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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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Readers' comments (11)

  • michael stone

    '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.”'

    Slightly off topic - and I have doubts that however this revalidation is designed, it will in practice be all that useful - my impression is that there are plenty of other things the RCN could point at, if it is concerned about parity (between nurses and medics - at least, I'm assuming that is the 'parity' issue alluded to).

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  • So if it is £1.50 per registrant where does the rest of the £98.50 or £94 if you take the medical model go?

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  • Not sure if GMC supports medics but NMC definitely doesn't support their registrants, which itself is just a bureaucratic burden. If 95% of registrants didn't bother to keep a prep portfolio up-to-date, chances are no one at NMC, work or patients would even notice. Then that's one massive saving for personal time not wasted on doing someone else's job.
    If quality is to be ensured, then interested parties better pump investment + resources in to make sure audits are more representative of the work force.

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  • are NMC failing their registrants yet again?

    it is strange none ever come forward to post here or defend their position.

    As far as £250 for auditing each portfolio, perhaps they should be paying nurses for keeping them up to date so this could be invested in their further training and development, etc.

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  • No need for this. Midwives have statutory supervision, where fitness and eligibility to practice are reviewed every year and whenever else as needed.

    Nurses have clinical supervision, which doesn't really work because the employers know it is not compulsory. It would be better for the NMC to promote the midwifery model of supervision and adapt it for nurses, instead of trying to get rid of it.

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  • As usual it's a half baked, ill thought out idea with little chance of being useful.

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  • is it surprising? britain seems notorious for its lack of organisation or is it just a passing phase?

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  • Will anyone from the NMC come to this forum and debate why they want this revalidation? After all, should we not be part of the discussion process? How big will the process become? I have a feeling it will become a bit of a beuracratic beast. Something else to add to the auditing/targets nightmare that we have to endure.

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  • Maybe I am sounding a bit naive, but isn't this done throughh our annual appraisal which your line mangager does every 12 months to ensure you meet your gateways, doctors already have portfolio to present at their annual appraisal (i am a nurse by the way). If every employee had this process available, then we wouldn't need to be revalidated, as your manager will check you are up to date with your essential training, what your personal development plan is (eg extra training , mentoring etc), in our trust we are supposed to do a drugs calculation booklet every year, and we have annual appraisals with our line manager. Part of the responsibility does lie with us to be sure we are safe, if perish the thought, an adverse event occured and we had to defend our quality of care, we need to be able to do so, and to feel we did what we could, however, employers have a duty to patients to ensure the staff they hire are safe too. Annual appraisals as a mandatory should be imposed, as is supposed to be provided now as best practice. Surely this is a more efficient, cost effective way of adapting a system already in existence?

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  • This bunch of NMC clowns don't even function adequately without dealing with revalidation. This will be a mess. You can guarantee that, true to form, they will press ahead and completely ignore the well founded warnings about the catastrophe to come. Sack them all now and save us the trouble of the call for investigations and promises of 'lessons will be learned', in a couple of years time, when they will called to account for the dog's dinner.

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