Following a national consultation, the Nursing & Midwifery Council (NMC) proposed in 2005 that 'advanced nurse practitioner' should become a registered title and that the NMC should seek approval from the UK Privy Council to open a subpart to Part 1 (Nursing) of the Register.

Decisions on the NMC proposals were delayed and in 2007 the Department of Health in England published UK White Paper  Trust, Assurance and Safety - The Regulation of Health Professionals in the 21^st Century. Thsi paper highlighted to need for proportionate regulation stating the following policy intention:

'…the regulatory body for each non-medical profession should be in charge of approving the standards which registrants will need to meet to maintain their registration on a regular basis. Where appropriate, common standards and systems should be developed across professional groups where this would benefit patient safety. The Department will ask the Council for Healthcare Regulatory Excellence (CHRE) to work with regulators, the professions and those working on European and international standards to support this work. This will encompass the development of standards for higher levels of practice, particularly for advanced practice in nursing, AHPs and healthcare scientists.'

Engagement work with regulators and other stakeholders initially focused on the development of understanding across the professions of the regulatory implications of advanced practice and, ultimately, whether a cross-professional understanding of advanced-level practice could then be articulated within a uniprofessional context.

CHRE published their report  Advanced Practice: Report to the four UK Health Departments in 2009 and concluded that:

"what is often called 'advanced practice' across many of the health professions does not make additional statutory regulation necessary."  (Full report can be accessed in the resources section)

Subsequently CHRE have produced further guidance on regulation which strengthens the position for governance rather than increasing regulation:

• Managing Extended Practice: Is there a place for 'distributed regulation'? (2010)
• Right Touch Regulation (2010)

Most, recently, the Command paper 'Enabling Excellence, Autonomy and Accountablity for Healthcare Workers, Social Workers and Social Care Workers'  was presented to the Westminster Parliament by the Secretary of State for Health (February, 2011).  This paper emphasises proportionate regulation for healthcare workers that is 'accountable, consistent, transparent and targeted.' It outlines the need to reduce the bureaucratic and cost burden of regulation while continuing to safeguard the public and maintain professional standards.   Any future requests for statutory regulation of the healthcare professions will be subject to a robust business case on the grounds of risk. For groups of staff that are not currently regulated the paper proposed employers take local responsibility through governance processes.

Nursing Midwifery Council work

The Nursing and Midwifery Council (NMC) continues to be an active participant in the workstreams associated with regulation. The NMC's work on revalidation (that is, the periodic reaffirmation of continuing fitness to practise against contemporary professional standards) is particularly important in this respect.

Discussions are still ongoing around the regulation of advanced nursing practice but with the current emphasis on risk, proportionality and reducing the regulatory burden statutory regulation would appear to be unlikely in the near future.