BIRMINGHAM AND SOLIHULL MENTAL HEALTH NHS FOUNDATION TRUST TRUST BOARD TO BE HELD ON WEDNESDAY 29 JULY 2015 Item 6.5 NURSING & MIDWIFERY COUNCIL REVALIDATION FOR NURSES AND MIDWIVES Strategic or Regulatory Requirement to which the paper reports Strategic ambition 1: Continuously improving quality by putting patients at the heart of everything the Trust does to deliver excellence Strategic ambition 2: Develop strong, effective, credible sustainable relationships with key stakeholders, building the Trust s reputation CQC Outcome 13, regulation 22 Staffing CQC Outcome 14, regulation 23 Supporting workers ACTION: The Trust Board is asked to note the contents of this paper, the implications of the new professional regulatory processes for registered nurses and midwives and to support the preparatory actions underway in the Trust. To agree to receive a progress update in November 2015, following national confirmation of NMC Revalidation requirements. Executive Summary Purpose: To (a) provide an overview of the Nurse Revalidation process currently being piloted by the Nursing and Midwifery Council (NMC) and (b) to inform Board Members of the current Trust position in respect of preparing for Revalidation. Summary: Revalidation for all nurses and midwives across the UK is likely to come into effect on 31 st December 2015. The first registrants to be directly affected will be those due to renew their registration in April. The provisional process is currently being piloted across range of healthcare providers and higher education establishments. These will report in the autumn enabling the NMC to make a decision on formal implementation and to provide definitive guidance for employers and registrants. The aim is for all registered nurses to meet a number of minimum standards in the three years preceding the date of their application for renewal. Individuals who fail to meet the Revalidation standards will not be eligible to practice as a qualified nurse in the United Kingdom. The NMC proposes, where possible, that Revalidation should take place during appraisal. This would allow Revalidation to build on existing processes and minimise potential burdens in terms of staff time and cost. Key risks: (a) Risk that nurses and midwives are not aware of Revalidation or fail to take appropriate action themselves, therefore being unable re register with the NMC when their renewal date is due and consequently not able to work as a registered nurse. (b) Potential risk of financial implications if additional time or resources required for managers to undertake the role of confirmer and for the confirmation process itself. Currently this is anticipated to be integral to the appraisal process, but has yet to be formally agreed by NMC who are awaiting the national pilot and evaluation June 2015. A final announcement is expected October 2015 BOARD DIRECTOR SPONSOR: Sue Hartley, Executive Director of Nursing REPORT AUTHOR: Patrick Cullen, Senior nurse for Professional Standards & Quality Page 1 of 9 please leave this numbering how it is thank you
APPENDIX: Appendix 1. The Code: Professional Standards of Practice & Behaviour for Nurses& Midwives Appendix 2. How we are planning to support our registered nurses PREVIOUSLY DISCUSSED: BSMHFT Nursing Advisory Council; BSMHFT Nursing Revalidation Steering Group, BSMHFT Revalidation Sub-committee; Page 2 of 9 please leave this numbering how it is thank you
Briefing Paper for Trust Board NMC Revalidation for Registered Nurses and Midwives May 2015 1. Nursing Registration Current Position Currently, all Registered Nurses, Midwives, Community and Public Health Nurses wanting to practise in the UK have to be registered by the NMC for which they each pay an annual fee of 120. Registered Nurses and Midwives have to renew their registration every three years. The renewal process is through self-certification wherein registrants confirm they have practised for the minimum of 450 hours over three years, undertaken and recorded at least 35 hours of continuing professional development over three years and declare that they are of sufficient good health and good character to be a Registered Nurse or Midwife. The Francis Inquiry into Mid-Staffordshire recommended that the NMC introduce a system of Revalidation for Registered Nurses and Midwives. The purpose of Revalidation is to improve public protection by making sure that Registered Nurses and Midwives continue to be fit to practise throughout their career and give greater confidence to the public, employers and fellow professionals that Registered Nurses and Midwives are up to date with their practice. 2. What is Nursing Revalidation? Revalidation is intended to replace the current self-certification approach and will be a continuous process that nurses and midwives engage with throughout their career. The process is currently being piloted across a representative range of health services in all four countries of the UK. Therefore at this time the renewal process remains as set out in section 1. The pilot sites are due to report in the autumn with a formal announcement on full implementation of revalidation expected in October 2015 with the go live date expected to be 31 st December 2015. The aim is to enable increased positive affirmation of an individuals practice based on the new NMC Code of Conduct (2015). It is about promoting good practice across the whole population of nurses and midwives. It s not an assessment of a nurse or midwife s fitness to practise and it s not intended to address poor practice amongst a small number of nurses and midwives. The NMC already have fitness to practise processes in place for this. Poor practice will continue to be managed through performance, capability and fitness to practice routes. Revalidation is intended to ensure that nurses and midwives maintain their skills and knowledge, reflect on their practice against the standards in the newly updated NMC Code of Conduct (March 2015) and demonstrate that they are working within the Code on day-to-day basis. Page 3 of 9 please leave this numbering how it is thank you
