Advanced practice: our recommendations for additional regulation

Published on 20 March 2024

We’re recommending to our Council that we proceed to develop an approach to the additional regulation of advanced practice – the complex, autonomous and expert roles that many experienced nurses and midwives carry out.

At its meeting on 27 March, our Council approved the recommendation that we proceed to develop an approach to the additional regulation of advanced practice. We will do further engagement with our stakeholders and run a public consultation on final proposals.

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. They also felt this could impact on confidence and trust in professionals in advanced practice roles and that additional regulation would help reduce these risks. 

Additionally, as there is no single definition of advanced practice and it’s unclear whether the public fully understands the role and what it means for their care. 

This evidence base informed our independent steering group’s discussions. We're now recommending to our governing Council that we develop a combination of approaches to the regulation of advanced practice. These 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 reviews of revalidation and the Code scheduled for 2025/26

The options are not mutually exclusive we could develop more than one at the same time. Alternatively, we could introduce them in a phased way. 

If Council agrees to proceed, we’ll also plan for a proportionate approach to recognising professionals with existing advanced practice qualifications. 

We’ll present these recommendations to Council at its next meeting on 27 March. Subject to Council approval, we’ll do further engagement with our stakeholders and then run a public consultation on final proposals. We’ll continue to work collaboratively with members of the public, professionals and our partners to ensure any proposed changes are in the best interests of people receiving care.  

Sam Foster, Executive Director of Professional Practice, said: 

“Advanced practitioners bring significant knowledge, skills, and experience to provide person-centred care. Regulation is about enabling the public to have consistently high expectations and experiences of working with professionals across settings and locations. If Council gives us the green light to proceed with the additional regulation of advanced practice, we’ll continue to collaborate with the public, professionals and stakeholders to refine proposals that will support advanced nursing and midwifery practitioners to give the best possible care.” 

The Chief Nursing and Midwifery Officers for the four countries of the UK said: 

“It’s welcome news that the NMC is looking to develop approaches to the regulation of advanced practitioners. These professionals make a significant and positive impact on people’s lives every day, and it’s vital that everyone receiving care from them has confidence in their knowledge, skills and experience. 

"It's been encouraging to see the NMC engaging extensively with members of the public, professionals and stakeholders from across the UK. If the recommendations to the NMC's governing Council are approved, we look forward to further collaboration on this important matter and would encourage others to get involved where possible. Gathering views from across all four nations of the UK will be key to ensuring any proposed changes are in the best interests of the public and everyone receiving care.” 

Dame Ruth May, Chief Nursing Officer for England 

Kate Brintworth, Chief Midwifery Officer for England 

Maria McIlgorm, Chief Nursing Officer for Northern Ireland 

Caroline Keown, Chief Midwifery Officer for Northern Ireland 

Alex McMahon, Chief Nursing Officer for Scotland 

Justine Craig, Chief Midwifery Officer for Scotland 

Sue Tranka, Chief Nursing Officer for Wales 

Karen Jewell, Chief Midwifery Officer for Wales 

Anyone interested in our ongoing review can join our community of interest on advanced practice for all the latest updates, including opportunities to get involved. 

Further information: 

  • More information is available in the full independent report into our engagement and our detailed recommendations in our Council papers 
  • You can register to join our webinar on Monday 15 April, 13:00-14:00 where you can find out more about our decisions so far and our next steps 

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