1. Implementation of nursing and midwifery revalidation Susan Aitkenhead Interim Head of Nursing NHS England
GP Autumn Seminar Programme 16 September 2015

2. Background
The Nursing and Midwifery Council (NMC) is proposing new requirements that nurses and midwives must meet when they renew their registration every three years. Revalidation will replace the post-registration education and practice (Prep) standards. Revalidation aims to improve upon the Prep system by setting new requirements for nurses and midwives.

3. Rationale from the NMC
The purpose of revalidation is to improve public protection by making sure that nurses and midwives continue to practise safely and effectively throughout their career.
Nurses and midwives should stay up to date in their professional practice. They need to develop new skills, keep informed on standards and understand the changing needs of the public they serve and fellow healthcare professionals with whom they work.
Revalidation provides nurses and midwives with the opportunity to reflect on their practice against the standards in ‘the Code’ and demonstrate that they are ‘living’ these standards.
For those nurses and midwives who are professionally isolated from their peers, revalidation will encourage them to engage in professional networks and discussions about their practice.

4. New model proposed:
Although the accountability for ensuring that nurses and midwives revalidate remains with the individual nurse or midwife, there is also a partnership approach with the employer around some components of these new requirements. 

5. System Leadership for Preparation
Responsibilities:
NHS England as a partner in this NMC-led work is responsible for assuring ‘readiness’ for implementation within primary care, and for the relevant staff working within NHS England, Clinical Commissioning Groups (CCGs), and Commissioning Support Units (CSUs).
TDA: Non-FTs, TDA staff;
Monitor: FTs, Monitor staff;
PHE: PH pilots, PH organisations, PHE staff,
DH: Independent sector, care homes, LA

6. Nursing and Midwifery Revalidation
The provisional revalidation model approved by the NMC for the purpose of the pilots sets out key requirements for revalidation:
Practice hours
CPD – including participatory learning
Practice-related feedback
Reflection on the Code, CPD and feedback
A reflective discussion with another NMC registrant
Declarations in relation to health and character, and professional indemnity
Confirmation from a 3rd party confirming compliance with the requirements

8. What is the new Code?
The NMC has updated its Code of professional standards.
The revised Code became effective on 31 March 2015 and all registered nurses and midwives are required to uphold its standards of practice and behaviours.
The Code is centred around four themes, with public protection at the core, and builds on the existing foundation of good nursing and midwifery practice.
The Code should be used as a ‘living’ guide at the heart of everyday nursing and midwifery practice.

9. Four themes brought together in one Code
Together they signify good nursing and midwifery practice.

10. Revalidation
Proposed Requirements
Practice hours
You must practise a minimum of 450 hours (900 hours for those with dual registration) over the three years prior to the renewal of your registration.
Continuing professional development
You must undertake 40 hours of continuing professional development (CPD) relevant to your scope of practice as a nurse or midwife, over the three years prior to the renewal of your registration. Of these hours, 20 must be through participatory learning.
Practice-related feedback
You must obtain at least 5 pieces of practice-related feedback over the three years prior to the renewal of your registration.
Reflection and discussion
You must record a minimum of 5 written reflections on the Code, your CPD and practice-related feedback over the three years prior to the renewal of your registration. You must discuss these reflections with another NMC registered nurse or midwife.
Health and character
You must provide a health and character declaration, including declaring any cautions or convictions.
Professional indemnity arrangement
You must declare that you have, or will have when practising, appropriate cover under an indemnity arrangement.
Confirmation from a third party
You will need to demonstrate to a third party that you have met the revalidation requirements.
Keeping a portfolio
We strongly recommend that you keep evidence that you have met these requirements in a portfolio (this is, however, optional).

13. NMC provisional guidance - Confirmers
‘What you are being asked to do’:
Have a face-to-face discussion with the registrant about their portfolio, where the registrant can explain to you how they have met the requirements. In most cases, this is likely to form part of the registrant’s annual appraisal.
Review the registrant’s portfolio to make sure that they have met the revalidation requirements. You might want to see the portfolio before the discussion.
Question the registrant where you are not sure if they have met a requirement.
Use your professional judgment in deciding whether you think that the registrant has met the revalidation requirements.

14. NMC provisional guidance - Confirmers
‘What you are not being asked to do’:
Decide whether a nurse or midwife will be revalidated or will remain on the register. This is the NMC’s role as the regulator.
Make a judgment on whether the registrant is fit to practice. Revalidation is not a new way to raise fitness to practice concerns. If you have a concern about the registrant’s fitness to practice, you need to raise this in the appropriate way, either through the organisation where they work or directly with the NMC.
Verify information in the registrant’s portfolio. For example, you do not need to contact CPD providers to check whether the registrant attended or completed a particular item of CPD. All of the information you require to make your judgment should be contained in the registrant’s portfolio.
It is important to understand you are being asked to confirm based on the evidence that you have seen. If you provide confirmation honestly, you will not be held responsible for future or past actions if you were unaware of them when giving the confirmation.

