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.
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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”
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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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”
“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”
“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”
“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.