The full introduction of revalidation for nurses and midwives could be delayed in England for two years due to government fears about the current state of NHS finances, Nursing Times can reveal.
The roll-out of a major new system of competency checks, due to be implemented from April, appears to be in chaos, despite being rubber-stamped by the NMC council on 8 October.
“We are working with the NMC to make sure revalidation is introduced in the right way so that it is manageable for trusts and does not divert nurse and midwives from patient care”
Department of Health
Nursing Times has learnt that the Department of Health wants to delay the full introduction of the process for two years, in order to protect trusts that are struggling financially.
Instead, in the interim, the department is understood to be planning to introduce a “voluntary” system for employers to provide support to registrants, with “minimal cost and no impact on taking staff from the frontline”.
An official announcement outlining the plans is expected in a letter on 31 October, probably from the chief nursing officer, who is based with NHS England.
As a result, trusts in financial difficulty will not be required by the department to support registrants through revalidation, for example with requirements for continuing professional development – effectively creating a two-tier system and potentially stalling its full introduction.
Revalidation for nurse and midwives was one of the recommendations made by the Francis review into failings at the former Mid Staffordshire NHS Foundation Trust and was subsequently accepted by ministers in their response. A similar system is already in place for doctors.
As an independent body, the NMC can still go ahead with the introduction of revalidation.
But senior sources have told Nursing Times they are concerned that the DH plans for a voluntary roll-out would cause further recruitment and retention difficulties for some trusts, if they chose not to support their staff through revalidation, while giving more financially stable trusts an advantage.
It could also mean that registrants working in “outlier” organisations, such as cash-strapped care homes or GP practices would not be supported with the new system of checks, despite nurses in these types of setting being identified from the pilots as most likely to experience difficulties revalidating.
The DH is understood to be concerned about the extra pressure on employer budgets that supporting nurses through the new system will add to trusts, many of which are already in deficit as winter approaches.
“Revalidation goes live in April for the whole of UK, and our position on that still stands”
Meanwhile, it is understood that the other three countries in the UK confirmed to the NMC earlier this month that they were largely ready to implement revalidation as planned.
Nursing Times believes that, at present, revalidation will go ahead in Wales, Scotland and Northern Ireland with the full support of NHS organisations.
Charlotte McArdle, CNO for Northern Ireland, said: “Northern Ireland has told the NMC we are ready to revalidate and we will be doing that for every nurse in every setting from April 2016.
“We have put in a business case to get some resource for admin support for the five large acute trusts… but even without that, we will introduce revalidation,” she told Nursing Times.
Fiona McQueen, CNO for Scotland, added: “Our view is that revalidation protects the public and so is good for patients and the profession – so in Scotland, we have confirmed we are ready to introduce revalidation from April 2016.”
NMC chief executive and registrar Jackie Smith said: “Revalidation goes live in April for the whole of UK, and our position on that still stands.
“I look forward to receiving official confirmation from the Department of Health about England’s position,” she told Nursing Times.
Under the NMC’s plans, nurses and midwives will need to complete revalidation every three years in order for them to remain on the register and, therefore, be able to practise.
- NMC approves introduction of nurse revalidation in April
- England lagging behind rest of UK on revalidation readiness
- Both nurses and employers warned to be ready for revalidation
The new checks process, designed as a replacement for the post-registration education and practice (PREP) system, was piloted by more than 2,000 nurses working at 19 different sites across the UK during the summer.
To revalidate successfully, the NMC’s approved guidance states that registrants will have to complete at least 450 hours of practice, compile five pieces of practice-related feedback and prepare five written reflective accounts relating to the code of conduct.
A reflective discussion with another registrant is also required, as is a health and character declaration and evidence of indemnity insurance.
In addition, registrants must have all of the revalidation requirements “confirmed” and signed off by a third party, who is preferably their line manager but does not have to be an NMC registrant.
Registrants will have to complete a minimum of 35 hours of continuing professional development in the three years prior to registration renewal, with 20 of these hours being participatory.
This represents a change from the original proposal of 40 hours of CPD, following feedback from organisations which tested the system and said there was no evidence of the benefits from this increase.
At its last council meeting on 8 October, the NMC said it was “confident” that, based on the results from the pilots, the introduction of revalidation was “achievable, effective and realistic”.
A spokeswoman for NHS England did not want to comment on the issue and said it was a matter for the DH.
A DH spokeswoman said: “As set out in our response to the public inquiry in to Mid Staffs, we fully support the principles of revalidation.
“We are working with the Nursing and Midwifery Council to make sure it is introduced in the right way so that it is manageable for trusts and does not divert nurse and midwives from patient care,” she added.