Platform 1: Being an Accountable Professional (The Code, Law and Ethics)

Scope and weight

Seventeen questions at 1.5 minutes each is about 25 minutes of the clinical part. This block rewards candidates who have read primary documents, because the questions rarely ask for a quotation. They describe a ward situation, such as a patient refusing treatment or a colleague breaching confidentiality, and ask what the registered nurse should do. The Code and the Mental Capacity Act decide the answer.

The cognitive level matters. Across Part B, about 62% of questions are at apply, analyse, evaluate or create level. In Platform 1 that means choosing between several defensible actions and picking the one that best fits the professional standard.

What is tested

• The Code. Four themes (prioritise people, practise effectively, preserve safety, promote professionalism and trust) and 25 standards, applied to a case.
• Consent and capacity. The five Mental Capacity Act principles, the two-stage test, best interests decisions, advance decisions, lasting power of attorney and the role of an Independent Mental Capacity Advocate.
• Liberty and detention. Deprivation of liberty safeguards, the Liberty Protection Safeguards, and Mental Health Act basics for adult nurses (sections 2, 3, 5(4) and 136).
• Confidentiality and information. UK GDPR, the Caldicott principles and when information may be shared without consent.
• Openness. Duty of candour, raising concerns and whistleblowing (Code 16 and 17).
• Records. Record-keeping standards (Code 10).
• Boundaries and conduct. Gifts, social media and online behaviour.
• Equality and rights. Equality Act 2010, reasonable adjustments and the Human Rights Act 1998.
• Accountability. Delegation (Code 11) and working within competence (Code 13).
• Regulation. The NMC fitness to practise process and sanctions, and revalidation every three years.
• Safeguarding and end of life. Care Act 2014 principles, DNACPR decisions, emergencies (Code 15) and reflective, evidence-based practice.

Local points to anchor your answers

• Presume capacity. The burden of proof lies with whoever claims lack of capacity. Capacity is decision-specific and time-specific, and an unwise decision does not prove incapacity.
• Candour is immediate. Code 14 asks you to act to put things right, explain fully and promptly, apologise, document and escalate.
• Emergencies. Code 15: offer help in an emergency in your practice setting or elsewhere.
• Delegation. You remain accountable for the decision to delegate, so delegate only to someone competent, with support and supervision.
• Revalidation. Every three years, with 450 practice hours, 35 hours of CPD (20 participatory), five pieces of feedback, five reflective accounts and a reflective discussion. Confirm at source on the NMC revalidation page.
• Mental Health Act. Section 5(4) is the nurse's holding power, for 6 hours. Confirm the other durations at source and do not answer from reform proposals.

Three typical traps

1. Treating a relative's wishes as consent. In UK law, relatives do not consent on behalf of an adult unless they hold a valid lasting power of attorney. If the person lacks capacity, the decision is made in their best interests, consulting those close to them.
2. Breaking confidentiality too readily, or too rarely. Confidentiality is not absolute. Information may be shared to protect someone from serious harm, but the default is to ask for consent and share the minimum needed. Options that disclose widely or refuse to share anything are both wrong.
3. Waiting before raising a concern. The Code expects you to act without delay when there is a risk to safety. An option that suggests discussing it informally for a week, when a person is at risk, loses to the one that escalates.

How the questions are framed

Platform 1 stems usually place you on a ward with an ethical or legal problem and four plausible responses. Typical settings include a patient who wants to leave against advice, a relative who asks for information, a colleague who posts about patients online, a drug error discovered after a shift, and a patient who cannot decide because of confusion. The task is to identify which framework applies and choose the response that follows it.

What the exam asks about each group

• Capacity and consent. Decide whether capacity is in doubt, which decision is in question, what support to give and who decides if capacity is lacking. Know the role of the Independent Mental Capacity Advocate for people who have no one suitable to consult.
• Confidentiality. Decide what may be shared, with whom and on what basis. The default is consent or the minimum necessary sharing for care, with disclosure justified where there is a risk of serious harm.
• Candour and concerns. Decide who to tell, in what order, and how soon. Prompt action and honesty beat delay and defensiveness.
• Records. Decide what a good entry looks like: contemporaneous, factual, signed, and not altered after the event except by clearly marked correction.
• Boundaries and online conduct. Decide whether a gift, a friend request or a post is acceptable, remembering that the Code applies to personal social media when it could affect trust in the profession.
• Regulation. Know that the NMC deals with fitness to practise concerns and can impose sanctions, and that revalidation is a three-year cycle.

When two options both seem correct, ask which one acts earlier, involves the person more and protects safety most directly. That ordering settles most Platform 1 items.

How to revise it

1. Read The Code once, in full, then write the 25 standards in your own words under the four themes.
2. Memorise the MCA flow: presume capacity, support the decision, two-stage test, best interests, least restrictive option.
3. Build a scenario sheet with columns for the situation, the Code or legal rule, the first action and the escalation route.
4. Practise "what first?" questions. Ask what the nurse does before documenting or reporting.
5. Review revalidation and fitness to practise last, since they are factual and quick.

Pair this domain with the UK guidelines guide, Platform 6 for incident reporting and Platform 7 for advance care planning.