Frequently asked questions

From the outset we set out to co-produce this work with our stakeholders. To that end, we set up a steering group to oversee the project, review its work, endorse its outputs and make recommendations to our Council. The group was chaired by Dr David Foster OBE. It included representatives from the offices of the four Chief Nursing Officers (CNOs), subject matter experts and representatives of professional bodies. 

Read more about the Steering Group.

External stakeholders were included in our standards delivery groups, which helped us define the content and draft the standards which we consulted on. These focused on: all specialties of specialist community public health nursing; health visiting; occupational health nursing; and school nursing. Each is led by an independent chair. Read more about the independent chairs.

We consulted on the draft standards between 16 April and 2 August 2021. During the consultation, we met with hundreds of people and we were pleased to receive responses from more than 2,300 individuals and organisations.

We worked with stakeholder organisation representatives and individuals from across the health and social care sectors to make recommendations on how we should change our draft standards. These recommendations were based on the updated evidence and consultation contributions you’ve given us. The teams included practitioners, the public, educators, employers and our partner organisations, working alongside NMC colleagues.

The recommendations and refinements were considered by the post registration steering group. Council approved the new standards at its meeting on 26 May 2022.

Read more about our post-consultation assimilation arrangements.

We engaged extensively with stakeholders during 2020, using digital and virtual methods due to the Covid-19 pandemic. We published two independent reports which describe the engagement and what we heard during the engagement events. The feedback we heard through these engagements helped shape the draft standards.

Read more about our pre-consultation engagement and what we heard.

We have two types of standards related to education of all of our professionals:

• The standards for education and training that r education providers, in partnership with their practice learning partners, must meet in order to deliver any NMC programmes. These include high level organisational standards, and programme standards that set specific requirements for individual programmes – such as pre-registration nursing or midwifery and, in this case, specialist community public health nursing (SCPHN) or specialist practice qualification (SPQ) programmes and standards for student supervision and assessment.
• Our standards of proficiency, which define the knowledge and skills professionals need to be proficient in by the end of their approved programme. They can then gain an NMC-approved qualification and are eligible to join the particular part of the register, or gain an annotation that is recorded on their registration.

We consulted on both types of standards:

• Standards of proficiency for specialist community public health nurses
• Standards of proficiency for community nursing specialist practice qualifications
• Programme standards for post registration programmes

Once a nurse or midwife is registered with the NMC they can undertake one of our post-registration programmes, which add to their initial registration. These include post-registration programmes, which are either specialist community public health nurse (SCPHN) or community nursing specialist practice qualifications (SPQs).

Specialist community public health nurse (SCPHN)

We are legally required to maintain a specialist community public health nurses (SCPHN) part of the register. If someone successfully completes a SCPHN programme, they can join the SCPHN part of the register in addition to the part of the register which indicates their initial registration as a nurse and/or a midwife. This register denotes the field of SCPHN practice that professionals (enter this register as. Current joiners tend to be SCPHN health visitors, , school nurses or occupational health nurses. These professionals are legally able to use the protected title ‘specialist community public health nurse’. This means it is a criminal offence for someone to falsely represent themselves as being on our register and use the protected title of specialist community public health nurse.

Specialist practice qualifications (SPQs)

If a nurse undertakes a programme leading to a community nursing specialist practice qualification (SPQ), this qualification is recorded, or ‘annotated’, next to their name on the register they are already on. There are currently five SPQ community nursing specialisms which are: community children’s nursing, community learning disabilities nursing, community mental health nursing, district nursing and general practice nursing. This demonstrates that they’ve successfully completed a programme in a particular field of community nursing we’ve approved. There are no protected titles associated with SPQs. This means other nurses working in the community can use a specialist practitioner title, such as district nurse, without undertaking an SPQ.

SCPHN is a qualification leading to registration on a separate part of the register with a protected title. This is not the case for SPQ. The knowledge and skills stated within each standards of proficiency are different.

The numbers of those identified as a Specialist Community Public Health Nurse (SCPHN) can be found on page 24 of our data report.

The numbers of community Specialist Practice Qualifications (SPQs) issued to professionals on the permanent register are can be found on page 25 of our data report.

The purpose of professional regulation is to reduce the risk of harm to the public. Historically it was perceived that community nursing represented a higher degree of risk because practitioners were generally working alone with vulnerable people in their own homes; and this risk could be mitigated by them being required to have an additional regulated qualification.

