Nurses and midwives may have to collect positive feedback from patients and colleagues every three years in order to remain on the register, under proposals for the revalidation of the profession.
The options put forward by the Nursing and Midwifery Council yesterday also suggest nurses and midwives could be signed off as fit to practise by an individual who is not a registrant.
The regulator committed itself to roll out revalidation by the end of 2015 in the wake of the Francis report into care failings at Mid Staffordshire Foundation Trust. The report, published in February, said revalidation would be “highly desirable”.
At a meeting next week, NMC council members are due to debate a range of options that include continuing with the current post-registration education and practice (PREP) system as it is or introducing more checks.
However, papers published yesterday show the favoured option is for the PREP system to be enhanced through the addition of “third party feedback”.
Registrants would then have to get confirmation from another “third party” that they were fit to practise, most likely the manager responsible for their appraisal. Under the current plans there is no requirement for this individual to be a registrant.
The document says the “confirmation model” needs to be “flexible” to take into account the variety of different settings nurses work in. For example, a nurse working in a care home may be the only registrant employed by that organisation.
Once they have got sign off, the nurse or midwife will then self-declare their fitness to practise – similar to how they would under the current PREP system.
A spokeswoman for the regulator said self-declaration was currently the only option because the NMC did not have the legal powers to compel non-registrants to provide them with information.
The NMC has been criticised for rarely auditing the documentation collected by nurses for their PREP and chief executive Jackie Smith admitted the system was not fit for purpose last year.
It is proposed that under revalidation annual audits would be completed with a sample picked partly at random and partly based on the NMC’s analysis of where there was a risk that procedure was not being followed.
Unison head of Nursing Gail Adams told Nursing Times anything would be better than the current system, as long as it was proportionate and did not lead to an increase in the registration fee.
She said: “We need a system in place for 2015 but it doesn’t need to be all singing, all dancing. We need something that can be tested and enhanced in future if needs be.”
Royal College of Nursing head of policy Howard Catton told Nursing Times that the RCN supported revalidation as a way of improving “public safety and public confidence”.
Meanwhile, Royal College of Midwives chief executive Cathy Warwick said in a statement that she supported the proposals but any method of revalidation “must be proportionate and cost effective”.
“The NHS and NMC will have to invest heavily in managerial skills and protected time for midwives if this new system is to work,” she said. “The RCM wants to see appraisal, which is part of midwives’ UK wide terms and conditions, work, but if this is to be the basis of revalidation it will need to be delivered uniformly across the NHS.”
She said: “The proposals appear to suggest a three yearly enhanced form of appraisal, but the issue is that currently a significant proportion of midwives do not get an appraisal and of those that do a large number do not find it useful.”
However, she added: “We look forward to working with the NMC to move these proposals forward.”
Unions will be consulting with their members on the proposals.
All of the options put forward for introduction by 2015 are possible within existing legislation that governs the NMC.
However, at next Thursday’s meeting council members will also be asked for their views on more radical options for the future.
These include the model adopted by the medical profession last year, where every doctor is appraised by a designated responsible officer who is also on the General Medical Council register. Adopting this system would be likely to almost triple the NMC’s costs.
Other options include rolling out the supervisory model currently used in midwifery, which requires all midwives to have an allocated supervisor, or a series of more minor moderations – for example reducing the frequency nurses have to renew their registration or changing the practice hours nurses must complete.
Under this option, council will also consider whether revalidation should be limited to nurses and midwives delivering direct patient care.
Once the NMC council has chosen its preferred option, the regulator will then hold an external consultation on the proposals.
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