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The NMC: Are we getting good value for money?

Along with the approximately 670 000 registered nurses in the UK, I receive notice from the Nursing and Midwifery Council (NMC) every year to pay the registration fee, a fee that is mandatory to be able to practise as a nurse in the UK. In February this year, the fee rose from £76 per annum to £100 per annum. If my calculations are correct that means that there now is an annual income of £67 million, which is an increase of almost £17 million from last year. I have often pondered on how that fee was spent.

Just in case you need reminding of what the NMC does, you can find the statement below in the NMC document The Code (NMC, 2008):

“We set the standards of education, training and conduct that nurses and midwives need to deliver high quality healthcare consistently throughout their careers. We ensure that nurses and midwives keep their skills and knowledge up to date and uphold the standards of their professional code. We ensure that midwives are safe to practise by setting rules for their practice and supervision. We have fair processes to investigate allegations made against nurses and midwives who may not have followed the code.”

So, it seems that the NMC, which takes £100 of our hard-earned cash each year, actually does nothing for nurses other than give us permission to practise. 

NMC expenditure
The 2011/2012 NMC annual report (NMC, 2012) stated that the total NMC expenditure was £61 million and annual income was £53 million, creating a deficit of £8 million, which was funded by reserves. Income from our fees must cover all the regulatory activity including quality assurance of education, maintenance of the register, development of standards, statutory supervision of midwives and the processing of “fitness to practise cases”. It seems to me that these core functions only ensure the protection of the public. Without a fee increase the NMC state that available reserves will run out by the end of this year (www.nmc-uk.org/Get-involved/Consultations/Past-consultations/NMC-fee-increase/FAQs-on-NMC-fee-rise). 

Increase in complaints against nurses
Unfortunately, complaints against nurses and midwives have soared by 48% since 2010 and the NMC caseload has increased as a result. To deal with the “fitness to practise” caseload in 2012–2013, the NMC forecast that expenditure will reach £42 million alone. Why this increase – are nurses becoming less safe or are the people we care for finding it easier to complain? 

Last year, I was asked to act for the NMC as an expert witness in a case of alleged misconduct. These hearings are conducted like any court hearing with solicitors, barristers, an adjudicating panel and expert witnesses. All of which are expensive. In all cases the NMC is working on behalf of the public. 

My experience of acting as an expert witness was interesting and personally beneficial as it made me recognise areas of my own practice which needed a spring clean. It was a huge wake-up call for me as far as record keeping is concerned. Since being involved in this case my record keeping skills have improved immensely, regardless of how much time it takes. 

I think you would all benefit from having a look at the booklet, Record Keeping: Guidance for Nurses and Midwives (NMC, 2010) to ensure that your record keeping is up to the required standard. I know we are all busy, but I would not want any of you to have to go through one of these hearings as a result of poor record keeping. Happy reading.

Along with the approximately 670 000 registered nurses in the UK, I receive notice from the Nursing and Midwifery Council (NMC) every year to pay the registration fee, a fee that is mandatory to be able to practise as a nurse in the UK. In February this year, the fee rose from £76 per annum to £100 per annum. If my calculations are correct that means that there now is an annual income of £67 million, which is an increase of almost £17 million from last year. I have often pondered on how that fee was spent.

Just in case you need reminding of what the NMC does, you can find the statement below in the NMC document The Code (NMC, 2008):

“We set the standards of education, training and conduct that nurses and midwives need to deliver high quality healthcare consistently throughout their careers. We ensure that nurses and midwives keep their skills and knowledge up to date and uphold the standards of their professional code. We ensure that midwives are safe to practise by setting rules for their practice and supervision. We have fair processes to investigate allegations made against nurses and midwives who may not have followed the code.”

So, it seems that the NMC, which takes £100 of our hard-earned cash each year, actually does nothing for nurses other than give us permission to practise. 

NMC expenditure
The 2011/2012 NMC annual report (NMC, 2012) stated that the total NMC expenditure was £61 million and annual income was £53 million, creating a deficit of £8 million, which was funded by reserves. Income from our fees must cover all the regulatory activity including quality assurance of education, maintenance of the register, development of standards, statutory supervision of midwives and the processing of “fitness to practise cases”. It seems to me that these core functions only ensure the protection of the public. Without a fee increase the NMC state that available reserves will run out by the end of this year (www.nmc-uk.org/Get-involved/Consultations/Past-consultations/NMC-fee-increase/FAQs-on-NMC-fee-rise). 

Increase in complaints against nurses
Unfortunately, complaints against nurses and midwives have soared by 48% since 2010 and the NMC caseload has increased as a result. To deal with the “fitness to practise” caseload in 2012–2013, the NMC forecast that expenditure will reach £42 million alone. Why this increase – are nurses becoming less safe or are the people we care for finding it easier to complain? 

Last year, I was asked to act for the NMC as an expert witness in a case of alleged misconduct. These hearings are conducted like any court hearing with solicitors, barristers, an adjudicating panel and expert witnesses. All of which are expensive. In all cases the NMC is working on behalf of the public. 

My experience of acting as an expert witness was interesting and personally beneficial as it made me recognise areas of my own practice which needed a spring clean. It was a huge wake-up call for me as far as record keeping is concerned. Since being involved in this case my record keeping skills have improved immensely, regardless of how much time it takes. 

I think you would all benefit from having a look at the booklet, Record Keeping: Guidance for Nurses and Midwives (NMC, 2010) to ensure that your record keeping is up to the required standard. I know we are all busy, but I would not want any of you to have to go through one of these hearings as a result of poor record keeping. Happy reading.

REFERENCES:

Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. NMC, London. Available at: www.nmc-uk.org/Documents/Standards/The-code-A4-20100406.pdf (accessed 31.05.13)
Nursing and Midwifery Council (2010) Record Keeping: Guidance for Nurses and Midwives. NMC, London. Available at: www.nmc-uk.org/Documents/NMC-Publications/NMC-Record-Keeping-Guidance.pdf (accessed 31.05.13)
Nursing and Midwifery Council (2012) Nursing and Midwifery Council Annual Report and Accounts 2011–2012 and Strategic Plan 2012–2015. NMC, London. Available at: http://bit.ly/19suD60 (accessed 31.05.13)

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