Things have changed since then. It’s no longer the case that every nurse working in the community is required to have the qualification, but it may be appropriate and expected for those whose work is more complex and often carries higher risk and responsibility. There are also many more roles for nurses working in the community, which are not represented by the five existing community SPQs. These professionals also lead care for people with complex needs.

An additional community nursing SPQ

We consulted on the inclusion of an additional SPQ for community nursing with no field of practice specified. This new qualification would be appropriate for people whose roles are not represented by the five existing community SPQs and require a higher level of knowledge and skill in settings near to, or in, people’s homes. It would enable individuals working in different roles to tailor their learning and practice to these standards in their own area of community nursing.

Examples where this new qualification would be appropriate include people working in hospital at home teams, in intermediate care, in care homes or in prisons.

At the moment, our current SPQ standards, published in 2001, contain overarching standards that sit alongside a small number of specific standards of proficiency for each individual community SPQ.

Our pre-consultation engagement looked at this approach and found that although there are differences between specialist community nursing roles, the knowledge and skills required across the five current specialist community SPQs are generally the same, but the differences relate to how they are applied in different client groups.

Standards for the future

So the draft SPQ standards we consulted on build on ambitions for community and public health nursing now, and in the future, by setting out the knowledge and skills that practitioners need to deliver complex care and improve public health.

The draft standards are presented as one set of standards that applies to each field of community nursing specialist practice. This is in keeping with our modernised approach to pre-registration nursing, where we have one set of standards for registration that apply to the  four fields of nursing (adult, child, learning disabilities and mental health).

We considered field specific standards when drafting, as we were very conscious that there may be requirements of some specialties that don’t apply to others. However, in our pre-consultation engagement all fields of community nursing practice said each theme was relevant to them.

We consulted on the applicability of the proposed new standards for other fields of community nursing practice – and 64% agreed.

Importantly, we asked questions in our public consultation in relation to the need for field specific standards and what they might be for each field. Where these are identified by the consultation findings, they will be included in our final standards. Any field specific requirements will need to be at the level of regulatory standards, not at the level of the curriculum and learning outcomes. Similarly, we will not include anything that is already part of our new pre-registration standards.

The key themes within the draft standards we consulted on are:

• autonomy
• higher level knowledge and skills in holistic assessment and treatment
• promotion of health and wellbeing
• management of caseload, teams and workload
• quality and risk management
• research, and
• working across professional and agency boundaries.

We found little disagreement in our pre-consultation engagement that these are core requirements for people working in the community in any specialty or setting, at a senior level.

Our ambition is that the new standards will support specialist nurses to provide expert care whether they’re at home, in the community, visiting a GP surgery or accessing public health services.

Professionals who already have one of these qualifications will retain them as they are currently annotated to their registration. All existing professionals will need to learn more about the proposed new standards in order to be able to supervise, support and assess student learning. There is also an opportunity for professionals to consider the new standards when revalidating in relation to their scope of practice.

The titles ‘school nurse’ and ‘district nurse’ are not legally protected titles, whereas ‘specialist community public health nurse’ ‘registered nurse’ and ‘midwife’ are. This means it is not a criminal offence for someone to use the title ‘school nurse’ or ’district nurse’ without the relevant qualification.

We could only stop people from using these titles if we had the legal power to ‘protect the title’, in other words, prevent people from using the title of district nurse, school nurse etc, unless they have our qualification. We aren’t able to do this without a change in the law.

Recent high profile cases have underlined the limitations of ‘nurse’ not being a protected title. It is essential that we have the right protected titles and associated enforcement powers to be able to take effective action to protect the public and maintain confidence in the professions.

The UK government has proposed changes to our legislation to help us improve the way we regulate. We welcome further discussions with the Department of Health and Social Care, and with other partner organisations, to ensure our protected titles and enforcement powers are fit for purpose when our legislation changes. 

The SPQ standards build on the format of the Future Nurse standards whereas registered nurses and midwives can undertake SCPHN qualifications which meant our approach was different to take account of the initial registration qualifications of future post registration students.

There is also a difference in the numbers of registrants with SPQs and those registered as SCPHNs. There are more than 30,000 SCPHN registrants and approximately 19,600 registrants with SPQs. About 15,000 of those with SPQs are district nurses, and so the numbers in each of the other four specialities (community children’s nursing, community learning disabilities nursing, community mental health nursing and general practice nursing) are therefore much smaller.

