The Provision of Regulator Medical Support Services Framework

Blood, hair and nail samples are to be taken locally across the UK with a secure transportation service to the provider's laboratory.

On request of the NMC, the provider will be responsible for arranging appointments with individuals on our register, or those applying to join our register, for samples to be taken for drug and/or alcohol testing.

The provider will be responsible for testing the samples and providing a comprehensive report to the NMC which explains the results, within agreed timeframes.

The provider must be able to carry out more than one method of sample testing, and be able to test for a variety of substances.

The samples and testing must be carried out in a manner that complies with chain of custody and with ISO standards ISO/IEC 17025:2017

The provider will be the point of contact between the NMC case teams and Medical Examiners.

The provider will need to have a pool of Medical Examiners available to conduct examinations, provide independent reports and attend NMC hearings to give evidence. The pool of examiners will need to contain a range of expertise in psychiatry, occupational health, substance misuse and general medicine.

When requested, the provider will need to source the appropriate Medical Examiner, within the contract price, and provide them with the necessary medical records, which the provider will need to source (consent would have already been obtained).

The provider is responsible for the quality of the reports, as well as feeding back any issues with reports or performance concerns, and is responsible for the timeliness of reports provided to the NMC.

The provider will be responsible for handling data in line with GDPR and in strict adherence to agreed timeframes.

Our Registrations team review applications for admission or renewal to the NMC register and as part of this assess whether the applicant is capable of safe and effective practise. In certain circumstances the Registrar may require a report from a medical examiner on the applicant's health. The Registrar will make an assessment based solely on the paperwork provided.

If the Registrar rejects an application, the applicant may appeal. An appeal hearing will be held before a panel with the parties able to attend to give live evidence.

Medical examiners may be required to attend appeal hearings to present the findings of their report and may be required to provide ongoing monitoring and updated reports.

Our Fitness to Practise teams arrange and co-ordinate a number of specific panels and committees, to hear evidence relating to allegations about individual registrants' fitness to practise.

Where concerns have been raised about a registrant's fitness to practise by reason of their physical or mental health they may be asked to undergo an examination by a medical examiner who will provide a comprehensive report to the NMC. Medical examiners are also required to attend hearings to present the findings of their report and may be required to provide ongoing monitoring and updated reports.

Some panels meet to hear evidence relating to the substantive case, which may lead to removal from the register, suspension, a caution, or the application of conditions of practice order.

Other panels will meet to consider whether an individual practitioner is safe to practise whilst a case is under investigation, and may impose an interim suspension or interim conditions of practice order. Preliminary meetings and hearings may be necessary to clarify issues and eliminate problems prior to the substantive hearing. Panels will hear cases relating to health issues in private.

The panels will also hear any cases relating to applications for restoration to the register or termination of suspension.

Examiners will usually be scheduled to attend in half-day units or multiples thereof, although on some occasions an hourly rate may also apply.

The provider will be the expert witness' point of contact, and will liaise with the NMC case teams for all arrangements of hearing attendance.

The provider will need to have a pool of, or be able to source, expert witnesses to conduct reviews of evidence, provide independent reports and attend NMC hearings to give evidence. The experts will need to contain a range of expertise in nursing and midwifery.

The provider will be responsible for the quality of the report and making sure it is provided within the agreed timescales and contracted prices

We sometimes need help to understand the basic facts of what happened, and whether it was serious enough to cause concerns about the registrant's (or applicant's) fitness to practise. We can usually discuss these issues with professionals at a local level who have the qualifications and technical expertise to help us with these issues.

Sometimes, however, we'll need the opinion of an independent expert during our investigation, and because of the issues involved.

We'll usually do this if we need:

• specialised knowledge or expertise that we cannot obtain locally
• an independent opinion
• evidence to help us decide whether the registrant's (or applicant's) actions were directly responsible for patient death or serious harm

When we investigate what caused the death or serious harm of a patient, we always need to think about the kind of evidence we'll need to explore.

The expert will need to consider whether there is evidence that clearly shows that the fault on the part of the nurse or midwife:

• led to the outcome
• made those outcomes more likely, or
• cost the patient a chance of survival.