REPORT TO TRUST BOARD
Date: 9 December 2015
Agenda No: 8.8
Date Paper produced:
Paper Title:
5 November 2015
Nursing and Midwifery Council (NMC) Revalidation for Nurses and
Midwives
Sponsoring Director
(responsible for signing
off report):
Michael Fanning Director of Nursing, Midwifery and AHP’s
Author:
Purpose/Decision
required:
Impact on Patient
Experience:
Jacquie Woodcock - Lead Nurse Professional Development and Education
Jackie Green – Consultant Nurse Haematology and Oncology
The purpose of the paper is to provide the Board with the information
related to NMC revalidation.
To assure public of workforce that is fit to practice.
Impact on Financial
Improvement
History: (which groups
have previously
considered this report)
Nursing, Midwifery and AHP Board have considered the implications of
revalidation and reviewed the draft versions of the Nursing Revalidation
policy for CHS.
EBM Q&O - 12 November 2015
Quality & Clinical Governance Committee – 17 November 2015
Executive Summary
This paper sets out the rational, purpose and requirements for nursing and midwifery revalidation, the
responsibilities of the Trust and action required to be prepared for the introduction of revalidation.
In April 2016 the NMC will introduce a new process of revalidation for all nurses and midwives.
Following recent revelations regarding poor practice the NMC have introduced this method of
Revalidation in order to provide confidence to the public, employers and fellow professionals that
nurses and midwives are up to date with their practice. The purpose of revalidation is to improve public
protection by making sure that nurses and midwives continue to be fit to practise throughout their
career.
Revalidation replaces the completion of a self-declaration form completed every three years. Whilst all
nurses and midwives have been expected to maintain a professional portfolio the new guidance sets
out a clear criteria for this and requires this evidence of practice achievement and development to be
discussed with and signed off by a third party.
Revalidation will provide nurses and midwives with the opportunity to reflect on their practice against
the standards in their NMC code of conduct and demonstrate that they are ‘living’ these standards. The
paper outlines the process for revalidation which is dictated by the NMC.
The paper also outlines how awareness of the launch of revalidation is to be communicated through: a
grand round, revalidation surgeries, information on the nursing page on the intranet and an agreed
Final Nurse Revalidation Report – Trust Board Dec 15
-1-
communication to go out to all nurse’s from the Director of Nursing, Midwifery and AHP’s.
The Trust need to consider the identified risks which are:

The risk to the Trust in relation to maintaining the nursing and midwifery workforce is lack of
engagement with this process leading to non-compliance with revalidation process. In order to
mitigate this risk the means of dissemination and awareness of ‘Revalidation’ needs to be
instigated. Line managers need to be responsible for ensuring that each nurse/midwives they
manage have provided them with their date of revalidation.

The new appraisal proforma does not align itself with the revalidation process. Further discussion
and review of the new appraisal documentation is required.

If an individual nurse/midwife has not complied with re-validation requirements they will not be
deemed fit to practice and will be referred to the NMC revalidation policy.

Trust will need to have an appropriate software package for nurse’s and midwives to access in
order they are able to upload information to revalidate. This will need to be similar to the doctors
SARD computer programme for revalidation. This could be achieved by updating sufficient
computers that the registrants and confirmers can access www.nmc.org.uk/registration/nmconline this requires an update in software on many computes or the Trust purchase software that
is available on the market.
The Trust reports progress on the plans to support revalidation to the Director of Nursing at the Trust
Development Authority.
Key Issues for discussion