15. Providing confirmation – draft guidance
The NMC expects registrants to seek confirmation from an appropriate third party. They strongly recommend that registrants obtain confirmation through their line manager wherever possible. In most cases, the line manager will be an NMC registrant. If you are the registrant’s line manager, you are likely to be the most appropriate third party to provide their confirmation.
If you are providing confirmation on the basis of being an NMC registrant, you must have an effective registration. You cannot be retired and no longer registered, or subject to a suspension, removal or strike-off order at the time of making the confirmation

16. Draft confirmer guidance
However, not all registrants have a line manager. Registrants who do not have a line manager need to use judgment to determine who is best placed to provide their confirmation. Wherever possible, the NMC recommends these registrants obtain their confirmation from another NMC registrant. Therefore, even if you are not the registrant’s line manager, you may still be the most appropriate third party to provide their confirmation. It will be helpful if you have worked with the registrant or have a similar scope of practice to them, but this is not essential.

17. Draft confirmer guidance
Healthcare professional (other than nurse or midwife):
A small number of registrants may not have a line manager or another NMC registrant to provide their confirmation. These registrants can obtain their confirmation from another healthcare professional that they work with and who is regulated in the UK, such as a doctor, dentist or pharmacist.
If you are a healthcare professional regulated in the UK and you work with the registrant, you might be the most appropriate third party to provide their confirmation. You will need to include your professional registration number and the name of your professional regulator on the confirmation form.
Because you are not an NMC registrant, the nurse or midwife will have had a conversation about their revalidation with another NMC registrant before seeking confirmation.

20. NMC Pilots
Pilot organisations were selected throughout the UK by the NMC to cover a variety of settings and employment circumstances for nurses and midwives. Learning from the pilots has been used to refine the final NMC model.

21. NHS England work – Primary Care
A number of high level ‘readiness’ assessments have taken place facilitated by the regional leads working in partnership with CCG colleagues, who asked their local primary care organisations such questions as:
Do you know the number of all nurse and midwifery registrants within your organisation?
Do you know your registrants’ revalidation dates?
Have you identified your first group of staff to support through revalidation?
How are you engaging with staff in preparation for revalidation?
Have you taken a paper to your Board/SMT/Partner’s meeting?

22. The leadership components within the role of the CCG nurses have driven this work:
A letter from the Chief Nursing Officer (England) was circulated to the lead CCG nurses on the 7th August 2015 thanking them for their work in leading this.
They were also requested to continue to support the regional leads in the gathering of evidence in relation to revalidation readiness.
Additionally they were asked to use all existing forums or meetings within their health and care economies, to raise awareness of nursing and midwifery revalidation within the General Practice Nursing community, including the key principles and requirements.

23. Timelines Welsh Programme Board – 8 September
England Programme Board – 9 September
Northern Ireland Programme Board – 10 September
Scotland Programme Board – 22 September
The four UK Chief Nursing Officers are also, as part of their professional leadership roles, to declare individual 'readiness' on behalf of their countries for the NMC's 8 October Council 2015 meeting when the decision will be taken by the NMC as to whether to proceed with formal implementation and an aim for the first nurses and midwives to revalidate from April 2016.

24. September 9th Programme Board: England
A final assessment round of ‘readiness’ has recently been undertaken by the regional leads prior to the go-live decision being taken by the NMC in October Full regional information, detail of work and good practice examples were provided within the individual regional reports which had been mapped against a template with the quadrants:
Awareness and understanding;
Resources: capacity and capability;
Systems and processes;
Guidance, tools and supports

25. Ongoing work
It should be noted that if the NMC does ratify a go-live decision at October Council, then there are still several months remaining to address any gaps, risks and challenges to ensure full ‘readiness’ for April 2016.
The definitive guidance from the NMC is keenly awaited, and the aligned preparation for regional Miad roadshows commencing from October 2015 will be a very important part of this ongoing work.
The NMC has a comprehensive communications plan that will be implemented following the October decision including liaison with registrants, employers, professional bodies, etc.
Guidance and support documents will be available for all nurses and midwives.

26. Further support to come from the NMC
Case studies
Toolkits
Employer’s guidance
Direct communications to registrants
Social media
Work with professional organisations

28. NB! Maintaining registration:
Applying for readmission is to become the only route back onto the register
From November anyone who allows their registration to lapse will need to make an application for readmission to regain access to the register. This process can take between two and six weeks, depending on circumstances.
A nurse or midwife's registration lapses from midnight on their expiry date if the NMC has not received the documentation and fee in time to process them. The short administrative window in which late submissions from nurses and midwives were processed without requiring them to apply for readmission is being removed.

29. Evaluation
The NMC has stated that an evaluation of revalidation will be undertaken at an early stage and that they recognise that this is the first phase of revalidation and it is important for Council to keep the model under review.

30. Reiteration of Key Dates
NMC Council is due to make a decision on proceeding with Revalidation at a meeting on 8 October, with the first registrants expected to revalidate from 1st April 2016.

31. Questions?
Contact: