Revalidation risks becoming 'bureaucratic burden'
Major new proposals for revalidating all 670,000 nurses and midwives in the UK risk becoming little more than a “bureaucratic burden” under current funding proposals, Nursing Times has been told.
The concern comes after analysis by Nursing Times established that new proposals for the revalidation of nurses and midwives are likely to cost four times less than the system introduced for doctors last year.
The Nursing and Midwifery Council is due to debate the options for introducing revalidation by the end of 2015 at its meeting on Thursday.
Council papers reveal the favoured option includes requiring registrants to collect patient and colleague feedback and get signed off as fit to practise by their employer.
The NMC estimates that start-up costs, which include recruiting new staff, engaging with the profession and a new IT system, will be £4.4m. The annual costs are estimated to be £1m, equivalent to about £1.50 per registrant.
However, the General Medical Council spends just over £6 a year for every doctor who is subject to revalidation.
Royal College of Nursing head of policy Howard Catton told Nursing Times questions still remained over the funding of the new system. He said: “They are two different systems so we wouldn’t expect the funding per head to be exactly the same, but I think this level of difference raises questions of parity.”
He said the RCN would be looking to see that gap closed to ensure nurses were supported in completing their continuing professional development and the profession received a fairer share of the funding available for post-registration education.
The medical model uses a system of senior responsible officers who are medics themselves and conduct detailed appraisals with doctors before recommending to the GMC whether they should remain on the register or not.
The NMC also wants to see revalidation incorporated into appraisals, with nurses reflecting on how they have met the code as part of the process.
Mr Catton said this needed to be handled carefully. “Appraisal is about being able to do your job, revalidation is about fitness to practise and our members will be concerned to ensure these things don’t get confused,” he said.
However, unlike the medical model, the individual signing off the revalidation would not necessarily have to be on the register themselves and that individual would not make a recommendation to the NMC. Instead nurses would have to self-declare that they had revalidated and been signed off.
Nursing Times understands self-declaration is currently the only option, as the NMC does not have the legal powers to compel non-registrants to provide them with information.
Peter Griffiths, chair of health services research at the University of Southampton, warned the potential for a nurse to be revalidated without any professional involvement undermined the principle of professional regulation.
He told Nursing Times that although the requirement to get sign off was an improvement on the current system, there was a risk the new system could become a “fairly bureaucratic exercise”.
“There’s a real danger that the resource isn’t enough to do anything that’s really worth doing,” he said.
Like the current post-registration education and training (PREP) system, the NMC will audit a selection of revalidation documentation to ensure registrants are complying with the requirements.
However, last year just 400 portfolios were audited, mainly when individuals were returning to practise after a lapse – at a cost of £250 a time.
A spokeswoman for the NMC said audit would be significantly increased under the new system and economies of scale and improved systems would mean it would cost less.
However, even if the NMC halved the cost, £1m would only cover the audits of 8,000 nurses and midwives. Over a three year period this would be equivalent to about 3.5% of registrants.
All the nursing unions have stressed revalidation should not be funded by an increase in the NMC’s registration fee.
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 cost nurses and midwives more.
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.”
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