The planned dissemination and support is appropriate and fit for
purpose and the agreed trust responsibilities.
The confirmer will normally be the registrant’s line manager or an
agreed designated senior nurse and the appropriate training
required.
The process for deferral (if approved by the the NMC).
How to mitigate the identified risks outlined above.
Agree how the revalidation process links with the Trust appraisal
system.
Related Corporate Objective:
Corporate Objectives: Links to corporate objectives to improve quality and manage resources.
Related CQC 5 Key Areas of Care:
√
Safe
√
Effective
√
Responsive
√
Caring
√
Well-Led
Has an equality impact assessment form been completed?
Yes
If not applicable, Please state why not applicable.
Has legal advice been taken?
No
Does this report have any financial implication? To be considered: possibly IT costs and project
manager costs.
If so, has the report been approved by the Financial Department? No
Final Nurse Revalidation Report – Trust Board Dec 15
-2-
NMC Revalidation
1.
Background
In April 2016 the NMC will introduce a new revalidation process for nurses and midwives.
Following recent revelations regarding poor practice the NMC have introduced this method of
revalidation in order to provide confidence to the public,employers and fellow professionals that
nurses and midwives are up to date and fit to practice. The purpose of revalidation is to improve
public protection by making sure that nurses and midwives continue to be fit to practise
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 will provide
nurses and midwives with the opportunity to reflect on their practice against the standards in
their NMC code of conduct and demonstrate that they are ‘living’ these standards.
This system replaces the completion of the self declaration form completed every three years.
Whilst all nurses and midwives have been expected to maintain a professional portfolio the
new guidance sets out a clear critieria for future requirements and how this evidence of practice
achievement and development is to be discussed with and signed off by a third party.
Revalidation is a requirement of individual nurses and midwives. Trusts are not obliged to
provide specific support to the nurses and midwives they employ. However, providing support
for revalidation could be considered as a key part of a Trust’s quality and assurance systems.
Good employment practice requires employers to have support in place so that the nurses and
midwives employed are competent to provide safe and effective care.
2.
Requirements for Revalidation
2.1
Revalidation is built on existing arrangements and adds requirements which encourage nurses
and midwives to seek feedback from patients and colleagues,reflect upon the Code by having a
professional discussion with another registrant and, importantly, seek confirmation from a third
party (confirmer) that the requirements for revalidation have been met.
Revalidation reinforces the duty on all nuses and midwives to maintain their fitness to practise
within the scope of their individual practice and incorporate the Code in their day to day practice
and personal development. Revalidation will encourage engagement in professional networks
and discussions, and reduce professional isolation.
Revalidation will enhance employer engagement by increasing their awareness of the NMC
regulatory standards, encouraging early discussions about practice concerns before they
escalate or require referral to the NMC, and increasing access and participation in appraisals
and professional development.
Revalidation supports professionalism through a closer alignment with the NMC Code of
Conduct. The revalidation model aligns to the four themes of the Code which are;
(i)
Prioritise people by actively seeking and reflecting on any direct feedback received
from patients, service users and others to ensure that you are able to fulfil their needs.
(ii)
Practise effectively by reflecting on your professional development with your
colleagues, identifying areas for improvement in your practice and undertaking
professional development activities.
Final Nurse Revalidation Report – Trust Board Dec 15
-3-
2.2
(iii)
Preserve safety by practising within your competency for the minimum number of
practice hours, reflecting on feedback, and addressing any gaps in your practice through
continuing professional development (CPD).
(iv)
Promote professionalism and trust by providing feedback and helping other NMC
colleagues reflect on their professional development, and being accountable to others
for your professional development and revalidation.
Nurses and midwives will need to meet a range of revalidation requirements designed to show
that they are keeping up to date and actively maintaining their fitness to practise. This will
include undertaking a range of continuing professional development activities and ensuring
completion of a minimum amount of practice. It is recommended that some of these activites are
identified and agreed as part of the annual appraisal system.
Nurses and midwives work across a wide range of roles, functions and settings. For example,
