant. Not proved No - - 2. On a date on or around 28 January 2020: a. Overshared personal information with Patient C and/or their mother. Not proved Yes - - b. Did not send information relating to the completion of PIP assessment forms as promised. Proved No No - 3. In relation to Patient N, on one of more occasion: a. Picked up the patient’s medication from the pharmacy and took it to the patient’s home. Proved (by admission) Yes No - b. Contacted the GP on their behalf. Proved (by admission) Yes No - 4. Between 15 April and 30 June 2020: a. Had limited contact with Patient E. Proved (by admission) Yes No - b. Did not fully record what had happened during your sessions with Patient F. Not proved No - - c. In relation to Patient H: i. Did not achieve contact with them. Proved No No - ii. Did not flag or raise a concern in relation to the lack of contact. Proved No No - iii. Did not try to assertively contact them. Proved No No -

d. Had minimal contact with Patient L. Proved No No - 5. Between 27 December 2019 and 30 June 2020, on one or more occasion, in relation to patient G did not record that plans had been followed through. Proved No Yes Yes 6. Between 29 April and 30 June 2020 had minimal contact with patient I. Proved No No - 7. Despite being allocated patient J on or around 29 November 2019 did not ensure that their formulation was added to their record prior to June 2020. Proved Yes, on the Panel’s finding Yes Yes 8. Between 5 December 2019 and 30 June 2020 did not record evidence of any assessment or intervention around patient K’s mental health needs. Not proved - - - 9. Between 1 April and 30 June 2020 had minimal contact with patient M and/or did not record that plans had been carried through. Between 1 April and 30 June 2020 had minimal contact with patient M and/or did not record that plans had been carried through. Proved No Yes Yes 10. Between 3 December 2019 and 30 June 2020, in relation to Patient O: a. On one or more occasion assisted them with a housing issue. Proved (by admission) Yes No b. Recorded minimal information about assessment of their mental health and/or their formulation and/or treatment plan. Not proved No - - 11. In relation to Patient P, stated in supervision that the main focus would be on assisting them to locate their brother’s burial/cremation details. Not proved No - - 12. Between 6 January and 18 June 2020, in relation to patient R, did not properly consider the treatment plan and/or record that it was being followed through. Not proved No - - 13. On a date on or around 20 April 2020 were aggressive in your communications with the midwifery team. No case to answer No - - 14. On 28 May 2020: a. Despite being asked to no longer work with patient D, left a voicemail on their phone and/or attended their home address. Proved No Yes Yes b. Having been informed of a concern relating to patient D’s dog did not inform your manager and/or make an incident report. Proved (by admission) Yes Yes Yes 15. In relation to Patient A: a. On one or more occasions took them to play group. Proved (by admission) Yes (one occasion) No - b. On one or more occasions took them shopping and/or did their shopping for them. Proved (by admission) Yes No - c. Did not arrange for carer help and/or for a social care package to be put in place. Not proven No - d. On 30 December 2019: i. Attended patient A’s address when they were locked out as opposed to helping them problem solve and/or calm them down over the phone. Proved (by admission) Yes No - ii. Revisited patient A later in the afternoon. Proved (by admission) Yes No -

e. Agreed to be their birthing partner and/or attended the birth of their child. Proved (by admission) Yes Yes -

f. Did not record any conversations with Patient A and/or social services about being the birthing partner of A. Proved No Yes Yes

g. On one or more occasion looked after their child/children at your house. Proved (by admission) Yes Yes -

h. Did not provide a proper handover to colleague 1 (CB). Proved (by admission) Yes No - 16. Your actions at charges 1 and/or 2 and/or 3 and/or 15 breached professional boundaries. - - Yes, in respect of Charges 15(e) and 15(g) No END APPENDIX 2: THE CONDITIONS OF PRACTICE ORDER MADE BY THE FITNESS TO PRACTISE COMMITTEE ‘For the purposes of these conditions, ‘employment’ and ‘work’ mean any paid or unpaid post in a nursing, midwifery or nursing associate role. Also, ‘course of study’ and ‘course’ mean any course of educational study connected to nursing, midwifery or nursing associates.’

[1]You must ensure that you are supervised by a registered nurse any time you are working, in the following areas: a). Record keeping, specifically in relation to: i. Patient plans and formulations ii. Communication with patients and multidisciplinary teams b). Undertaking tasks in line with instructions Your supervision must consist of working at all times on the same shift as, but not always directly observed by, a registered nurse until signed off as competent by a more senior registered nurse. You must provide evidence of having been successfully signed off as competent to your NMC case officer within 7 days of completion.

[2]You must meet monthly with your line manager/supervisor to discuss your progress and performance regarding: a). Record keeping, specifically: i. Patient plans and formulations ii. Communication with patients and multidisciplinary teams b). Undertaking tasks in line with instructions Until signed off as competent by your line manager/supervisor. You must provide evidence of having been successfully signed off as competent to your NMC case officer within 7 days of completion.

[3]You must obtain a report from your line manager/supervisor in relation to your progress and performance regarding: a). Record keeping, specifically: i. Patient plans and formulations ii. Communication with patients and multidisciplinary teams b). Undertaking tasks in line with instructions You must send this report to your NMC case officer 14 days prior to the next review hearing.

[4]You must keep a personal development log in relation to your progress and performance regarding: a). Record keeping, specifically: i. Patient plans and formulations ii. Communication with patients and multidisciplinary teams b). Undertaking tasks in line with instructions You must send your NMC case officer a copy of the log 14 days prior to the next review hearing.

[5]You must keep the NMC informed about anywhere you are working by: a). Telling your case officer within 7 days of accepting or leaving any employment. b). Giving your case officer your employer’s contact details.

[6]You must keep the NMC informed about anywhere you are studying by: a). Telling your case officer within 7 days of accepting any course of study. b) Giving your case officer the name and contact details of the organisation offering that course of study.

[7]You must immediately give a copy of these conditions to: a). Any organisation or person you work for. b). Any agency you apply to or are registered with for work. c). Any employers you apply to for work (at the time of application). d) Any establishment you apply to (at the time of application), or with which you are already enrolled, for a course of study.

[8]You must tell your case officer, within seven days of your becoming aware of: a). Any clinical incident you are involved in. b). Any investigation started against you. c). Any disciplinary proceedings taken against you.

[9]You must allow your case officer to share, as necessary, details about your performance, your compliance with and / or progress under these conditions with: a). Any current or future employer. b). Any educational establishment. c) Any other person(s) involved in your retraining and/or supervision required by these conditions END