Our standards of proficiency state what nurses need to know and be able to do to join our register, or have a qualification annotated. Health and care is evolving, and nursing practice is changing and advancing at the same time. We therefore need to update our standards routinely to keep pace with that.
In the last five years we’ve reviewed and transformed all of our pre-registration standards and it is now time to move on to the remaining post-registration standards – this is the final phase of our education change programme that started in 2016.
Dealing with a global pandemic
Changes in practice accelerated as Covid-19 hit: specialist community nurses adapted to new challenges, new technology and new ways of working. They prioritised people’s needs and care, kept them out of hospital and provided reassurance for our communities. As we deal with the longer-term impact of the pandemic, community and public health nurses are shown to be more important than ever – helping get us back to workplaces and schools, keep communities safe and support people dealing with the impact of long Covid.
Our post-registration standards will equip the next generation of specialist community and public health nurses working in health and social care with the right proficiencies to care for people in a rapidly changing world.
Setting a strong foundation for the future
These important standards were last updated over more than 15 years ago. We need fit for purpose standards that reflect the realities of modern nursing. The draft standards we consulted on from 8 April to 2 August 2021 areare designed to support the innovation in practice that is already happening across the four countries of the UK. They are are also flexible enough to take account of future ambitions for support and care which will develop as our communities evolve and grow.
These FAQs explain the background to our work on reviewing our post-registration standards, they seek to answer the questions we are frequently hearing from our stakeholders about our proposals and they explain how people can get involvedwhat’s going to happen next.
Background and context
How we've reviewed the standards
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 is chaired by Dr David Foster OBE. It includes 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 are included in our standards delivery groups, which have helped us define the content and draft the standards which are being consulted on. These are each focusing on: all specialties of community 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.
Now, we’re working with teams of individuals from across the health and social care sectors who will come together to make recommendations on how we should change our draft standards. Their recommendations will be based on the updated evidence and consultation contributions you’ve given us. The teams will include practising professionals, students and educators, working alongside NMC colleagues.
Their recommendations will be considered by the post registration steering group. Ultimately, our Council will review the standards in a public meeting to make a decision on their adoption. Read more about our post-consultation assimilation arrangements.
We engaged extensively with stakeholders during 2020, using digital methods due to the Covid-19 pandemic. We published two 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.
Our ambitions for community nursing standards
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 are suggesting 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 will 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 our draft SPQ standards 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 practice. This is in keeping with our modernised approach to pre-registration nursing, where we have one set of standards for registration in one of 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.
Importantly, we’ve 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:
- 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 on the register. 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 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’ and ‘registered nurse’ are. This means it is not a criminal offence for someone to use the title ‘school nurse’ or ’district nurse’.
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.
There is a significant difference in the numbers of registrants with SPQs and those registered as SCPHNs. There are over 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.
So, 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.
For the SCPHN standards, the team began their work by developing a core set of standards that applied to all fields in SCPHN. They then sent on to identify bespoke standards for each of the SCPHN fields. SCPHN professionals work in very different settings – in schools, in industry and in the NHS – where the impacts on, and drivers for, public health and wellbeing are very different. This made high level standards for each role 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.
The NMC has made a commitment 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 completed their pre-registration education, and the Code.
We don't have the legal powers to 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.
More about university courses
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, 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, 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 speciality. 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 beter 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 series of events to engage with different groups.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.
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.
What happens now the consultation has closed?
The consultation closed on 2 August 2021, after more than 16 weeks.
Immediately after closing the consultation, an independent research company starts to analyse all of the responses.
From the start, we’ve been committed to co-producing these new standards. Over the next few months teams of individuals from across the health and care sectors are going to come together to make recommendations on how we should change the draft standards.
Their recommendations will be based on the updated evidence and consultation contributions we’ve received. The teams will include practising professionals, students and educators, working alongside NMC colleagues.
Their recommendations will then be considered by the post registration steering group.
The Council will be presented with a final version of the standards and asked to make a decision on their adoption during a public meeting. We hope to be in a position to take final sets of standards to our Council to seek approval at the end of 2021.
Now the consultation is closed we are looking again at the standards in line with all the feedback we have received, as well as further evidence.
We fully expect the standards we consulted on will change before they’re finalised. We’re open to making any changes necessary to deliver the best outcomes for the people and communities that these professionals serve. We want our new standards to support specialist community nurses to provide expert care whether they’re at home, in the community, visiting a GP surgery or accessing public health services.
Terms and conditions of employment, including job titles, are not within our remit as a regulator. These are decided by employers, policy makers, and professional bodies. Should we receive comments from our consultation regarding these items we will pass this feedback onto the relevant country/organisation.