Workforce issues
a portfolio. This is generally viewed, at least internationally, as offering the most advantages to both the public and the profession. Those in the focus groups who advocated for a second tier often did so because they believed in wholesale reform which would remove the historical irregularities and anomalies left over from previous reforms. However, as we have discovered with the development of new powers and autonomy for the NMC, perhaps that time has already come.
Other routes to strengthening advanced practice The NMC could, regardless of the heralded changes to healthcare regulation, make use of other influences such as engaging and encouraging employers to develop consistency in roles and role descriptions. Greater governance and safeguards for the public could be attained by promoting consistency and quality in education delivery across advanced practice academic programmes. Northern Ireland and Scotland have set precedents for this by developing and implementing a joined-up system of service and educational needs assessments matched to the commissioning of educational places, alongside robust governance and accountability arrangements. It has also been suggested that other
regulatory bodies should be encouraged to be more vigilant in ensuring that practitioners are appropriately employed, with structures in place to enable governance and oversight. This could be reviewed by the Care Quality Commission who already has the power to ensure that staff have the appropriate qualifications, competence, skills and experience to keep patients safe, as well as a broad oversight of different care providers. There is also a view that there should be a
cross-national strategy to address the issues of advanced practice across the departments of health, the medical and nursing Royal Colleges, higher education providers and employers. To this author, this solution seems to be a bit of a ‘fudge’, giving no one the final say and inevitably a compromised outcome on all fronts. However, more responsibility could be given to employers to ensure that they support and strengthen the accreditation of courses and the credentials of individual practitioners.
Conclusion There are no published decisions yet on how the NMC will respond to the deliberations and the content of this report. The timing is interesting, coming as it does at a time of
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significant change to all healthcare regulation and with greater freedom for the NMC to determine its own rules for practitioners at every level. Any proposed regulation of advanced practice would need to meet the Professional Standards Authority principles of good regulation, the report states, which is that regulators should act in ways that are proportionate, consistent, targeted, accountable and agile.7 A shift from professional self-regulation
seems to be inevitable with an increasingly litigious population and greater morbidities in the patient population. Advanced practice is a good thing for the individual practitioner and for their patients, but it needs to be assured by appropriate level management and governance to enable it to develop safely. Advanced practice probably needs to be contained in a more constructed framework, so that employers,
the individuals, their educators and mentors all understand the context, so that patient safety is upheld at all times.
References 1. The role of advanced nurse practitioners | Nursing in Practice
2. Independent report on the regulation of advanced practice in nursing and midwifery | Nuffield Trust
3. Ibid 4. Ibid 5. Ibid 6.
https://www.gov.uk/government/consultations/ regulating-healthcare-professionals- protecting-the-public/outcome/regulating- healthcare-professionals-protecting-the-public- consultation-response-executive-summary
7. Ibid
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