SPQ standards

For the development of the SPQ standards, we decided to have one overarching group with an independent chair (from a community learning disability nursing and higher education background). We ensured that a range of people representing all the different specialities were involved, sometimes in specialty specific meetings, and sometimes together.

SCPHN standards

For the SCPHN standards, the team began its work by developing a core set of standards that applied to all fields in SCPHN. They then sent on to identify field specific standards for each of the SCPHN fields HV, SN and OHN. SCPHN professionals work in very different settings – at home, in the community, in schools, in industry and in the NHS – where the impacts on, and drivers for, public health and wellbeing differ. This made high level standards for each field easier to define.

Our standards of proficiency structure for registered nurses (proficiencies arranged under seven platforms covering all of the aspects of knowledge and skills required) was consulted on and agreed when we produced the future nurse standards in 2018. In 2018, we applied the same structure to the nursing associate standards in England. This was also consulted on and agreed. We have adopted the same structure for the draft SPQ standards.

The structure for draft SCPHN standards is different because SCPHN professionals can be nurses or midwives. We have a different structure for pre-registration midwifery standards, since midwifery is a separate profession. It was therefore not appropriate to use the pre-registration nursing structure for the draft SCPHN standards. Instead we have proposed a structure which takes account of standards for both nurses and midwives.

The content of the draft standards reflect the components of advanced practice (clinical practice, leadership, research and education) and exceed the knowledge and skill in those areas which is expected at initial registration.

We committed to explore whether the regulation of advanced practice is needed in our 2020-2025 strategy. This will require a large scale evidence review, engagement, collaboration with other regulators, and consultation. It would be confusing and inappropriate to apply a recognised structure for advanced practice before we have done that.

In developing these draft standards, we have reviewed a number of advanced practice frameworks to ensure that there is alignment, and this is what we mean by these standards forming a ‘bridge’ to advanced practice. It is also worth saying that prescribing, and the high level advanced practice frameworks that are currently in existence across the UK, are not specialty based. Specialty requirements are encompassed at the level of the curriculum.

We protect the public predominantly by allowing people to access and remain on our register when they have successfully qualified as a registered nurse, midwife or (in England) nursing associate, the Code and through revalidation.

We don't mandate the use of post registration qualifications, so essentially they are optional, rather than being fundamental to public protection. We believe that retaining some post registration qualifications would be beneficial to community services, but to play our part in encouraging an increase in the uptake of these qualifications, our approach should be modernised.

These proposals are intended to make our standards more flexible for universities to run programmes. When we have separate sets of standards, each university has to ensure they meet all of the standards for each programme individually, to be approved by the NMC. The approval process – and keeping all of the infrastructure in place for individual programmes – is not worthwhile for universities, unless they’re guaranteed to get enough demand from students for each field of practice to make it cost effective to run.

So this is a complicated issue. If there is insufficient demand, programmes will not run. Because there are then fewer programmes, they are often not accessible to those who do want to do them. For example, a programme may not run near where they work, so the demand falls further.

This is a complex problem, which is not in the hands of the NMC alone. Solutions lie with policy makers, nursing and midwifery leaders, employers, educators, commissioners and an understanding of the career aspirations of future professionals. What the NMC can do is to try and make our standards as flexible and easy to apply as possible. And to allow universities to develop one programme with different routes, which can be flexed to meet different levels of student demand from different specialties. The safeguard in this is that the requirements for specific specialities must still be met in order to lead to a specific annotation.

No. All students seeking to gain any NMC SCPHN or community SPQ will join an NMC approved programme. Different fields of SCPHN or community nursing SPQ practice will have their own route within the single programme that each university will go onto seek approval for. Students’ learning will follow a route where teaching, learning, support and assessment against the proficiency standards is tailored to their intended field of SCPHN practice or community nursing SPQ. This is the successful approach that was taken for pre-registration nursing programmes and the four fields of nursing practice.

Universities do not need to write standards as we are doing that. Regulatory standards are by nature high level. It has always been the role of the universities to design and develop the curriculum, programme outcomes and assessment to meet their award, but they have to do that in line with our programme standards.

