Shaping the future of practice learning: Our response to the NMC review

Practice learning is fundamental to preparing the future nursing and midwifery workforce. The experiences students gain in clinical, community and other practice settings play a critical role in developing their confidence, competence and readiness to provide safe, effective and compassionate care. Against this backdrop, the Nursing and Midwifery Council’s Practice Learning Review has prompted one of the most significant debates about the future of nursing and midwifery education in recent years.

Through engagement with our members from higher education institutions across the UK, we heard a range of perspectives on the proposals. Given their scale and complexity, it quickly became clear that there was no single, unified view on every aspect of the consultation. However, alongside areas of difference, there was also significant consensus on many of the key issues facing nursing and midwifery education and practice learning.

Members broadly agreed that educational standards must evolve to remain fit for purpose. However, they stressed that any reforms should be evidence-based, co-produced with education providers and stakeholders and introduced with sufficient time and resource to support effective implementation.

Our response to the consultation focused on the key themes emerging from discussions with our members, highlighting both the opportunities and concerns identified. This blog summarises some of the key perspectives shared, while also highlighting areas where there was broad agreement.

Proposals

The Council is broadly supportive of reducing pre-registration nursing programme hours from 4,600 to 3,600, provided this forms part of a more flexible, competency- and outcomes-based approach that prioritises the quality of practice learning over prescribed hours. We also highlighted potential challenges across the four UK nations, including implications for graduate mobility in Northern Ireland (where students are also regularly recruited from the Republic of Ireland) and questions about alignment with Scotland’s existing honours degree framework. Crucially, we opposed any reduction in theoretical learning hours, warning that this could undermine academic rigour, professional standards, patient safety and the value of nursing as a graduate profession. We also noted that the NMC should consider whether greater alignment between Nursing Associate and pre-registration nursing curricula is needed to support streamlined progression routes and greater consistency in student outcomes.

In our response, we emphasised that simulated practice learning should be recognised as a core component of nursing education rather than a supplementary activity. While we opposed a fixed cap on its use, members emphasised that any expansion must be supported by consistent standards, investment in facilities and staff training and equitable access for students. Similarly, while we supported strengthening community-based learning opportunities, members cautioned against an overly prescriptive approach and called for greater recognition of the role of social care placements. Proposals aimed at increasing flexibility, improving inclusion and anti-racism and strengthening partnership working around reasonable adjustments were generally welcomed.

Members held a range of views on the proposals for pre-registration midwifery programmes, reflecting the complexity of the issues under consideration. While opinions differed on specific aspects of the proposed changes, there was a shared concern about how the proposals were being communicated and how they might be perceived if implemented alongside the proposed changes to nursing education.

In particular, members highlighted the contrasting direction of travel across the two professions. While the nursing proposals focus on greater flexibility and a reduction in practice learning hours, the midwifery proposals would increase practice learning requirements. Without a clear and compelling rationale, introducing these changes concurrently could create unintended narratives about the relative value, expectations and future development of nursing and midwifery. This has the potential to generate confusion among prospective students, the public, education providers and practice learning partners.

Members also emphasised the importance of ongoing engagement throughout the review process. There was strong support for continued consultation, a transparent evidence base and close collaboration with education providers, practice partners and the wider sector to ensure that any changes are implemented effectively and achieve their intended aims.

Discussions around extending pre-registration midwifery programmes from three to four years revealed a range of perspectives. While additional programme time could provide valuable opportunities for students to consolidate their learning and further develop their confidence, competence and professional readiness prior to registration, questions remain as to whether programme length alone is a reliable indicator of preparedness for practice. Members warned of potential unintended consequences, including increased financial pressures on students, reduced applicant interest and additional barriers for underrepresented groups. Extending programmes would also have significant cost implications for governments, universities and healthcare systems, alongside potential impacts on student finance and access to higher education funding.

Members expressed mixed views on the use of simulated practice learning in pre-registration midwifery programmes. While recognising its value in developing knowledge and skills, there was strong consensus that it should complement, not replace, direct clinical experience, particularly given the importance of relationship-building and real-world practice in midwifery education. Alongside this, proposals to strengthen continuity of supervision and require a final practice placement towards the end of midwifery programmes were broadly welcomed.

Looking ahead

Members also highlighted concerns that the consultation process itself. In particular, the predominance of Likert-scale questions limited opportunities to fully explore complex issues, nuances and alternative approaches. The timing of the consultation, during an especially demanding period for higher education institutions, may also have constrained engagement from educators and academic staff.

Recognising these challenges, the Council of Deans of Health was pleased to secure opportunities for our members to engage directly in the consultation process, including organising dedicated sessions for our nation groups and the Regulation Strategic Policy Group with senior colleagues from the NMC. These discussions provided valuable opportunities to test ideas, raise concerns and explore the potential implications of the proposals. We are grateful to the NMC for their constructive and collaborative approach to this engagement.

A recurring theme across our discussions was the need for a whole-system approach to reform. The success of any changes will depend on collaboration between governments, education providers, practice learning partners and professional bodies across all four UK nations, with the NMC playing a key role in bringing partners together to deliver practical, evidence-based and sustainable change.

As the review moves into its next phase, we look forward to continuing to work with the NMC and partners across all four UK nations to ensure future reforms strengthen nursing and midwifery education and support the future workforce.