After more than 15 years the Nursing and Midwifery Council (NMC) is reviewing standards for specialist practice (NMC, 2021). There has been extensive work undertaken to explore what practitioners, educators and employers think about the outdated standards (NMC, 2019; Pye Tait Consulting, 2020). This work shows how, in the past, the NMC, through the standards for Specialist Community Public Health Nursing (SCPHN) and the Specialist Practitioner Qualifications (SPQs), attempted to create an economy of scale by conflating community nursing with public health work. That this did not meet the needs of nurses is evident in the pre-consultation evaluation (NMC, 2019). There is concern from children's community nurses (CCNs) that the NMC is repeating its error of attempting to construct ‘generic’ standards (Launder, 2021), which allow education providers to deliver potentially more commercially profitable programmes, but which do not meet the needs of nurses or their patients.
For many years community nurses completing an SPQ undertook public health projects that did not prepare them for nursing in the community. And some elements were not focused on public health nurses' practice needs (NMC, 2019). To make matters worse, some employers have not recognised SPQs.
Many universities no longer provide SPQ programmes, for commercial reasons. Often, a local NHS trust would indicate an urgent need for SPQ courses and the university would recruit a specialist to design and deliver the programme. Once the local need had been met, course provision would end.
Although commissioning of community nursing services has been the focus of many reports, including one from the Royal College of Nursing (2020), there remains a great deal of variance in the organisation and funding of services. Despite recognition by the Queen's Nursing Institute and Queen's Nursing Institute Scotland (2018) of standards for CCNs' education and practice, there remains an absence of universally agreed frameworks. Without universal standards and centrally agreed funding arrangements, service delivery and budget allocation will continue to vary.
It would seem the draft NMC standards are likely to add to the uncertainty in the sector as they propose a core programme with modules on a particular area of the SPQ (NMC, 2021). CCNs, for example are likely to receive a programme mainly aimed at district nurses, with one or two modules focusing on children. The draft proposal to divide the SCPHN and SPQ also adds to the jeopardy. Previously, community nursing programmes were often made viable by modules that could be taken by both SCPHN and SPQ students, the clearer division of these programmes means a further risk to community nursing programmes.
Although new NMC standards provide a universally accepted framework, this in itself will not address the structural and political problems that beset community nursing. Investment is required to provide a skilled workforce in a sustainable way. This could be achieved through collaboration between universities to provide SPQs in specialties where local demand cannot be sustained, employing a regional or national approach. Employers and commissioners also need to play their part in agreeing sector-wide requirements to promote safe and effective practice relating to educational qualifications and performance reviews.
The new standards may afford recognition of community nursing work, but may not be a panacea. Without sector-wide collaboration and public finance investment the promise of the NMC to ensure safe and effective nursing for all people in communities will continue to be an empty promise.