Health Service Focus

Revalidation must be seen as an improvement process

Head of learning and education at the Royal College of Midwives, Carmel Lloyd, and the Royal College of Nursing’s head of policy and international affairs, Howard Catton, discuss revalidation for their members.

As NHE went to press, revalidation, the new process that all nurses and midwives in the UK will need to follow to maintain their registration with the NMC, went live. 

The new process replaces the PREP requirements, and nurses and midwives will have to revalidate every three years to renew their registration. It also includes a number of new requirements including nurses and midwives demonstrating that they have practised a minimum of 450 hours, five written reflective accounts, a reflective discussion and how this links to the new NMC Code. 

When the NMC first talked about the idea of revalidation three years ago it was met with some scepticism, with former CEO of NHS Employers Dean Royles noting that employers would have concerns about implementation, and “the scale of the challenge in reaching the 670,000 registrants should not be underestimated”. 

However, fast forward to 2016, following an extensive pilot phase, and revalidation is here. In fact, in February, more than 80% of those on the register had signed up for an NMC online account, which they need to submit their application for revalidation. 

The Royal College of Nursing’s (RCN’s) head of policy and international affairs, Howard Catton, said lots of effort has been made with key organisations and employers in the build up to the go-live date, and the pilots have led to a remodel of revalidation. He is also confident that, despite there still being some concerns from members, there is “enormous potential” for the new process. 

Carmel Lloyd, head of learning at the Royal College of Midwives (RCM), added that the information and support the NMC has developed has also been “incredibly useful, it has been very detailed and our members are using its information”.

She said midwives are used to doing an annual review about their practice, though they may not have done it in the structured way as has been laid out by revalidation, “but the model, if you like, wouldn’t come as a complete shock to them”. 

Revalidation is not about fitness to practise 

Both Lloyd and Catton noted that there are still some concerns from members with regards to the extra amount of time revalidation will take, writing reflections in a new way and some are worried that the process could focus on critical feedback and poor performance. 

But the NMC notes that revalidation is not about whether a nurse or midwife is fit to practise. The role of the confirmer in the revalidation process is an important one as they will confirm that they have seen the evidence that a nurse or midwife has met all the requirements – but they are not making a judgment about whether they are fit to practise. 

“It is really important to have the conversation about flipping mind-sets around revalidation,” said Catton. “Revalidation has enormous potential. At the bottom line it provides patients and the public with an assurance that the professionals looking after them have their skills up to date. Above and beyond that I think it has potential to drive quality improvement within organisations that foster the more open, collaborative and blame-free cultures that everybody would say we want. 

“Some of the organisations that have already strong appraisal processes in place, linked to their training and development plans for staff, where there is strong clinical leadership, revalidation will be less onerous for them. But appraisal and revalidation must be separate.” 

He added that for those employers where good HR processes aren’t in place, or they are starting from a lower base, the task is likely to be harder. 

The Code as a living document 

With regards to writing the reflective accounts for revalidation, Lloyd noted that many midwives will have written something very similar in the past. “It might not have been in the structured way the NMC requires, because they might not have directly linked it to the Code, but many will be prepared to some degree,” said Lloyd. 

“I think the new Code is more modern than what went before. I think the way they outline it is very clear and is easy for people to work with. I recently wrote a reflective account on something I had done CPD-wise, and it was very easy to link with what was in the Code. 

“What it will do is make the Code a living document. The NMC is right in this regards, and they are trying to get people to engage with it. People will, hopefully, be reflecting on things that go well as well as things that don’t.” 

Seeking support 

Both Lloyd and Catton stressed the importance of nurses and midwives seeking support from the NMC, RCN and RCM if they have any concerns with regards to the revalidation process. 

“If midwives have got concerns they should talk to their supervisor of midwives because they are the people who are easily accessible at the moment, but also at the RCM,” said Lloyd. 

Catton added that the RCN, which has been involved throughout the revalidation development process, is aware that its members work in a myriad of settings, and there can be issues for those working in smaller or more isolated roles. 

“What we’ve said is for people to talk to colleagues about how they can still comply with revalidation,” he said. “One of the principles at the heart of the new model is that it absolutely has to work for all nurses in all settings. It isn’t about a model for somebody working in a big NHS trust or private or charitable organisation.” 

Revalidation evaluation 

NHE was told that it will be vitally important that the NMC will continuously evaluate revalidation, which is something the organisation has said from the outset it will do. 

“When you do a change this size it would be remiss if you didn’t,” said Lloyd. “They need to check that the specifications are right, or whether it is a step too far, and what the impact is.” 

She added that it will be important to have a detailed impact analysis on nurses and midwives at an induvial level, but also the system. So, how easy is it to deliver this from the perspective of the employers? 

Both representatives noted that it is important that employers feed back to the NMC in terms of impact and what it is costing in terms of time.

Revalidation Requirements 

• 450 practice hours, or 900 if renewing as both a nurse and midwife
• 35 hours of CPD including 20 hours of participatory learning
• Five pieces of practice-related feedback
• Five written reflective accounts
• Reflective discussion
• Health and character declaration
• Professional indemnity arrangement
• Confirmation

FOR MORE INFORMATION

W: http://revalidation.nmc.org.uk

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