these include roles in front line clinical care both in acute and community settings, roles in
nursing and midwifery education and research, policy advisory roles and management and
leadership roles specific to nursing or midwifery. The activities they undertake to meet these
requirements will reflect the individual scope of practice as a nurse or midwife.
Nurse and midwives will need to meet with a third party to discuss their compliance with the
revalidation requirements.In most cases the third party will be the nurse or midwives immedicate
line manger and this process will be undertaken as part of their appraisal.
2.3
The NMC recommends that all nurses and midwives maintain a portfolio of evidence that will
demonstrate that they have met the requirements of revalidation. This will be used in the
discussion with the third party-confirmer.
The portfolio will need to provide evience to support the following:
Achievement of minimum practice hours
Nurse
Midwife
Nurse and SCHPN12
Midwife and SCHPN
Nurse and midwife (including Nurse/
SCHPN and Midwife/SCHPN
450
450
450
450
900 (450 Nursing and 450 Midwifery)
Continuing professional development
Nurses and midwives need to show evidence of undertaking 40 hours of continuing
professional development (CPD) relevant to their scope of practice as a nurse or midwife, over
the three years prior to revalidation. Of those 40 hours of CPD, 20 must include evidence of
participatory learning.
Practice-related feedback
Nurses and midwives must obtain at least five pieces of practice-related feedback over the
three years prior to revalidation.
Reflection and discussion
Nurses and midwives must record a minimum of five written reflections on the Code, their CPD,
and practice-related feedback over the three years prior to the revalidation.
Health and character
Nurses and midwives must provide a health and character declaration.
They must declare if they have been convicted of any criminal offence or issued with a formal
caution over the three years prior to their revalidation.
Final Nurse Revalidation Report – Trust Board Dec 15
-4-
Professional indemnity arrangement
Nurses and midwives must declare that they have, or will have when practising, appropriate
cover under an indemnity arrangement.
Confirmation from a third party
For the purposes of revalidation nurses and midwives will be asked to make a declaration that
they have demonstrated to an appropriate third party that they have complied with the
revalidation requirements. The NMC have provided a form online for use to obtain this
confirmation from the third party. The name, NMC PIN or other professional identification
number (where relevant), email, professional address and postcode of the appropriate third
party will need to be provided.
2.4
The distinction between revalidation and raising fitness to practise concerns
Revalidation is based on a third party evaluation of a nurse or midwives ongoing fitness to
practise. Confirming the registrants fitness to revalidate is a specific interaction with the NMC
that stands apart from other contact with the NMC (for example, raising concerns about a
nurse’s fitness to practise). Importantly, revalidation does not replace or override the NMC’s
existing procedures for dealing with concerns about fitness to practise.
The confirmers recommendations about the nurse or midwife’s revalidation are not a route for
raising concerns about their fitness to practise with the NMC. Concerns about nurses’ fitness to
practise must be referred to their line manager.
2.5
Revalidation and the appraisal system
For the confirmer to recommened the registrant is fit to revalidate they must agree to
statements relating to the registrants participation in annual appraisal during the revalidation
period. It is recommended that for the majority of nurses and midwives this third party
confirmation will be undertaken by their line manager as part of the annual appraisal process.
To revalidate the registrant must participate in annual appraisals that have the code of conduct
at the core and maintain a portfolio of supporting information. The information that forms part of
the portfolio should form the basis for discussion at the appraisal. It is recommended that some
of the activity required to demonstrate fitness to pratice are identified and agreed as part of the
annual appraisal system.
2.6
A registrant is not ready to revalidate
The NMC have not as yet pronounced on the action to be taken if the registrant is not
ready to revalidate but based on the GMC guidance the following may apply:
A deferral request:
A deferral request is a request made by the confimer to the NMC for the NMC to provide the
registrant and confirmer with more time in which to submit a recommendation of revalidation. A
successful deferral request results in a revised submission date for revalidation that is later
than the original revalidation submission date. It should be agreed how long the registrant will
need to collect any outstanding supporting information that the confirmer will need in order to
confirm the registrants fitness to revalidate.
Deferral requests apply to nurse’s and midwifes who are:
Final Nurse Revalidation Report – Trust Board Dec 15
-5-

