Workforce issues
and improve a range of outcomes for people who use services. There is also an argument for better retention of people when so many are leaving the professions. The promise of increased recognition, status and better pay might not only attract more into the roles but also act as a retention factor. The ambition of the roles is that the expertise will benefit service users, practitioners and the NHS. Some of the key challenges they are designed to meet are to provide care more economically, addressing workforce shortages by providing higher level clinical roles and offering career development. The roles are not just confined to nursing,
there are also a number of advanced practice midwives – although, centrally, it is difficult to understand their roles, as midwifery has a considerable degree of autonomy already in its practice. Reviewing the Health and Care Professions
Council, there are around 2,000 allied health professionals who consider themselves to be practising or working towards advanced level practice in the UK in 2021 – roles in radiography and operating theatres being common care settings, as well as developed roles in the ambulance service. The advancement of clinical practice is
reliant on practitioners who can visualise the future with the potential of advanced practice and pursue that vision.4
They need to be bright
enough to manage the academic requirements, enjoy the challenge of problem solving and be resilient within a team, but often working alone. The experience of many nurses developing new roles as surgical care practitioners twenty years ago was that there was a degree of professional jealousy from colleagues, which made the
implementation of developing practice a difficult task, requiring great resilience by the individual. It is to be hoped that this era has passed.
Options for regulation The Nursing and Midwifery Council (NMC) has a number of options in front of it with decisions that have many consequences. The focus groups run by the Nuffield Institute as it worked on this report, held a consensus view that some form of specific regulation was required for advanced nursing and midwifery practice and that the status quo was not satisfactory. Individuals suggested that an annotation on the existing Register would be a reasonable way forward. This promises some benefits – a boost to the profession, clear standards for educational attainment and job descriptions and improved
patient safety without major revisions to other aspects of regulation.5 The regulator (NMC) could decide to leave
the regulatory framework as it is, at least in the short term before the Health Regulations Bill becomes law which will change many other aspects of healthcare professions regulation. The changes could equally imply that Nursing and Midwifery need to define more accurately the nature of advanced practice and annotate the current register for advanced practice qualifications or evidence of equivalence. In February of this year, a proposal for the
future of healthcare regulation was set out by the UK Government, following extensive consultation.6
The outcome is substantial reform
of the environment of healthcare regulation. The plan is to reduce some of the rigidity and inflexibility in the current legislation by a series of statutory instruments giving each regulator greater autonomy to set out their own ‘rules’ for the professions they regulate. This greater degree of freedom will enable
more flexibility to respond to future healthcare needs and to protect the public. There will be a duty to collaborate with other regulators. In addition, there will be an onus on each regulator to determine the standards of education and training, as well as to identify specific and approved education and training providers. It will be their responsibility to provide assurance that the providers are meeting the needs of the service and equipping learners with the skills, knowledge and experience they need. Other options for regulation, even in the new
environment, include developing a second tier of the current NMC register, specifically for advanced practitioners, based on competencies, which might be assessed by examination or
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www.clinicalservicesjournal.com I August 2023
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