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Testing times

Testing times

Revalidation hit the headlines in 2012 when the General Medical Council (GMC) introduced the process for all licensed/practising doctors. This meaning that if a doctor fails to engage with the process they can risk losing their licence to practice. Now history is repeating itself – all nurses and midwifes face revalidation, which the Nursing and Midwifery Council (NMC) claims will be ‘the most significant change to the regulation of nurses and midwives in a generation’.

The NMC has introduced revalidation replacing the Post Registration Education and Practice Standards (PREP) requirements previously set out by the NMC in 2008. This means that from April 2016 all nurses and midwives practicing in the UK will be required to revalidate every three years to maintain their registration with the NMC, which allows them to practice in the UK.

The NMC says: “The introduction of revalidation… will mean that everyone on the NMC’s register will have to demonstrate on a regular basis that they are able to deliver care in a safe, effective and professional way.”

Adding that “revalidation will help to encourage a culture of sharing, reflection and improvement… [and] it will allow nurses and midwives to demonstrate that they practice safely and effectively, strengthening public confidence in the nursing and midwifery professions”.

Additionally, the NMC has made it clear that it plans to have all 685,000 nurses and midwifes on the NMC register revalidated over the next three years.

This new regulation system can be considered a ripple effect from the revalidation process put in place by the General Medical Council (GMC) in 2012, which ensures all GPs working in the UK revalidate, normally every five years following a doctor’s first revalidation.

The GMC states on its website that “all licensed doctors are required to demonstrate on a regular basis that they are up to date and fit to practise in their chosen field and able to provide a good level of care”. Explaining that the aim of the process is “to give extra confidence to patients that their doctor is being regularly checked by their employer and the GMC”. However, Dr Gavin Jamie, a GP practising in Swindon doesn’t see the process as beneficial. He says: “There is not a great deal of enthusiasm for revalidation among working GPs.”

Jamie feels that revalidation is seen “largely as a paperwork exercise”, and can be time consuming for GPs, and doesn’t necessarily benefit patients. “There has never been any concrete claim of patient benefits from doctors’ revalidation and the GMC has instead concentrated on process.”

Although, Jamie does explain that being organised early makes revalidation easier, therefore, recording learning as it happens is a key way to prepare.

Niall Dickson, chief executive of the GMC says that the feedback they receive from “both doctors and employers [has] told us that revalidation is helping doctors to reflect on their practice”. Dickson also says that “more than 100,000 doctors have had their licenses revalidated and we expect to have covered the whole profession by the end of 2016. More than 1.6 million patients have given feedback on their doctors as part of this process.”

In terms of how nurses and midwifes revalidate, the NMC explain in their online downloadable guideline that eight requirements must be completed when revalidating (see Box 2).

The NMC does press that the process is not ‘an assessment of a nurse or midwives fitness to practice’, it is however, a ‘process that allows you to maintain your registration with the NMC’.

Janet Kelly, chief matron in community services at Northumbria Healthcare NHS Foundation Trust says: “Revalidation will work, however, I can see there may be some nurses who now work in different roles who could find the new process more difficult. There is a perceived additional workload too.”

However, this workload in Kelly’s opinion isn’t something nurses should be concerned about because it is something she feels nurses already do.

“I don’t believe it’s difficult for nurses to adapt to revalidation because as a nurse you typically reflect about your practice on a daily basis and revalidation just formalises the process,” she adds.

Marilyn Eveleigh, nurse advisor and independent trainer also feels there is a lot of negativity around revalidation that simply doesn’t need to be present. “Sadly, I have heard many nurses say they are not going to renew their registration under the new revalidation process. They are generally the ones who are worried, weary and overwhelmed.” But Eveleigh thinks that revalidation can actually help the nursing profession. “In a profession overwhelmed by pressures and uncertainties, revalidation is an opportunity for nurses to develop links, share and reflect on their practice and increase their self-worth.”

Kelly also sees the positive side and feels revalidation can help patient care. She says: “I think it will have a positive impact on the nursing profession in general as it helps to give patients reassurance of the high quality care available to them.”

The Queen’s Nursing Institute (QNI) feels that revalidation should be seen as an opportunity for the workforce, with the QNI’s chief executive Dr Crystal Oldman, saying: “I think it will serve to enhance practice, drive up standards of nursing care and will assure the public that nurses are actively evidencing their learning and reflection on practice… revalidation should not be perceived as a burden – it is an opportunity for the nursing profession.” But Oldman understands the process will require preparation. She says: “I think it [revalidation] will work – but like every change it will take time to embed and there will be a period of learning as we adjust to a new way of demonstrating that we are, as registered nurses, working in accordance with the NMC code.”

However, Oldman adds that revalidation can be challenging for nurses and midwifes that work in small organisation including GP practices and small care homes, because they can lack support from their employer and don’t always have a strong network of colleagues to “share practice, reflections and experience” with.

Heather Henry, co-vice chair at the NHS Alliance’s general practice nurse network agrees that it can be a more challenging process for those working in small organisations. Although, she feels that “for every challenge there is an opportunity”.

“Revalidation provides a call to action to accelerate the need to connect and support all nurses in primary care and it provides an opportunity for them to demonstrate their competence and value,” she adds.

Oldman also agrees that although there are difficulties the process should still be viewed as an opportunity for the nursing workforce. “Even in these situations though, revalidation can be viewed as positive as it may be the catalyst which starts local networks between colleagues working in these disparate environments.”

Danny Mortimer, chief executive of NHS Employers says: “It is critical that the preparation work that will now follow before revalidation goes live is focused on engaging with employers to address this. We are keen to work with the NMC and key partners to ensure that everything possible is done to ensure that the implementation of revalidation goes smoothly.”

The NMC’s introduction of revalidation has been supported by many organisations, but those, including NHS Employers and QNI have expressed the preparation it requires.

So what can nurses do in order to prepare for revalidation? The NMC has various resources on there website to support nurses and midwifes through the process, these include: guidelines, twitter chats, e-newsletters etc (see Resources section). Organisations such as the RCN also offer support to those awaiting the process, and have a variety of vaulable information on their wesbite to help nurses and midwives prepare for revalidation (see Resources section). See Box 1 for some top tips to get you prepared for revalidation.

Additionally, discussing the process and reflecting on practice with fellow colleagues can help with the transition. However, in instances like Oldman examined where nurses and midwifes don’t have employers and colleagues close to them to discuss revalidation with, it can open opportunities for individual nurses and midwifes to branch out and build new relationships.


NMC revalidation –

NMC revalidation templates –

NMC Code –

NMC revalidation preparation –

NMC revalidation guide –

RCN revalidation –

RCN top tips –

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The shadow of revalidation is looming over the nursing and midwifery profession, so preparations need to be made for the regulation checks they face from April 2016