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New head of NMC prepares to end impasse on advanced level practice
Dickon Weir-Hughes speaks to Tamsin Snow about advanced nurse practitioners, healthcare assistants and future fee rises
For more than a decade, nurse regulators and health departments have been grappling with the regulation of advanced nurse practitioners (ANPs).
The Nursing and Midwifery Council (NMC) agreed in 2005 to regulate the group and place it on a new sub-section of the nursing register, but implementation of the change stalled.
However, within three months of becoming NMC chief executive, Dickon Weir-Hughes has begun a fresh push, insisting the regulator is committed to ensuring ANPs are adequately trained.
Professor Weir-Hughes, a former trust director of nursing, explains: 'There is a commitment to making sure that the public is protected and that ANPs are competently and consistently trained.
Currently that it is not the case. While many ANPs take continuing professional development seriously, we need to make sure all patients are protected and receive consistent nursing care.'
He acknowledges that progress on the regulation of ANPs has been slow, but says it is important to re-open the debate to ensure the protection of the public.
‘When I took the job this was the one issue that nearly every nurse I had worked with said they hoped I would sort out,' says Professor Weir-Hughes.
‘As a director of nursing, I employed hundreds of ANPs. But we are not rushing ahead. ANP regulation has faltered before so if we decide to do it, we need to make sure it comes off.'
Healthcare assistants
He points out that, unlike healthcare assistants, ANPs are already registrants.
Earlier this month, the NMC ordered a study into the risks and benefits of UK-wide regulation of healthcare support workers (HCSWs).
The move has been welcomed by health unions, and researchers are expected to report back in the spring.
Professor Weir-Hughes says other bodies, for example the General Optical Council, already regulate HCSWs to whom their registrants delegate tasks.
‘We get hundreds of calls a week from nurses about delegating,' he says. 'The training of HCSWs is variable. We also receive many calls every week from members of the public who want to make a referral of someone they think is a nurse, but who is not. It is confusing for the public and we need to step up to the plate on this.
‘The easiest way ahead is for staff who accept delegated instruction from nurses and midwives to be regulated by the same group.'
Professor Weir-Hughes acknowledges that bringing HCSWs working alongside nurses and midwives under the NMC would be a challenge.
‘However, we are here to protect the public and if we take that responsibility seriously, we have to cut into the issue of regulation for HCSWs.'
Another task on Professor Weir-Hughes's agenda is to reduce the number of inappropriate referrals to the NMC. He points out that the regulator investigates more than two thirds of referrals, while the General Medical Council investigates around one third.
‘We would like employers to deal with staff locally where they can,' he says. 'A tiny number of nurses and midwives are referred and investigated, but we should be investigating cases of poor clinical care and patient safety, not employment matters or cases in which people have upset employers by doing something outside of work.'
Fee increases
Professor Weir-Hughes expects NMC fees to be discussed in the summer, when a strategy goes before the regulator's governing body. He believes fees should increase by a small amount on a regular basis rather than by a large amount every five years or so.
‘Smaller increases would be easier for people to budget for,' he says. 'However, no decision on this has been made.'
The professor has invited all directors of nursing, midwifery and human resources to one of 12 workshops on the fitness to practise process, the first of which will take place in March. Directors of nursing in the military and independent sector will also be invited to take part. practitioners, healthcare assistants and future fee rises.
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