We’re proceeding with the additional regulation of advanced nursing and midwifery practice – the complex, autonomous and expert roles that many experienced nurses and midwives carry out.
The proposed options are founded on independent research by The Nuffield Trust, followed by NMC-led key lines of enquiry involving engagement with professionals and the public. These both found great variation in how professionals across the UK undertake advanced practice roles.
We’ve heard clearly from both the public and professionals about the important role advanced practitioners play in delivering care for people. They’ve also said a lack of consistency in education and training, qualifications, responsibilities, and governance processes can create a risk to the public, and that additional regulation will help reduce the risk.
Additionally, there is no single definition of advanced practice and it’s unclear whether the public understands the role and what it means for their care.
We’re therefore exploring a combination of approaches to the regulation of advanced practice to include:
- developing standards of proficiency for advanced level practice (and associated programme standards)
- adopting a collaborative approach to develop a UK-wide advanced practice principles framework incorporating a shared position or definition of advanced level practice
- ensuring that advanced level practice requirements are included in the wider review of revalidation and the Code scheduled for 2025/26.
These recommendations, supported by the NMC’s independent stakeholder steering group, were presented to the Council at its meeting on 27 March 2024. Following Council’s agreement, we’re undertaking further engagement with our partners before publicly consulting on any proposed changes.
The options presented are not mutually exclusive and we could implement more than one option at the same time. Alternatively, we could introduce them in a phased way.
We’ll also develop a proportionate approach to recognising existing advanced practice qualifications (“grandparenting”).
The approaches we’re proposing
Developing standards
Setting standards of proficiency for advanced practice programmes would create a consistent threshold of what they should know and be able to do. It would set clear regulatory expectations in education (including outcomes) and in practice. This option would provide us with regulatory oversight and assurance of how nurses and midwives qualify and become advanced practitioners.
Enhancing revalidation
Including specific revalidation requirements as part of our revalidation review (scheduled for 2025/26) could ensure that a professional has continued capability as an advanced practitioner. It wouldn’t make an initial assessment of their competency and would have to be applied alongside another regulatory option to provide the full assurance we seek to maintain public confidence and trust in our professions.
Set of principles or joint statement
Working with partner organisations on a set of principles/AP framework or joint statement would positively influence across the four pillars of advanced practice that can support consistency across education and practice. It could improve engagement across the health and care system, including increased employer input. However, it would be voluntary and non-enforceable so the problem of variability and inconsistency will be unaddressed. Therefore, this option would also have to be applied alongside another regulatory option to provide the full assurance we seek.
Further information
You can read more about how we developed these proposals in:
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