3. Revised Code of Conduct (March 2015) The NMC proposals for a system of Nurse and Midwife Revalidation is underpinned by a new NMC Code of Professional Standards of Practice and Behaviour which came into effect on March 31st 2015. The Code sets the principles of what the public should expect from a nurse and midwife and is the basis for Revalidation. It is shaped around four principles, which states that nurses and midwives will: Prioritise people, Practise effectively, Preserve safety. Each principle has between 5 and 7 The Code was presented to our Nursing Advisory Council in advance of its launch and this was followed by a number of presentations at local governance forums and key meetings by the Trust Senior Nurse for Professional Standards and Quality. The presentations provided the context which had reshaped the Code the Francis report, The Neuberger Review, the Clwyd and Hart Report and the rise of social media and highlighted the key revisions and updates. To support this, some of the BSMHFT NHS Care Makers made a video about the revised Code. This was endorsed by the NMC Professional Standards Committee who deemed it excellent and embedded it on the NMC website. NHS Employers have since done the same. It is also available on Youtube where at time of report it has received 3400 views. We have designed a poster (again approved by the standards committee at the NMC) for display in all service areas to inform service users and remind staff what they should expect from registered nurses. Please see Appendix One. 4. Requirements under Revalidation The proposals intended to strengthen the current renewal process will require Registered Nurses to meet a range of Revalidation requirements designed to show that they are keeping up to date and actively maintaining their fitness to practise. These are A minimum of 450 practice hours over the three years prior to renewal. A minimum of 40 hours of continuing professional development (CPD) relevant to the registrant s scope of nursing practice. 20 of the 40 CPD hours must be participatory learning i.e. with other people At least five pieces of practice-related feedback over the three years prior to the renewal of registration. This may come from service users, students or colleagues. Feedback can be informal or formal, written or verbal. It could be specific feedback about the registrant or feedback about their ward, team or even the Trust. A minimum of five written reflections on the Code, CPD and practice-related feedback over the three years prior to the renewal of registration. These must be discussed with another NMC-registered nurse or midwife. Page 4 of 9 please leave this numbering how it is thank you
A good health and character declaration. Registrants must declare if they have been convicted of any criminal offence or issued with a formal caution Declaration of appropriate cover under an indemnity arrangement. All Trust employees are automatically covered by virtue of their employment in the NHS Registrants will need to provide evidence to a third party (known as a confirmer) that they have met the Revalidation requirements. In the provisional process, the confirmation discussion forms part of the registrant s annual appraisal with their line manager. The process also requires a Professional Development Discussion (PDD) with another registrant about the reflections on the Code. For the majority of nurses the line manager is also a registrant so the confirmation and PDD can be done in one appraisal meeting. Where the line manager is not a registrant the line manager can still confirm the evidence but a separate PDD will be required. It is our intention that n such situations, the registrant for the separate PDD will need the approval of the Deputy Director of Nursing. 5. Submission of Revalidation declaration The NMC will write out to the registrant 60 days prior to their renewal date to formally notify them of the upcoming need to revalidate. Confirmation that the registrant has met the requirements for Revalidation will be submitted to the NMC online. The confirmer will be required to countersign the declaration. The NMC have announced that a sample of registrants will be contacted to provide their portfolio. 6. BSMHFT Readiness Developments around Revalidation have been tracked by and discussed in the Nursing Advisory Council. Our Council contributed to the NMC consultation by way of formal correspondence by the Nursing Advisory Council Chair putting forward the Council s consensus view of the proposals to the NMC. A Nursing Revalidation Working Group has been convened led by the Deputy Director for Nursing and Quality who is the designated Trust lead for Revalidation of nurses. Other members include HR, workforce information, learning and development and staff side colleagues. It has not been necessary for the group to meet routinely during whilst the process is being piloted nationally but members have been kept appraised of developments arising from the pilot sites by the senior nurse for professional standards. The group was able to determine the following That the Trust already has appropriate arrangements in place to enable staff to receive required training, professional development, supervision and appraisal; and for them to be enabled to obtain further qualifications appropriate to the work they perform. These arrangements provide a solid foundation for Revalidation. Page 5 of 9 please leave this numbering how it is thank you
That we will amend the Working Better Together appraisal and Regular Management Supervision documentation to enable to the confirmation meeting for Revalidation to be captured That it is not our intention to recommend investment in an e-portfolio for nurses to collate their evidence as some other Trusts are exploring. That Electronic Staff Record (ESR) already provides Revalidation dates for all nurses. We used this to map out the impact of Revalidation in year one and to target the first affected registrants for support and awareness raising We will use ESR and notify registrants of the requirement over 112 months in advance. This notification will make it clear that it is the registrant and not the employer s responsibility. The purpose of this advance notice is to allow Ward Manager s to schedule appraisals (especially in areas where there may be a particular peak of staff needing to revalidate) and secondly to give the registrant as much time as possible to meet the requirements and gather their evidence. That particular policies such as