Engaged in the systems and processes that support revalidation, but about whom there is
incomplete information on which to base a positive recommendation (this will be where a
nurse has not been able to gather all of the required supporting information by the time
the revalidation submission date falls due).

Participating in an ongoing local human resources or disciplinary process, the outcome of
which may be material to your evaluation of the doctor’s fitness to practise and that you
will need to consider prior to making your recommendation.
When is a deferral request considered appropriate?
.
Some Nurse’s and Midwife’s may not have been able to collect and reflect on all of the required
supporting information by the time that their revalidation falls due.
Examples of the reasonable circumstances that could account for a nurse or midwife having
incomplete supporting information might include:




parental leave
sabbatical or break from practice
periods of practice outside the UK
sick leave
This list is not exhaustive. The confimer must exercise their judgement in determining whether a
nurse or midwife has engaged in the local processes that support revalidation, and whether it is
appropriate to request a deferral.
3.
Trust Responsibilities
The NMC have provided guidance for employers regarding their responsibilities towards
nurses and midwives in the revalidation process. These have been categorised as the
minimum support that could be offered and that which could reasonably be expected.
Croydon Health Service NHS Trust as a responsible employer will aim to meet the category of
“reasonably expected” the table below outlines the expectations required of the employer and
how Croydon Health Service can achieve these requirements.
Reasonably Expected Table
Final Nurse Revalidation Report – Trust Board Dec 15
-6-
Core building blocks of support that you might
be “reasonably expected” to put in place that
would assist your nurses and midwives to
successfully revalidate and contribute to greater
professionalisms
Awareness and
Culture
 Understand the proposed
changes to current
requirements and how
revalidation will impact on
nurses and midwives in the
organisation
 Communicate to your nurses
and midwives the changes
and new requirements under
revalidation
 Put basic plans in place to
support revalidation and share
with organisations leadership.
Resources
capacity and
capability
 Assess what is needed to
support revalidation in your
organisation including what
level of support staff may
require , along with plans to
address this.
 Ensure line managers are
made availiable to undertake
confirmation roles and where
relevant, professional
development discussion roles
 Identify renewal dates for all
of your nurses and midwives
 Encourage nurses and
midwives to register for NMC
Online
 Put plans in place for all
nurses and midwives to
receive confirmation as part of
your appraisal process, or an
alternative process
 Permit access to feedback
where it already exists
(including audits, satisfaction
surveys, complaints and the
nurse or midwife’s individual
appraisal).
 Signpost nurses and
midwives to the NMC’s
standards, guidance,
information and materials on
revalidation.
 Provide further information
about roles, responsibilities,
and expectations for nurses,
midwives and confirmers
within your organisation
(including clinical and nonclinical).
 Provide further information
Systems and
processes
Final Nurse Revalidation Report – Trust Board Dec 15
Croydon Health Service NHS Trust
Suggested actions
 Nominated leads for revalidation develop
paper for Board and policy and share this
with Senior Mangement.
 Trust Focus
 Grand Round
 Provide and disseminate information on
revalidation via:
o Letter form Director of Nursing to go
out with each nurse/midwive payslip
o Intranet/Link to NMC website
o Revalidation Surgeries (dates
booked throughout September 2015)
o Matrons meetings
o Ward managers meetings
o Keep TDA informed of plans.
 Revalidation Surgeries – to assist nurses
and midwives to acess NMC Online and
confirm their revalidation date
 Workshops for confirmers
 Workshops on reflective writing/highlight
other suitable evidence .
 Use allocated management time and
integrate with appraisal.
 Revalidation surgerys to highlight NMC
On-Line via methods above and advise
ward mangers to ask staff to provide them
with details of revalidation date ? set
deadline for this process to be completed
e.g. end of November 2015.
 Provide link to this on Intranet page and
offer “surgeries” to assist access.
 Work with HR to review inclusion of
revalidation within appraisal process.
 Provide preparation for confirmers
 Workshops on reflective writing/highlight
other suitable evidence.
 Nurse and Midwives will be provided with
guidance through the following activities:
o Trust focus
o Grand Round
o Provide and disseminate information
on revalidation via:
o Letter form Director of Nursing to go
out with each nurse/midwive payslip
o Intranet/Link to NMC website
o Revalidation Surgeries (dates
booked throughout September 2015)
o Matrons meetings
o Ward managers meetings
 Draft NMC Revalidation Policy wriiten to
outline these rsponsibilities.Roles and
responsibilites wil be outlined in
-7-

