Dear Dr Swann Re: Regulation 28 reportto preventfuture deaths: Benjamin Orrill note receipt of the above report of the 19th October made under paragraph 7, Schedule 5 ofthe Coroners and Justice Act 2009 and regulations 28 and 29 of the Coroners(Investigations) Regulations 2013. also note that this report has been sent to as Chief Executive of the Nursing and Midwifery Council(NMC). My sympathies go to the family of Mr Orrill and thank you for drawing my attention to the concerns as outlined. within your report. I would like to address them individually as set out below:
1.0 There is no regulatory body for advanced nurse practitioners: NHS England has nc~ jurisdiction over the regulation of nurses. The NMC is the body which sets standards of education,training, conduct and performance and ensures that nurses and midwives keep their skills and knowledge up to date and uphold professional standards. They have processes to investigate nurses and midwives who do not meet those requisite standards and maintain a register of nurses and midwives allowed to practice in the UK.
2.0 Advanced nurse practitioners may independently buy into a partnership and may not have an employer directly responsible for their appraisal;and therefore may be operating as independent practitioners without any supervision or regulation: Again NHS England has no mandate in relation to registered nurses who have chosen to practise independently. Those registrants remain accountable to the NMC as their regulatory body and through a process of professional revalidation are expected to maintain their registration.

However, NHS England as the commissioner expects general practices to complete within the annual electronic general practice self-declaration(eDEC)that they recognise the need to have the right knowledge,experience, qualifications and skills for the purpose of providing services in the practice and demonstrating capacity to respond to unexpected service changes.. The eDEC also states that all health care professionals employed in the practice have annual appraisals and where applicable personal development plans and that this is aligned to revalidation for doctors and also for registered nurses and midwives(according to requirements issued by the Nursing and Midwifery Council). As previously mentioned I note that as Chief Executive ofthe NMC has also been sent this report and she will be able to provide more detail on the regulatory aspects signposted above.

Dear Madam Benjamin Orrill Further to your Report to Prevent Future Deaths made under Paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 and Regulation 28 and 29 of the Coroners (Investigations) Regulations 2013, I am writing to provide you with our response. We note the concerns you have raised relating to the regulation of advanced nursing practice. To help explain how we fulfil our statutory objective to protect the public, we have enclosed with this letter a document that summarises our statutory framework and provides background information about advanced practice. We are aware of the particular concern raised about the registered nurse who reviewed Mr Orrill in the weeks leading up to his death. We are working closely with you in relation to this and are considering the concerns in accordance with our statutory functions. We will not be taking any further action in relation to the concerns you have raised because, for the reasons we summarise in the enclosed document, we believe that our statutory framework and the process of revalidation are sufficient to protect the public in respect of advanced practice. hope that the attached information is helpful, If we can provide any further input on this matter, please do not hesitate to contact me again.