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‘Degree of concern’ over nursing associate fee expected by NMC


There will be “a degree” of concern over proposals for nursing associates to pay the same yearly registration fee as nurses for regulation, the head of the Nursing and Midwifery Council has said as the body launches a consultation on the plans.

Following an NMC council decision last week, the consultation began yesterday proposing setting annual registration fees at £120 for nursing associates – despite those in the role being expected to earn a lower salary than nurses.

However NMC chief executive Jackie Smith said that although there would be concerns, she believed there was also an understanding among nursing associate trainees that regulation came at a cost.

At the meeting last week the NMC’s director of education, Geraldine Walters, explained it would cost the body the same to regulate nurses as it would for associates.

She also noted that all nurses were charged £120 every year to stay on the register, despite large differences in salaries among the profession. Under the NHS’s Agenda for Change system this range includes an entry level band 5 nurse earning just over £22,000 and a band 8 matron earning up to around £48,000.

“We don’t currently differentiate our fees based on salary for current registrants”

Geraldine Walters

The difference in salaries between a nursing associate – expected to be paid band 4 wages, ranging from £19,000 to £22,000 – and an entry level band 5 nurse was much smaller, she indicated.

Nursing associates will not be able to earn higher salaries unless they undertake additional training to become a nurse.

“We don’t currently differentiate our fees based on salary for current registrants,” Ms Walters told the meeting. “We have given this quite a lot of consideration.”

In addition, other healthcare regulators charged assistant roles similar annual fees to the £120 being proposed by the NMC, she said.

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Geraldine Walters

However, the fee for assistant roles at these regulators was lower than those for other professionals, based on evidence that there were fewer fitness-to-practise cases.

“The issue for us is we don’t have any evidence at the moment about what sort of fitness-to-practise activities nursing associates will generate,” she told the meeting.

In an interview with Nursing Times after the meeting, NMC chief executive Ms Smith said the regulator had been “very clear” with unions and national organisations – including workforce planning body Health Education England, which first developed the new role – that the NMC expected to consult on a fee of £120 for associates.

“We do expect there will be a degree of concern about the fee set at £120 but we have been very clear that this is the cost of regulation”

Jackie Smith

“We do expect there will be a degree of concern about the fee set at £120 but we have been very clear that this is the cost of regulation,” said Ms Smith.

“Nursing associates will be a professional group in their own right, they will have a separate bit of the register, they will have their own proficiencies. There will be aspects of their practice that are very clear in the code and we will deal with them as part of revalidation and fitness to practise,” she added.

She said the alternative option was for “somebody else” to pay. She noted that if associates and nurses paid fees proportionate to their salaries, those who earned more would end up subsidising the cost of regulation for others – and that this system would also be costly to set up.

“I haven’t heard a single trainee [nursing associate] say regulation is not the right thing…There is a general recognition that comes at a cost”

Jackie Smith

“I haven’t heard a single trainee [nursing associate] say regulation is not the right thing – quite the reverse….They support regulation because it gives them a very clear identity, it sets the standards and protects the public….I think there is a general recognition that comes at a cost,” she told Nursing Times.

The Royal College of Nursing said it needed to understand the “true” cost of regulating associates by consulting its members.

“The RCN will also be looking at similar roles overseas to find out how they are regulated, and what we can learn by way of comparison,” said Stephanie Aiken, RCN deputy director of nursing.

 “In this way, we hope to come to a fair and reasonable conclusion about the potential cost of regulation for nursing associates, one that provides the right solution for members, patients and employers,” she added.

Unison said it was “disappointing” that the NMC was charging nursing associates the same as nurses and midwives.

“This flat-fee approach ignores the fact that nursing associates have considerably lower earning potential than many of their colleagues,” said Unison head of health Sara Gorton.

“This flat-fee approach ignores the fact that nursing associates have considerably lower earning potential”

Sara Gorton

“We strongly urge the NMC to think again, and move to a system of fees that’s more clearly linked to salaries. People should be able to stagger their payments too.

“Without these affordability changes, cash strapped trainees may well be deterred from becoming nursing associates in future,” she added.

Nursing associates will only be regulated in England – the first country in the UK to be piloting the training of the new role. Wales, Scotland and Northern Ireland have so far not revealed any plans to introduce nursing associates.

If healthcare assistants from other parts of the UK want to register to work in England as a nursing associate, they will have to pay an additional fee to have their qualifications assessed by the NMC.

At the regulator’s meeting last week, concerns were raised by council members about the NMC’s proposal to charge these UK applicants £140 – higher than the £110 that would be paid by those applying from other parts of the European Union.

In the consultation document released yesterday, the NMC said this was due to the fact applicants from other parts of the UK would not come under EU rules that make it easier, and therefore cheaper, to assess applications.

