Contextual factors in fitness to practise is not a new concept but this pandemic has laid bare the reality of medical practice, difficult decisions and stressful workplaces. 

Healthcare regulators have adapted to recognise the extraordinary circumstances presented and the need to take this into account when fitness to practice complaints are made.  In this article I will look at some issues faced by healthcare professionals and some things that can be done to mitigate the risk of impairment.

What have regulators said?

There is acknowledgement of the unique and challenging circumstances presented by Coronavirus and that these circumstances will stretch established principles of care and clinical decision making beyond the norm. 

Healthcare regulators have pledged support for clinicians and other healthcare professionals and confirmed that it will take into account the unique circumstances in any fitness to practise complaint and investigation saying:

“We recognise that the individuals on our registers may feel anxious about how context is taken into account when concerns are raised about their decisions and actions in very challenging circumstances. Where a concern is raised about a registered professional, it will always be considered on the specific facts of the case, taking into account the factors relevant to the environment in which the professional is working. We would also take account of any relevant information about resource, guidelines or protocols in place at the time.”

Issues faced by healthcare professionals

Although statements have come from individual regulators, the general principles remained the same:

  1. Stress and anxiety – There is no doubt the Coronavirus has added to the stress and anxiety felt by healthcare professionals that existed before the Coronavirus pandemic. 
  2. Clinical decisions – The pandemic has required difficult clinical decisions of healthcare professionals. I know from working with clinicians and other healthcare professionals that these decisions often needed to be made in the “heat of the moment”.  The unique circumstances presented by the virus also required unique solutions and decisions that, at times, might not fully have complied with established practice and guidance.
  3. Areas of practice – Linked to the point above, clinicians and other healthcare professionals might have to depart, possibly significantly, from their specialist area of practice to care for patients in the highly challenging but time-bound circumstances of the peak of a pandemic.
  4. Environment – The flexibility required of all healthcare professionals might also include working at different and unfamiliar places of work and with different teams and colleagues.

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Whilst contextual factors are considered relevant, that is not to say that in each case a clinician or other healthcare professional will be “absolved” from responsibility.  Care must continue to be taken to ensure your fitness to practise is not compromised to found impaired. 

Here are a number of things to bear in mind:

  1. Always act with professionalism – Very challenging circumstances will naturally place substantial stress and pressure on clinicians and other healthcare professionals.  A core principle of being a healthcare professional is to act with integrity and professionalism at all times. 
  2. As far as possible, follow established practice and guidance – Although in practice this might be easier said than done, but adherence to the core principles of good care and professional guidance relevant to your profession is very important.  Within practice and guidance there are general principles that could apply to any situation.  A strong rebuttal in any fitness to practise complaint and investigation is evidence of good practice and adherence to guidance despite the very challenging circumstances.
  3. Notes and records – Make comprehensive notes particularly of your clinical decisions and your reasons for these.  This might prove to be important evidence in a fitness to practise complaint and investigation to show how you applied your professional judgement to assess risk and make sure people receive safe care.
  4. Speak up when necessary – There is a duty of care on clinicians and other healthcare professionals but this duty cannot come at the expense of patient safety.  If you feel what is being asked or expected of you goes too far beyond your abilities, skills or knowledge, do not be afraid to say something.


Using a Barrister was a first time experience for us, and Stephen explained everything in a polite, non-patronising manner and always showed us the full extent of his knowledge.


I would just like to express my sincere thanks to Catherine Stock who was absolutely amazing on how she handled my NMC case for Restoration to Nursing.


Catherine Stock represent me in a NMC Case with great excellence and expertise showing great empathy, compassion and understanding.


Honesty. Integrity. Transparency and Partnership with you in a time of great need is what Kings View Chambers Catherine Stock & Steven McCaffery extended towards me as a professional nurse.


Both Stephen and Catherine from the outset have been approachable, knowledgable and are without question extremely competent professionals and experts in their field.

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Well prepared and reassuring…. most definitely would recommend them if you ever have an issue with the NMC.

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