Therefore, our education programme standards will specify what universities need to do to deliver programmes which will lead to SCPHN registration or an annotation of a qualification in a particular community nursing SPQ. This is something approved education institutions (AEIs) and their practice partners have done successfully for our ‘future nurse’ standards, and we will follow the same principle for SPQs.

We worked hard to hear from a wide range of people through the consultation, including nurses working in the community and public health roles, educators, students, employers and those commissioning services. The final standards we take to Council will be better because people have had their say.

We had a wonderful response to the consultation and received more than 2,300 responses. We’re very grateful that so many people took the time to share their views.

During the consultation we also hosted and attended a series of events to engage with different groups. They didn’t form part of the consultation itself, but were an opportunity for people to hear more about the project, the draft standards and what they might want to think about when responding to the consultation.

We usually work with an external agency during our consultation. For this work we also engaged them to work on the pre-consultation engagement phase. To ensure that we were able to capture and record all the feedback we received and for the responses to be independently analysed.

We ran this consultation in the same way as previous consultations on nursing standards and midwifery standards, and our recent consultation on nursing and midwifery programme standards. As you would expect, Covid-19 affected our approach to engagement and the types of events we hold during consultation, but we were pleased to take part in more than 60 evens over the course of the consultation.

The reports, written by independent research agencies, confirm that the standards we consulted on are welcomed and largely fit-for-purpose.

Each report has a helpful executive summary that provides an overview of the findings.

A large majority of the 2,363 respondents welcomed the three sets of standards, agreeing they were largely fit for purpose:

• 75 per cent agreed that the draft core and field specific standards of proficiency reflect the specialist knowledge, skills, and attributes necessary for all SCPHN registrants. There was strong agreement that they meet the proficiency requirements for health visitors (76%), occupational health nurses (79%) and school nurses (83%).
• For SPQs, we asked about the applicability of the draft standards for each of the seven platforms of nursing. 72-88 per cent of respondents across the five fields of SPQ practice agreed they were applicable. 64 per cent of all respondents felt the standards were appropriate for nurses who practice in other community settings.
• For post-registration programme standards for both SCPHN and SPQ at least 67 per cent of respondents agreed with most of the proposals, with higher levels of agreement for many of them.

We reviewed the consultation findings with teams of individuals from across the health and care sectors. We worked with these teams to develop recommendations for how we should refine the draft standards.

The recommendations were based on the updated evidence and consultation contributions you’ve given us. The teams included practising professionals, students and educators, working alongside NMC colleagues.

The recommendations were then considered by our post registration steering group, made up of partners from across the UK. Ultimately, our Council reviewed the standards and decided to adopt them at its meeting on 26 May 2022.

Many of changes we have made are refinements in language and strengthening specific areas that were proposed by stakeholders. We have also added some new standards.

In terms of where the standards have been strengthened, key areas include:

• sustainable development and environmental factors;
• the SCPHN’s role in addressing health inequalities;
• an increased emphasis on co-production, partnership working and empowering local populations in developing public health interventions;
• greater recognition of individual needs;
• prioritising support on the basis of immediate and continuing risk and need;
• improving access to local community assets and sources of support;
• providing early interventions; and
• evaluating the success and positive impacts of local public health campaigns and initiatives.
• Leadership

In terms of new standards, areas where we have introduced new standards include:

• promoting the rights of school aged children and young people;
• ensuring that services are holistic, inclusive and responsive;
• highlighting the SCPHN’s safeguarding role,; and
• highlighting the increasing importance of new and emerging science and technology including genomics and how this will influence future  SCPHN practice.

Under proposals from the Department of Health and Social Care, we'll be able to more meaningfully regulate additional qualifications in a way that helps to protect the public. Initially, those additional qualifications will reflect these post registration qualifications, as well as prescribing. In time, we could use the same mechanism to regulate advanced practice.

We could then enforce the principle that nurses and midwives should not use titles that suggest they hold one of our qualifications if it’s not recorded on our register and they haven’t demonstrated through revalidation that their practice is current and up to date.

This will be positive for practitioners themselves, and the people and communities they care for and support. We’ll continue to recognise, register and record these qualifications.

Terms and conditions of employment, including job titles, are not within our remit as a regulator. These are decided by national bodies, employers and, policy makers. Should we receive comments from our consultation regarding these items we will pass this feedback onto the relevant country/organisation.