Regulator Updates

The regulation of advanced nursing practice

Regulation of advanced nursing practice

The Report of the Prime Minister’s Commission recommends:

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“The Nursing and Midwifery Council must regulate advanced nursing practice, ensuring that advanced practitioners are recorded as such on the register and have the required competencies. Stakeholders must also consider how to reduce and standardize the proliferation of roles and job titles in nursing. The Midwifery 2020 programme should consider whether midwives working in specialist and consultant roles need advanced level regulation.”


Advanced nursing practise is an umbrella term which is used to describe a number of specialist roles including clinical nurse specialist and nurse practitioner.


In June 2005, the NMC’s governing Council considered the outcome of its consultation on a post-registration nursing framework. As a result, it agreed that the level of practice should be called advanced nursing practice and that this level of practice should be registered.

The next step was to seek approval from the Privy Council to open a further sub-part of the nurses’ part of the register in order to register advanced nurse practitioners. A letter was sent to the Privy Council in December with additional information being sent in January 2006.
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There followed a period of very little movement until in February 2007, the Government set out its proposals for the reform of professional regulation in the White Paper, ‘Trust, Assurance and Safety – the Regulation of Health Professionals in the 21st Century’.

The White Paper stated that ‘where appropriate, common standards and systems should be developed across professional groups where this would benefit patient safety. This will encompass the development of standards for higher levels of practice, particularly for advanced practice in nursing, AHPs and healthcare scientists.

The Department will discuss with the Nursing and Midwifery Council the outcome of their consultation on advanced nursing practice to agree next steps (2.30)’.

Next steps

The NMC will be establishing a project group to examine the basic competencies required of someone practising at an advanced level in order to protect the public.

The group will be seeking to learn the views of stakeholders and the lessons from how other countries, such as Australia and the USA, already regulate advanced nursing practice. The group will also be giving consideration to how such a model would be appropriate for midwifery.

First created: 02/03/2010

NMC – The proposed framework for the standard for post-registration nursing – February 2005 (Updated 2008)

The proposed framework for the standard for post-registration nursing – February 2005


This consultation outlined the NMC’s proposals to establish a framework for the standard for a level of nursing practice beyond initial registration.

The purpose of these proposals is to protect the public by setting a standard that the public can expect of any nurse who is working at this level. The establishment of a regulated level beyond initial registration is intended to meet the concerns of the profession and the public that, currently no UK-wide standards for this level of practice exist or are enforceable by the NMC. Proposals for a regulated standard have, in part, been in response to the concerns of both the public and the profession of the rapid growth in the number of titles that suggest an advanced level of knowledge and competence. Although an aim, it is unlikely that introducing the standard will have an impact on this. Agenda for Change may lead to the harmonisation of titles, but this only applies to the NHS. Council has agreed to work closely with employers on the need to reduce the number of titles.

Feedback from this consultation illustrates overwhelming support for the suggested framework, with 94% of respondents in agreement for its implementation. Among concerns expressed were those about the future of specialist practice. The NMC is looking at a strategy to deal with this and will continue to record specialist practice qualifications.
As at February 2006:

A revision of the definition of advanced nurse practice so that it could be accessible to patients and the public
The approved definition of advanced nurse practitioner reads:

“Advanced nurse practitioners are highly experienced and educated members of the care team who are able to diagnose and treat your health care needs or refer you to an appropriate specialist if needed.”

Whilst definitions are helpful they have their limitations. Therefore we think it would be helpful to expand the definition to provide patients, their carers and other health care professionals with more detailed information about what they can expect of an advanced nurse practitioner.

“Advanced nurse practitioners are highly skilled nurses who can:

  • take a comprehensive patient history
  • carry out physical examinations;
  • use their expert knowledge and clinical judgement to identify the potential diagnosis;
  • refer patients for investigations where appropriate;
  • make a final diagnosis;
  • decide on and carry out treatment, including the prescribing of medicines, or refer patients to an appropriate specialist;
  • use their extensive practice experience to plan and provide skilled and competent care to meet patients’ health and social care needs, involving other members of the health care team as appropriate;
  • ensure the provision of continuity of care including follow-up visits;
  • assess and evaluate, with patients, the effectiveness of the treatment and care provided and make changes as needed;
  • work independently, although often as part of a health care team;
  • provide leadership; and
  • make sure that each patient’s treatment and care is based on best practice.

Only nurses who have achieved the competencies set by the Nursing and Midwifery Council for a registered advanced nurse practitioner are permitted to use the title Advanced nurse practitioner. The title will be protected through a registrable qualification in the Council’s register.”

Aligning the competencies to the Knowledge and Skills Framework Setting out a policy for accommodating existing practitioners This was completed and approved by the Council at its meeting on 1 December 2005.

What happens next?

In order for the Council to open a further sub-part of the nurses’ part of the register for advanced nurse practice, it has to seek permission from the Privy Council. The Privy Council has to give permission in order for legislation to be drawn up to open a sub-part of the register for ANP. A letter has been sent to the Privy Council and we are waiting for their reply. The development and approval of any legislation has to go through a number of stages and the earliest that we could anticipate that legislation will be in place is August 2006.

In the meantime, work is being undertaken to develop guidance for existing providers of programmes for advanced clinical practice so that once the legislation is in place we can then approve programmes. Once programmes are approved individuals from those programmes will be able to apply for registration. We are also developing guidance for applicants.

Standards to support learning and assessment in practice – NMC 2006 – UPDATED DEC 2006

SEE NMC IMPACT ANALYSIS REPORT – BELOW – DECEMBER 2006 The AAPE draws your attention to this document – see below. We urge you to read this carefully.

This proposal encompasses the prospective ANP register. In brief, it will require ALL future ANPs to be assessed in practice by registered ANPs, and their competencies to be signed off in practice by registered ANPs. Candidates for the ANP register will need their competencies ‘signed off’ in practice – by an identified and suitably prepared registered ANP mentor – to be entered onto the ANP register.

Implications of this is self evident:


The AAPE has respond to this proposal by representation at NMC review in September 2006.

Advanced Practice Updates July 2006

The Nursing and Midwifery Council (NMC) is acutely aware that there is a great deal of interest in the progression of the work on advanced nursing practice. Approval was sought from the Privy Council to open a further sub-part of the nurses’ part of the register in order to register advanced nurse practitioners. A letter was sent to the Privy Council in December 2005 with additional information being sent in January 2006. The Privy Council has been seeking the views of the Department of Health (England), which takes the lead on regulatory matters relating to health care professions across the UK.

Unfortunately these things do take time to process and we are still awaiting the response. Once we get the response, and assuming that it is positive, legislation will need to be in place in order to open a sub-part of the nurses’ part of the register for advanced nurse practitioners. There is a parliamentary process to go through in establishing any legislation and that has its own time frames. The formulation of legislation will take at least 6 months.

The work with regard to producing the standards of proficiency for advanced nurse practitioners document and providing guidelines for approved education institutions and applicants is well in hand. We will continue to keep you updated with information.

Further background to this work can be found at:

NMC Documents (Received)
TitleOwnerModified DateSizeFile
Standards for supporting learning and assessment in practice AAPE 08/04/2006 217.59 KB Download
Impact Analysis Dec 2006 AAPE 13/12/2006 48.50 KB Download
APEL Guidance - (Draft) July 06 AAPE 07/07/2006 184.02 KB Download
Approved Institution Guidance (Draft) July 07 AAPE 18/07/2006 102.53 KB Download