registration and fitness to practice policies will require some revision once the implementation of Revalidation is formally announced The NMC have recruited KPMG to conduct a nationwide readiness assessment. Our Trust contributed to this and met the criteria for readiness set out in the assessment tool. We were also recently asked to provide assurance to Monitor. In the main the thrust of the preparatory work has been (a) To engage with the regional programme board for the Council to keep the Council up to date with developments (b) To draft a provisional Trust process for supporting registered nurses in the Revalidation process (see appendix two ) (c) To look at how we will embed Revalidation in existing trust processes rather than create new parallel procedures (d) To raise awareness amongst registered staff across the Trust of the requirements and to ensure that they are clear that it will continue to primarily be their responsibility to maintain their registration. We have engaged well with the regional programme board which reports to the national NMC Programme Board and have been asked to provide support and advice to other organisations on our proactive approach. In terms of raising awareness we have delivered the following (a) Revalidation has been highlighted in the Code road show delivered by our Senior Nurse for Professional Standards and Quality delivered across teams and forums in spring 2015 (b) We organised a morning long workshop event on 15 th May 2015 to help registered nurses start planning for Revalidation. This was part of our series of events to celebrate International Nurses Day. The morning was open to Nursing Advisory Council members and all registrants due to renew in April, May and June 2016 likely to be the first cohorts of registrants who will renew their registration under Revalidation. Page 6 of 9 please leave this numbering how it is thank you
We also invited colleagues in the local area working in more isolated services such as hospices and care homes. Each attendee was provided with an information pack about Revalidation and the Code. After a few short presentations about Revalidation. Attendees broke into three groups for smaller work groups on a. Using reflection to improve practice b. Practical advice for developing a portfolio (session delivered by the RCN) c. Using the Code in every day practice The event closed with a presentation of the proposed trust oversight process and a question and answer session. The workshop evaluated very positively. Attendees agreed unanimously with the proposal to not invest in an e-portfolio system. (c) Regular email bulletin updates to all 56 members of the Nursing Advisory Council (d) Started a Revalidation Newsletter in June which has been disseminated across all service Based on the positive evaluation of the work shop on 15 th May, we have planned a number of shorter sessions covering all Trust areas in September and October. It is intended that the sessions will reinforce the Code, update on Revalidation (as the pilot comes to a conclusion) and will particularly highlight the recently launched guidance from the NMC/GMC on professional duty of candour. In addition to classroom sessions we are also providing webinar updates for those on night duty. We are also developing a Trust intranet site with the support of colleagues from communications and marketing team and have devised a board game to help raise staff awareness. The senior nurse for professional standards was invited to attend the Trust Revalidation sub-committee and advised committee of the developments for nursing. We have been invited to attend again once the pilot of the process has concluded and the way forward is more definite, in order to discuss whether the committee will be happy to receive a report on Nursing Revalidation for assurance on behalf of the Trust board. 7. Summary The Trust has done a lot of work to prepare for Revalidation for Nursing, building on the existing solid foundation for learning and development and appraisal of staff. We have articulated our approach to supporting staff to meet their requirements whilst making it clear that the onus is on the individual registrant and not the employer. We have engaged with the regional programme board and are well regarded for the work we have done and support we have provided to other colleagues in the local health economy. Revalidation for Nursing has been and continues to be something of a moving feast. We therefore hope that this update for Board is helpful and would ask that we are allowed to present again in November 2015 by when a formal announcement on full implementation will have been made. Page 7 of 9 please leave this numbering how it is thank you
Appendix One Page 8 of 9 please leave this numbering how it is thank you
Appendix Two How we are planning to support our registered nurses Revalidation is the responsibility of each individual registrant. The Trust however is developing processes to support staff in the Revalidation process. The provisional process is outlined below we would welcome any comments or suggestions on this. Please email Stuart Wix, Deputy Director for Nursing and Quality. Revalidation requires third party confirmation agreement from another registrant that the RN has met the requirements. For most RNs that will come from their line manager. If an RN is not managed by a registrant then the confirmer must be another RN or healthcare professional who has a good knowledge of the RN s practice. If the confirmer carrying out the Professional Development Discussion (PDD) is not the RNs line manager, this will need approval from the Deputy Director for Nursing and Quality The NMC will provide RNs with 60 days notice. We plan to write out a year in advance as this will give RNs more time to ensure they have met the requirements and allow managers to ensure Revalidation appraisals are scheduled We are planning to embed Revalidation into our existing appraisal and Working Better Together process rather than create a new one. We will be monitoring all participants experience of the Revalidation process to ensure fairness and to promote consistency The Trust has a Revalidation subcommittee of the Board which oversees Revalidation of medical colleagues Page 9 of 9 please leave this numbering how it is thank you