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NMC to vote on proposals for nurse revalidation

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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We will be hosting a twitter debate on these proposals at 3.30pm on Friday 6 September.

To join in, search for #NTtwitchat at use this hastag in your tweets.

Readers' comments (48)

  • i hope they start with the Nurse Managers and see if they are fit to practice, because I don't think many would cut the mustard myself.

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  • Yet another monumental paper shovelling exercise !

    Hands up all those who have not received a competent appraisal this year to date !

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  • I agree.Many nurse managers do not seem up to standard to cope with modern nhs problems.My experience is that people are promoted into management positions many years ago and have not continued their development.Result is often an 'infantile'approach to dealing with complex issues.

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  • What checks will there be in place to ensure that there is no bias? If your face doesn't fit will you suddenly find that you are de-registered? If nurse 'A' gets mentioned a lot of times by patients whereas nurse 'B' doesn't get mentioned at all, although they are equally competent, will nurse 'A' remain on the register whilst 'B' is removed?

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  • Wake up! Wake up! Whatever the inadequacies of the existing system these proposals should give every NMC registrant very great cause for concern.

    Bad enough that a Nurse or Midwife's ability to remain on the Register will now be determined ultimately by what by any other name is a job reference - with all the vagaries and potential injustices of that system - but that the party providing the reference need not need themselves to be Registrant?? Horrifying.

    There is a place for 3rd party assessment of practice but such assessment should never be the deciding factor in weighing up whether someone should remain on the Register. Whatever the intention of this proposal otherwise competent and caring nurses will find themselves vulnerable and their ability to continue in practice (and employment) permanently compromised.

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  • And those "nurses" in the NMC Ivory Tower last had patient contact??? who will validate them. We have numerous mechanisms in place annual registration appraisals evidence of going development. All for the allocation of a supervisor as per midwifery but can this really be implemented.

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  • I wonder how much this will all cost and who will pick up the cost through increased registration fees????? Could it be us?

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  • Aurely what should be being regulated is an effective sytem for appraisal. If appraisals are carried out appropriately and timely this should pick up on any areas of weakness and adress them through a workable action plan or if necessary performance management. The type of reporting suggested is both overly costly in a time where money is scarce, and open to bias!

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  • Yet another paper exercise with a cost that will likely be covered by the staff in some way shape or form.... I think there is a place but agree that it should not be the deciding factor. They continue to skirt around the fact that staffing levels are poor and we do far to much duplication in terms of documentation.

    It seems as if we should concentrate on what is broken and not create more to break?

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  • why isn't it the registrants/members/fee payers who vote on this issue?

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  • When will the NMC assess the competence of lecturers and managers - many of these have not done any care for years yet feel they can stand in judgement over those of us at the coal face...
    When the NMC elections are held I will only vote for practitioners involved in direct care...
    Then the need to prevent rises in fees might be understood.

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  • If managers were competent in supervising and appraising their staff in the first place themselves and took appropriate steps to improve their practice or go down the competency route we would have less need for this. Having courage should be on their job description. I work for a social work team and our secretary sends out feedback forms to all our clients on closing a case. This can be anonymous but tells us if they and/or their families feel we are doing our jobs to a good standard or not. If we have nothing to hide, this shouldn't be a worry.

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  • I hope some of you get jobs in nurse management one day and realise how difficult, stressful and thankless it is.

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  • I agree that the appraisal system should be used properly. Many nurses do not get an annual appraisal, and even if you do, and want to do training or even go on a study day it is unlikely that you will go because of low staffing levels. Sometimes nurses do not even get "mandatory training". All I can see is it getting more and more expensive for us to do a job which the vast majority of the public would never dream of doing! Most nurses are just trying to get on with their job and have very little support. The NMC just seem to have a very critical attitude, instead of a supportive attitude.

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  • What on Earth are the NMC directors thinking? Perhaps they are trying to undermine themselves from the inside?
    If indeed this proposal comes to fruition, the same rules should apply to all registered nurses.
    Failing that a new professional body will have to be conceived for both practicing 'hands on' nurses and others following an alternative path.
    As a nurse manager and director I would be more than happy to work the wards or community to maintain my registration.
    The NMC is doomed if the same criteria do not extent to all members/registrants.
    A replacement for the NMC is in the making. If senior nurses do not set an example, then it is a shame. Many nurses would pay more in registration if a new body worked for nurses on a level playing field.
    To my NMC managers - 'Develop a moral centre - not a self centre'

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  • Another sledgehammer to crack a nut. How will this be monitored? Why are yearly appraisals not enough to demonstrate that a registrant is fit enough to stay on the register. In the many Trusts where the culture is one of bullying by management it would be nice to see the NMC propose that they are going to do all they can to support nurses and be actively seen to do this by taking these bully's to task and remove them from the register

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  • The appraisal question should by and large be answered by Trusts implementing the increment/gateway plan accepted by the unions earlier this year. No positive appraisal - no pay increment uplift and for those at the top of the scale the option to be taken down the competence route.

    For those "worried" about managers, those at a certain point at or above 8a will see local pay conditions that will basically see poor performance met with a pay cut.

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  • Revalidation has been along time coming, so nurses shouldn't really be surprised. However the GMC has taken over five years to launch its revalidation scheme and it has more talent and money available to it than the NMC does.

    The NMC has much on its plate and has spent 18 months actively being seen to paper over the cracks. Its recent launch of course providers to be inspected is laughable as its outsourced to a company who does little more than a tick box exercise and certainly not the level of probing undertaken by other regulators into standards of teaching and education.

    Before NMC takes on any further development work it should concentrate on enduring the basics are robust and fit for purpose and obtain genuine proof that it has achieved that. Allow those systems to bed down before taking on more challenges.

    For a registrant base the size of the NMC, it is surely unrealistic that a scheme like this can be launched in 2015. Try 2025 and they may be nearer the mark, but at a time when nurses are leaving the profession in droves is this really the answer?

    More regulation isn't necessarily better regulation.

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  • Roll on 2015, I Retire !! Never thought I would wish the end of my career to come quickly.

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  • As an 18 year old about to start a course in Adult Nursing, this is really demoralising. The profession seems to be in a mess, I'm coming into it at a bad time.

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