Guidance, tools
and support





4.
about who in your
organisation can perform this
confirmer role as detailed in
the NMC’s requirements
Develop information and
examples setting out the
expectations you have for
your registered nurses and
midwives regarding each
aspect of revalidation. These
could include: an example of
a note of feedback received,
an example of a written
reflection or evidence of
having undertaken a
development in clinical
practice as per the NMC’s
requirements
Review whether informal
organisation systems could be
implemented to allow for
participatory (joint/team) CPD
learning
Take a view locally about
issues such as reflective
models that could be adopted
by or suggested within your
organisation to support and
guide reflective processes.
Make job descriptions or other
relevant information available
for nurses and midwives
across bands to assist with
additional reporting
requirements on practice
hours, should these be
requested
Plan to communicate
requirements for online
revalidation submission and
timing for this submission.
Remind nurses and midwives
of their obligations of
confidentiality under the Code
and Data Protection
legislation.
Revalidation Surgeries and NMC
revalidation policy will outline who in the
organisation will take on the role of
confirmer. Those identified as having this
role will be expected to attend workshops
for Confirmers.
 Develop proforma for portfolio with
examples of evidence this could be
accessed alectronically via NMC
revalidation Intranetpage.
o Current Clinical Supervison policy needs
review and decision made re which
reflective model is promoted for use
across Trust.
o Liase with HR could JD’s be loaded onto
Intranet
 Nurse and Midwives will be provided with
guidance through the following activities:
o Trust focus
o Grand Round
o Provide and disseminate information
on revalidation via:
o Letter from Director of Nursing to go
out with each nurse/midwive payslip
o Intranet/Link to NMC website
o Revalidation Surgeries (dates
booked throughout September 2015)
o Matrons meetings
o Ward managers meetings
o Nurses and midwives will be
reminded via information on intranet
and during Revalidation Surgeries of
their obligations of confidentiality
particularly in relation to producing
evidence for Practice-related
feedback and Reflection and
discussion
Resources
Final Nurse Revalidation Report – Trust Board Dec 15
-8-
4.1
The resources required to support the dissemination of information for nurses and midwives on
NMC revalidation:
(a)
The communctions team will be asked to support the development of an NMC
Revalidation page on the Intranet.
(b)
Practice Education Team to plan and run Revalidation Surgeries 6 dates have been
planned for September 2015. Each surgery will run for an hour to inform nurses and
midwives on the requirements for revalidation. This will include how to acess NMC online
to find their individual date for revalidation.
(c)
Practice Education team to run workshops on reflective writing and also for those
identified within the organisation as confirmers-dates yet to be set.
(d)
Access to computers to undertake the revalidation process on line.
5.
Risks
5.1
The risk to the Trust in relation to maintaining the nursing and midwifery workforce is lack of
engagement with this process leading to non compliance with revalidation process. In order to
mitigate this risk the above means of dissemination need to be instigated. Line managers need
to be responsible for ensuring that each nurse/midwife they manage have provided them with
their date of revalidation.
5.2
The new appraisal proforma may not align itself with the revalidation process. Further
discussion and review of the new appraisal documentation is required.
5.3
If an individual nurse/midwife has not complied with re-validation requirements they will not be
deemed fit to practice and will be referred to the NMC revalidation policy.
5.4
The Trust will need to have a appropriate software package for nurses and midwives to access
in order they are able to upload information to revalidate. This will need to be similar to the
doctors’ SARD Computer Programme for revalidation. This could be achieved by updating
sufficient
computers
that
the
registrants
and
confimers
can
access
www.nmc.org.uk/registration/nmc-online this reqiuires an update in software on many
computers or the Trust purchase software that is available on the market.
Final Nurse Revalidation Report – Trust Board Dec 15
-9-