NMC Update and Regulation of Advanced Nursing Practice

1. Susan Aitkenhead Professional Adviser in support of Policy and Strategy The Nursing and Midwifery Council and an update on Advanced Nursing Practice regulation 9 February 2007 Protecting the public through professional standards

2. Content: • NMC update • Latest on ANP • Relevant Policy • Partnership working • Standards for Supporting Learning and Assessment in Practice – related to ANP

3. NMC Update

4. Health regulation today • Established by Parliament 1 April 2002 • A clear remit to protect the public • Consists of 12 registrant members, 12 alternate registrant members and 11 lay members. The registrant members consist of equal numbers of nurses, midwives and SCPHNs • First elected Council • Balance of professionals and lay people: New NMC President: Sandra Arthur NMC has: • Range of powers and responsibilities • Range of sanctions • New focus on lack of competence

5. Elections • The 2007 NMC Council Election in Wales is taking place. • From 2007, the NMC elections will take place annually, by rotation, in one of the four national constituencies. • From 2007 onwards, all members will serve for four years. Members elected in 2007 will remain in office until 2011, in 2008 until 2012, and so on. Members may serve for up to three consecutive terms.

6. On Wednesday 26 July 2006, lots were drawn by the Electoral Reform Services. The results of the draw give the following order of rotation for the UK countries: 1. Wales2. England3. Scotland4. Northern Ireland

7. Legislative MandateAny changes can take up to 6 months…

8. Key External Policy • Reviews of regulation • Modernising Nursing Careers • Reforms of the delivery of healthcare • New ways of working • Changes in commissioning….et al

9. NMC’s policy and guidance will reflect practice in 21st century and current work is progressing in line with the roll out of major changes in the delivery of care…

10. The Code of Conduct: being revised…

11. Request to open further part of the nursing register; • Fitness for purpose at the point of initial registration; • Robust QA framework; • Non-medical prescribing; • Revision of admin of medicines • The NHS IT programme…and so on…

12. Changing roleRegulation is changing fast …. and nursing and midwifery have lead with many changes to the regulatory framework already…

13. The regulation of the non-medical healthcare professions • Published by the Department of Health (England) at the same time as Good doctors, safer patients addressing the regulation of medical staff. • It was developed to examine the effectiveness of professional regulation. • It posed several questions around the role, structure, functions, governance and number of regulators of non-medical healthcare professional staff.

14. White Paper recommendations due soon…

15. Key Partners to the NMC in relation to the reviews of regulation and work progressing from the reviews • The other regulatory bodies; • The DH (England) and the devolved administrations; • The professional bodies/unions; • Patient Groups; • Registrants; • Other key stakeholders – such as UK Council of Deans, NDA, etc.

16. Modernising Nursing Careers Several workstreams will come out of this and the NMC is one of the coalition members; with regard to ANP: • Scotland is leading on this work; • National Framework for Practice; • Toolkit being developed; • Lead by Karen Lockhart at SE; • The NMC is working closely with the SE and all other relevant partners to ensure that the regulatory impact is included as appropriate…

17. Key Partners in Modernising Nursing Careers • DH (England) and devolved administrations; • Professional bodies/unions; • UK Council of Deans; • NHS Employers; • NDA; • Patient groups…and many more…

18. MNC Education Summit • To be held on 13th February 2007… • Will be an ‘OpenSpace’ event facilitated by MNC/DH Team… • Will discuss ANP… • NMC participating…

19. Advanced Practice and Regulation: an update

20. One Register with three parts: • Nurses’ part: • Sub-part 1: all level 1 nurses • Sub-part 2: all level 2 nurses • Midwives’ part: • All midwives • Specialist community public health nurses’ part: • Health Visitors • School Nurses • Occupational Health Nurses • Family Health Nurses (Scotland)

21. Background • A major concern of the NMC, the public and many NMC registrants is the existence of the plethora of job titles that do not help the public to understand the level of care that they can expect. • There are nurses who hold job titles that imply an advanced level of knowledge and competence, but who do not possess such knowledge and competence. • In addition, their practice may not be subject to the scrutiny of another professional as they often act as independent practitioners.

