The Nursing and Midwifery Council has approved plans for the revalidation of the profession - provided the new system can be shown to be worth the cost.
Council members were given the opportunity to debate three options for the introduction of revalidation by 2015 at their meeting yesterday morning. However, they were unanimous in backing the third option.
This will see increased audit of post registration education and practice portfolios and require registrants to collect feedback from patients and colleagues every three years. The nurse or midwife must then declare they have had had an appraisal and are fit to practise.
Lay member Louise Scull, who is also vice chair of Nottingham University Hospitals Trust, warned any system would need to be worth the cost to the wider health and social care system. She said if this could not be proven she would prefer the second option, which involves only increased audit.
Both options have the same £4.5m start up costs and £1m annual running costs. However, the second option would not require any extra investment from employers or registrants in collecting feedback or conducting appraisals.
Other council members also raised concerns. Stephen Thornton called for the NMC to invest in a “completely independent evaluation” to look at whether revalidation had “any impact on patient safety”.
Judith Ellis told council there was concern among nurses working in academia about what revalidation would mean for them and called for all registrants to be subject to the same system of revalidation.
She also raised concerns about relying on employers to conduct good quality appraisals. The NHS staff survey for 2012 found that, although nationally 83% of staff reported having an appraisal, only 37% said they were well structured.
Professor Ellis said: “We know that the value of appraisal varies dramatically across the health service… if we are developing a system that’s reliant on other peoples’ processes, that is a concern.”
NMC chief executive and registrar Jackie Smith acknowledged that appraisal was “variable and patchy”, but said that was “not a reason” for not introducing the proposed model of revalidation. She said revalidation could help drive up the quality of appraisal.
Speaking to Nursing Times after the meeting, NMC chair Mark Addison denied that a requirement for a nurse or midwife to sign a declaration saying they had undergone an appraisal in the last year risked becoming a “tick box exercise”.
“There are tick boxes that are lies where you haven’t had an appraisal, in which case the audit system would kick in. A tick box where a registrant will be required to say they have had an appraisal will encourage trusts and registrants to take it seriously,” he said.
The NMC will consult on the proposals until next summer and plans to begin piloting the model in early 2015.