Exclusive GP practices are at risk of losing ‘many’ experienced nurses because of an NHS accreditation scheme that needs ‘urgently’ reviewing, a new report from the Queen’s Nursing Institute (QNI) has found.
Shared exclusively with Nursing in Practice, the results of a QNI survey completed by more than 600 nurses have added weight to concerns that the digital badge scheme for advanced nurse practitioners (ANPs) in England is ‘discriminatory’ and causing unnecessary stress among the profession.
Concerningly, the report found that specific rules within general practice meant experienced nurses in this sector were ‘significantly’ disadvantaged and that this workforce was at particular risk.
The digital badge scheme was launched by NHS England (NHSE) in 2022 as a way of evidencing the ‘accredited education and training’ of ANPs. It is currently voluntary for all ANPs, apart from those seeking employment under the additional roles reimbursement scheme (ARRS) in general practice.
It can be obtained via two routes: from doing an accredited Master’s programme or via an ePortfolio which includes a 5,000-word essay.
Concerns have previously been raised that as it is largely courses post-2017 that are accredited – because they are matched to a ANP framework launched that year – ANPs who have done their education before then have to undergo the extensive ePortfolio option if they want to obtain the badge.
As reported by Nursing in Practice in the summer, some nurses have been forced to take sick leave or look for jobs elsewhere because of delays and several barriers in obtaining the accreditation, especially via the ePortfolio route.
Today, the QNI will publish an impact assessment of the introduction of the digital badge scheme, based on a survey undertaken by the QNI’s International Community Nursing Observatory (ICNO), led by Professor Alison Leary in July.
The report, seen by Nursing in Practice, shows the scheme has caused significant stress to many nurses and could be an ‘exit trigger’, especially for those in the later part of their careers.
And it stressed that those reporting disadvantages within the survey were primarily women over 50 and mothers of young children.
The QNI’s survey suggested some 72 nurses had been put at a disadvantage, either in their own job or in seeking another job due to not having the digital badge.
‘The absence of a digital badge can significantly hinder career progression, preventing individuals from accessing higher-level bands, positions, or promotions,’ the report said.
It added that it was felt to be ‘discriminatory to nurses’ because of their age and their profession, particularly in general practice where the badge is mandatory.
One respondent said: ‘At 59 years of age having done a [role] for 20 years (11 of which are as an independent non- medical prescriber), I would be insulted to be told I had to obtain yet another piece of paper which will not change my practice.’
When asked if the digital badge was to become mandatory for all ANPs, respondents described this as an ‘exit trigger’ – with 77 suggesting either retirement, leaving their current role or demotion.
Less than one in five found process ‘straightforward’
Of the 254 respondents that had tried to obtain a badge, only 18% found the process ‘straightforward’.
Some described the process as ‘lengthy, bureaucratic, and requiring excessive paperwork’, according to the report.
There was confusion around eligibility and ‘many’ examples of nurses feeling ‘unsupported’.
Some raised concerns around the cost of obtaining the badge, such as fees and time spent on the process, while others ‘questioned the actual value of the digital badge, arguing that is does not accurately reflect clinical competence of experience’.
Some respondents also described the process as ‘unfair’ – particularly for those ‘with extensive experience but lacking specific qualifications [or] qualifications that were equivalent but did not meet the time requirement’.
Situation poses threat to GP nursing workforce
The report drew particular attention to the negative impact the scheme has had in primary care.
It explained that under the ARRS – where certain healthcare workers can be employed through a national subsidised scheme – ANPs must have a digital badge to be eligible for employment. But there is ‘no funding whilst in training’, the report said.
It added that other roles, including first contact practitioners, ‘appear to have a different arrangement, with advanced practice courses funded’.
‘The national funding approach appears inconsistent,’ the report said.
Leading this assessment, Professor Leary said: ‘The current situation runs a real risk of losing many experienced workers and expertise from the nursing workforce, particularly in general practice.’
The report concluded that an urgent review of the digital badge process for advanced nurse practitioners was needed, ‘in particular within the ARRS in primary care’.
‘In general practice, the inequity in the implementation of the requirement for the digital badge before employment under ARRS between [allied health professionals] and registered nurses is unsustainable and discriminatory,’ it said.
‘The rules of the ARRS significantly disadvantage nurses who have many years of experience successfully working in an advanced practice role.’
It added: ‘A review of the digital badge requirements, funding, process, and current impact on the nursing workforce is needed.
‘Such a review should take into consideration the findings of this analysis. This will help to navigate a way forward to support the retention of nurses and prevent early retirement and unwelcome movement in the nursing workforce which will create instability, particularly in general practice.’
Data suggests badge scheme ‘is a problem’
Sandra Dyer, who qualified as a nurse in 1990 and completed her advanced practice Masters in 2015, was told last year that her ARRS ANP role could no longer be funded as she did not have the digital badge.
And despite trying to secure a place on the ePortfolio route to obtain a digital badge since September 2023, she is still yet to be offered one and is therefore left struggling to find a job in primary care.
Today she told Nursing in Practice that it was helpful to see robust data support that the scheme ‘is a problem’ and ‘a problem for quite a lot of people’.
‘It is problematic in the sense that it is affecting everybody’s ability to potentially be employed and do their job. It’s going to have an impact on retention and recruitment as well, and it looks like it is particularly affecting older nurses.’
Ms Dyer said she wanted to see the requirement for a digital badge for ANPs under ARRS to be removed.
‘That would have a very positive benefit, very quickly, on people,’ she said.
She added that she also wanted to see a review of the badge scheme and its implementation overall.
Sarah Ellison is a community research ANP who has tried and since given up securing the digital badge because of significant barriers securing it, despite years’ of experience and Masters and non-medical prescriber qualifications.
She agreed there should be an ‘immediate review’ of the scheme by NHSE.
‘I think that it needs a huge review. Nurses’ lives are being impacted by this, especially the ones that work in GP surgeries from the ARRS perspective.’
Ms Ellison told Nursing in Practice that she had tried to first raise concerns outlined in today’s report some time ago.
‘I tried to raise these concerns over the fact that [the badge scheme] was inequitable, unfair and discriminatory two years ago,’ she said.
‘I raised it with leaders of the programme, and said all of these genuine concerns and the impact that it could have.
‘And I couldn’t get a straight answer out of any of them.’
About today’s report, she said it was welcomed and demonstrates clearly the concerns that many had, adding that nurses ‘at long last are just saying “enough is enough”’.
Meanwhile, QNI chief executive Dr Crystal Oldman, said: ‘The introduction of the digital badge has had widespread repercussions for nurses, and unforeseen consequences on the health and care system.
‘Action could be taken now, supported by this evidence, to provide equitable employment conditions and equal access to the support for education under the ARRS – a scheme that has a real impact on employment prospects and careers.’
She added: ‘An excellent idea in principle, the digital badge has had unintended consequences on the nursing workforce.
‘But these consequences can be addressed, and any positive measures introduced now will boost the nurses’ morale, improve their sense of being valued, and will directly assist with retention.’
NHSE has been contacted for comment.
