04 November 2013
On 12th September 2013, the Nursing and Midwifery Council (‘the NMC’) met to decide on a model for the revalidation of nurses and midwives in the UK. The first stage of the statutory formal consultation will run from January - March 2014 and will include an online consultation and focus groups. There will be a second formal consultation from April - June 2014.
This followed on from strong recommendations for revalidation for nurses made in the Francis Report, arising out of the Mid-Staffordshire NHS Foundation Trust Public Inquiry, which was published in February 2013.
The proposed model for revalidation is that:
Nurses and midwives will revalidate on a 3 yearly cycle;
- There will be a requirement for nurses to declare that they have practised for 450 hours during that period. However, although the NMC have not yet provided specific guidance on this point, it can be anticipated, based on the GMC’s experience that should an appraisal and CPD be missed, due to sick leave, this should not of itself prevent a nurse revalidating. Accounts will be taken of information relating to the two years practice prior to that.
- There will an increase in the practice portfolio requirements and post-registration educational auditing;
- There will a requirement for patient and colleague feedback;
- Both nurses, midwives and their employers will be required to sign declarations verifying fitness to practise.
- Similarly to the system of revalidation of Doctors, the Francis Report has suggested that the NMC should introduce the concept of a Responsible Officer for nurses, who would be appointed by and accountable to the NMC. The Responsible Officer would be required to report to the NMC on their performance on a regular basis. The existence of this professional obligation would immeasurably strengthen the power of the nursing voice in the leadership of provider organisations. Following a successful recommendation to the NMC, by their Responsible Officer, nurses will have their licences to practice renewed.
There are plans to begin piloting the model of revalidation in early 2015.
There are many positives to revalidation, it is one route to achieving an important aim identified by Lord Willis’ Independent Review of Pre-Registration Nursing in 2012, as an important aim, namely that nurses
must stand up and be counted, to restore professional pride and provide leadership and solutions to the challenges of poor care and a decline in public confidence.
There are, however, also concerns about the introduction of revalidation, some feel it to be a ‘knee-jerk’ reaction to adverse press coverage, there are concerns about costs implications (particularly given the recent increases in the Annual Registration Fee from £76 to £100) and others worry about the extra burdens that complying with revalidation may place on nurses and midwives who are often already overstretched in their professional capacities. The latter sentiment being captured in the following quote:
“Often, deficiencies in care are not because nurses ‘lack compassion’ or lack the necessary skills – it is because they are over-stretched and struggle to provide the rudiments of care to inappropriately large groups of patients.”
Whether the above concerns materialise is likely to largely depend on how the process of revalidation is implemented and utilised. One suspects that most, if not all, nurses, if questioned, would say that they would wish to be less focused on paperwork and more on patient care. The challenge now is to ensure that the revalidation is used as a means to improve patient care and not just as a ‘tick-box’ exercise. This challenge has clearly been identified by the NMC who state that they aim to ‘deliver a proportionate, risk-based and affordable system that will provide greater public confidence in the professionals regulated by the NMC. The NMC also states that it is also important that revalidation raises standards of care and promotes a culture of continuous improvement amongst nurses and midwives.’
Tom Sandford, Director of the Royal College of Nursing summarised the intended outcome of nurses revalidation, “knowing that every nurse, no matter when they qualified, is fit to practice in a modern setting, and competent for the role they are performing is an important issue of patient safety as well as patient confidence.”
Please contact Aoife McShane if you would like to discuss any matter arising from this article in more detail.
Paragraph 23.64 Francis Report
 Report of the Willis Commission 2012 Executive Summary
The Journal of Advanced Nursing; The UK Francis Report; the Key Messages for Nursing volume 69, Issue 8, pages e1-e3, August 2013.
Tom Sandford, Director of RCN England http://www.rcn.org.uk/newsevents/press_releases/uk/royal_college_of_nursing_comments_on_nmc_revalidation_proposals