An overview of the NMC’s updated guidance on the role of midwives including scope, standards & fitness to practise.

Practising as a midwife in the UK

The new guidance, “Practising as a midwife in the UK”, contains sections relating to each of our statutory functions:

  • the education and training of midwives;
  • registration and revalidation;
  • standards and guidance; and
  • fitness to practise.

It is important to note that the guidance “describes” the NMC’s approach to the regulation of midwives but it is not a regulatory standard.

Midwifery – Scope of Practice

According to the guidance, a midwife’s ‘scope of practice’ might mean:

‘the range of things that the midwife has the skills, knowledge and proficiency to do’ and it should not be confused with ‘protected function’ which means ‘something that only midwives can legally do’.

The standards of proficiency and the Code are important factors when considering a midwife’s scope of practice.  Whilst a midwife’s scope of practice may change depending on the nature of their roles and the learning they have undertaken, note that the Code requires midwives not to practise outside of their skills, knowledge or competence.

Midwifery Standards

The NMC sets standards for how midwives practice their profession.  Fitness to practise investigations will consider whether a midwife has breached the Code or other standards.

A brief overview of these standards as outlined in the guidance:

  • The professional duty of candour – Midwives must be open and honest with women and their families in the event that something goes wrong with their care, or where that care causes (or has the potential to cause) harm or distress.
  • Raising and escalating concerns – professional responsibility to report and escalate concerns.
  • Record keeping – Midwives should also be aware of and comply with the provisions in the law and the Code (paragraph 10) that cover the creation, handling, storage, retention and sharing of service users’ personal information.
  • Conscientious objection by midwives – the Code states that if midwives have a conscientious objection to a particular procedure they must tell colleagues, their manager and the person receiving care. They must also arrange for a suitably qualified colleague to take over responsibility for that person’s care.
  • Guidance on using social media responsibly – Midwives must use social media responsibly taking into account the NMC’s guidance.  You might be interested in my article “Social Media and Fitness to Practise”.

Midwifery Fitness to practise

Concerns about a midwife’s fitness to practise can be referred to the if either, those concerns cannot be managed by their employer, or are so serious that there is a need to take immediate action.  The NMC’s updated guidance gives the following examples matters such that could raise a fitness to practise concern:

  • Misconduct – behaviour that falls short of what can be reasonably expected of a midwife which could put women, babies and families at risk or undermine the public trust in midwives. Such cases may relate to conduct in work, or outside of work.
  • Lack of competence – evidence of a lack of knowledge, skills or professional judgment that raises a question as to whether the midwife is capable of meeting the required standards for safe and effective practice.
  • Health – a question as to a midwife’s ability to provide safe care arising from a serious, long-term, untreated or unacknowledged health condition that cannot be managed with the support of the employer.
  • Convictions or cautions – where a midwife has received a criminal conviction or caution that calls into question their fitness to practise or has the potential to undermine the public trust in the midwifery profession.
  • Not having the necessary knowledge of English – evidence that a midwife does not have the necessary knowledge of English to practise safely and effectively in the UK.
  • Determinations of other regulatory bodies – where a midwife has had a finding of impairment made against them by another regulator of a health and social care profession, within the UK or by a licensing body elsewhere

Indemnity insurance

In order to hold registration, midwives must declare that they have an indemnity arrangement appropriate for their role and the risks associated with their practice. The cover must be relevant to their scope of practice, so that it is sufficient if a claim is made against them.

You might be interested in our article “Indemnity Cover and Fitness to Practise

The Future Midwifery

Midwifery is a distinct profession, with its own standards of proficiency and part of the NMC register.  In November 2019, the NMC’s Future Midwife standards was introduced “ensuring that all midwives of the future receive a world class education.”

Disclaimer: This article is for guidance purposes only. Kings View Chambers accepts no responsibility or liability whatsoever for any action taken, or not taken, in relation to this article. You should seek the appropriate legal advice having regard to your own particular circumstances.


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