“We recognise that this is a complex issue, as this is the first time the NMC will regulate a profession in only one of the four countries of the UK, however…we believe that this is the right approach to take,” said the document.

“This could be subject to change in the future, depending on the outcome of the review that we are conducting into our evaluation processes,” it added.


Readers' comments (8)

  • Wouldn't it be a good idea to define the role of the associate before they start regulating what they do??

    I utterly despair at what is happening to a once proud profession.

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  • As a trainee nursing associate myself and part of the pilot scheme/first wave that will qualify I agree that regulation is absolutely necessary and correct (I have always thought HCA/HCSW’s should also be regulated). However I do have some issues with the rate being set as the same for RN’s. Firtstly, I don’t believe that any of us who will qualify in Jan’ 19 will suddenly progress to the top of our banding and therefore most if not all will be at the bottom of band 4, which is quite a bit less than the £22,000 suggested in this article for the top of band 4. Furthermore stating that the NMC currently treats everyone as equal regardless of their banding/earning potential is fine to say at the moment because any RN in any banded role is a fully fledged registered nurse, which NA’s are not and nor will they be! This brings me to my last point, within this article it states that the NA’s will have there own section to the register, this acknowledges my comment above that an NA is an NA and an RN an RN. NA’s will not be able to work within the scope of practices that an RN from band 5 upwards is able to and so I feel this should be recognised. If the NMC truly felt we were the same as RN’s we wouldn’t be needing a separate part on the register and we would be being paid from band 5 upon qualifying!! Just my thoughts what do others feel?

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  • Paul can you tell me what your role will be on a ward? what separates the associate from the HCA , dont forget the RGN has overall responsibility and more importantly accountability oh and of course a huge debt to pay repay for their training.

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  • The NMC wants their cake and eat it. First they get rid of all the Enrolled Nurses, then Registered Nurses, then the stupid idea of making everyone a degree nurse - help needed now the numbers are dropping, let's invent the enrolled nurse again, what a load of rubbish. I would have liked to have gone back after my RGN training, you know what: I don't want to go to Uni, their loss. There would not be the amount of vacancies if they had kept the RGN training together with degree nursing separately as well, everyone would have been happy. Now if you are a degree nurse in training you get treated no better then the old fashioned way of training, in fact worse, you have to pay for the privilege. They wonder why the uptake is so low. This infuriates me so much it is not rocket science!

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  • Anonymous 1.34pm, you attitude is appalling. 'A degree nurse gets treated no better than the old fashioned way of training?' Seriously? I have been dual qualitfied for more years than I care to rtemember and it is nurses such as me that have contributed to the knowledge base of every student and newly qualified nurse that crosses our paths. Old fashioned it may have been but it provided way more knowledge that students I meet these days. Look after a patient with a tracheostomy? No they can't do that; it isn't taught. Look after patients requiring peg feeds? Nope. Look after ventilated patients? No, sorry, can't do that. I did ALL of that in my first year of student nurse training in 1975. And no, I don't have a degree. What I do have is a wealth of knowledge and experience that I have been able to, and continue to, pass on to trainees and the people in my care and you appear to be suggesting I am worth less than a newly qualified nurse, simply because she has a degree? Shame on you.

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  • Nurse 57 here, hear absolutely! I thankfully trained in the late 80's under the apprentice style training, qualifying as an RGN. I continuously keep myself up to date, studied for my diploma, but have no desire to obtain a degree. I have worked consistently full time within the acute ward environment, providing current, researched based, individualised care also based on 30 years nursing knowledge and experience. It infuriates me some of the attitudes I hear today in both the media and students who I mentor (which I put a lot of time and effort in to), themselves on how they few mine and my fellow colleagues qualification, who do they think they're gaining knowledge and skills from? Completely insulting.

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  • Ok, I understand where they are coming from but i’m going to stick with what I said in response to the consultation document (Which has actually also been said above). I think it is unfair and will act as a deterrent charging Nurse Associates the same as us. I’m not ashamed to say that I find it difficult on the months the fee is due, I pay quarterly because my renewal is December and £120 is a nightmare to pay out that close to Christmas. I think Nurse Associates are going to find this even more difficult due to the lower salary.

    This is another way we are constantly screwed over, cost of living keeps rising and yet we still don’t get the pay rise we deserve. It’s that bad that you can get pretty much the same pay working for ALDI without the stress and crap Nurses often have to deal with.

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  • A fair system is to charge a percentage of salary, so that everyone pays what they can (just!) afford. I believe the payment is for public protection, so I am slightly puzzled why the public don't pay. I would be quite willing to put in my share as one of the taxpaying public.

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