The Prime Minister’s Commission on the Future of Nursing and Midwifery will unleash reforms that could lead to a significant reduction in the numbers of highly paid “specialist nurses”.

HSJ’s sister title Nursing Times obtained the commission’s draft recommendations, which are due to be published next month. They include a call to regulate so-called “specialist” or “advanced” nursing practice, which can see nurses escalate up the Agenda for Change pay scale to band 8, where they can earn more than twice the salary of a band 5 nurse.

HSJ has been told there would be a strong case for NHS employers to revisit the pay of any “advanced” nurses stripped of that title through a revalidation process

But advanced practice is not regulated and nurses do not at present need to provide any proof of their ongoing “advanced” skills or experience. There is also no national criteria defining “advanced” status, which has been highlighted as a concern by the Nursing and Midwifery Council.

But the draft recommendations include the regulation of advanced practice, alongside a standardisation and reduction in the “confusing proliferation” of nurse job titles.

Sources close to the commission told HSJ that would lead to a reduction in the number of nurses categorised as “advanced” or “senior” as some would fail to meet the requirements of a revalidation scheme.

HSJ has been told there would be a strong case for NHS employers to revisit the pay of any “advanced” nurses stripped of that title through a revalidation process, although that could take some time and was not the prime motivation for the commission, which was more focused on safety concerns.

The commission is also concerned about the lowly status given to the ward sister and charge nurse role in relation to advanced nurses. Its draft recommendations include a call for sister pay, support and training to be reviewed and improved locally.

The Prime Minister’s Commission on the Future of Nursing and Midwifery

Main recommendations

  • New pledge for all nurses and midwives stating their commitment to and accountability for high quality and continuously improving care
  • Protection for the title “nurse”: only those registered by the NMC should be able to call themselves “nurses”
  • Regulation of specialist and advanced practice nurses by the NMC, and consideration given to requiring the same of specialist midwives
  • Support workers – including healthcare assistants and assistant practitioners - to be regulated
  • Degree a requirement for all clinical leadership and specialist roles by 2020
  • Boost to ward sister and charge nurse role and upward review of their pay and grades
  • Framework of national nursing indicators to be developed to measure nurse quality and its impact on patient outcomes and satisfaction
  • Nurses to act as “role models” for healthy living – their employers should help them do this
  • Career structures and training that allow nurses and midwives to move between different healthcare settings, such as hospitals, community services and social care
  • Scheme to identify, train and mentor future generation of nurse leaders, ripe for “fast track” into posts
  • High level group to review options for boosting capacity of nurses to understand and influence the design of new technology and informatics
  • Every woman to have a named midwife responsible for coordinating her care
  • Scheme and fellowship awards to encourage innovating in nursing services
  • Marketing campaign to “paint an appealing picture” of nurse careers and opportunities and to recruit the highest calibre, diverse candidates