DHSC and NHS England implementation update provided to the Thirlwall Inquiry (April 2025). This is the government's own account of progress, submitted to the inquiry. Reviewed extent of implementation: Implemented – Ongoing.. The NMC introduced a new Fitness to Practise Strategy in 2018. This is based on 12 key strategic principles which reiterate and promote a local first approach: "employers should act first to deal with concerns about a nurse, midwife or nursing associate's practice, unless the risk to people receiving care or the public is so serious that we need to take immediate action" (Principle 4). This principle reiterates that the NMC only needs to become involved early on if the registrant poses a risk of harm that an employer cannot effectively manage. The NMC has also published detailed guidance for employers on managing concerns, which explains which concerns should be raised with it and seeks to encourage employers to take steps to manage the referral locally where appropriate. It has a specific section dedicated to managing concerns locally. Its Employer Link Service (ELS) team also support this aim – please see response to recommendation 232. Safety culture is one of the two key foundations of the NHS patient safety strategy. PSIRF is a contractual requirement under the NHS Standard Contract and appropriate concerns about safety should be reported. By law, all employers must have a grievance policy and share that in writing For nurses, the RCN provide guidance on the grievance process. Revalidation and appraisal requirements for nurses are set by the NMC.

Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.