22. NMC also recognises • That there are now significant changes in the way that services are delivered to patients, particularly following the GMS contract and EWTD, nurses, midwives and specialist community public health nurses are undertaking treatment and care that was once the domain of other health care professionals, notably doctors.

23. Consultation: • December 04 – February 05 • External analysis undertaken • Report to June Council 2005 Registration: • Council agreed that advanced nurse practitioner should be a registrable qualification and the title protected through this registrable qualification in the Council’s register • Council to seek approval from the Privy Council for opening a further sub-part to the nurses’ part of the register

24. December Council 2005 • Agreed revised definition • Agreed the competencies –aligned to the KSF and where appropriate re-written to more accurately reflect an advanced level of practice • Agreed the outline process for accommodating existing practitioners • Agreed a five year transition period from the opening of the register for practitioners wanting to register as ANP

25. Domains • Assessment and management of patient health/illness status • The nurse-patient relationship • The education function • Managing and negotiating health care delivery systems • Monitoring and ensuring the quality of advanced health care practice • Respecting culture and diversity

26. Access copies of the mapping of the NMC approved competencies against the KSF at: www.nmc-uk.org Click on left hand side of page under nursing then click on advanced nursing practice update…

27. Steps Taken • Approval sought from the Privy Council to open a further sub-part of the register in order to register advanced nurse practitioners; • A letter was sent to the Privy Council in December with additional information being sent in January 2006.

28. Current Position • The Privy Council has been seeking the views of the Department of Health (England) which takes the lead on regulatory matters relating to healthcare professions across the UK. • The NMC is awaiting the response.

29. Productive Use of Waiting Time Without making any assumptions or speculating as to the response from the Privy Council, the NMC decided that it would be productive (although programmes will only be approved once the ANP register is open) to: • Develop draft guidance for AEIs • Develop guidance for applicants including APEL

30. The NMC is aware of the changes in the delivery of healthcare, the changes in roles and responsibilities and continues to work with the professions, service users and all key stakeholders to ensure that protection of the public is inherent in these changes and through its standards, codes, rules and guidance, the NMC sets out a path to enable practitioners to develop but also to remain safe and effective…your collaboration in this work is very much appreciated…and it may be helpful to be aware of the following…

31. If given the ‘go ahead’ detailed issues to consider… • Legislative processes • Entry to the Register • Maintenance of registration • Removal from the Register

32. Legislation • Any modifications require a change to the ‘Order’ and can take up to six months to progress through the relevant parliamentary processes…

33. Entry to the Register…

34. Maintenance of Registration…

35. Removal from the Register…

36. Stakeholders will be kept up to date with all stages of the work and encouraged to comment…

37. Standards to support learning and assessment in practice • The NMC has developed new Standards to support learning and assessment in practice (available on NMC website). Lead Officer: Garth Long

38. The new Standard… • Has a developmental framework with outcomes, from four stages, for the roles of NMC registrant, mentor, practice teacher and qualified teacher. • Implementation of the standards includes requirements that are derived from the NMC Fitness for practice at the point of initial registration project. • A new category of sign-off mentor has been approved for implementation for cohorts of students from September 2007.

39. When the Standards were approved the Council decided to undertake an impact analysis relating to implementation.

40. Views from all stakeholders taken into consideration and through the channels of all relevant NMC committees and it was agreed…

41. ANP Decision: • Defer until (if) part of the Register opens – sign off mentor agreed by Council. • Plans to later examine the need for practice teachers. • Paper going to next Nursing Committee to examine the issues around inter-professional assessors.

42. Happy to take any further comments and thoughts back to feed into workstreams…

43. susan.aitkenhead@nmc-uk.org www.nmc-uk.org Lead for SLAIP: garth.long@nmc-uk.org

44. Protecting the public through professional standards