Advanced Practice – is it new?Fleur Kitsell – PhD, MSc MCSPAssociate Director Workforce Transformation, Wessex

IGH Programme Lead, National

ACP Definition (2017)“Advanced clinical practice is delivered by experienced,

registered health and care practitioners. It is a level of

practice characterised by a high degree of autonomy and

complex decision-making. This is underpinned by a master’s

level award or equivalent that encompasses the four pillars of:

clinical practice; leadership and management; education; and

research; with demonstration of core capabilities and area

specific clinical competence.

ACP embodies the ability to manage clinical care in

partnership with individuals, families and carers. It includes

the analysis and synthesis of complex problems across a

range of settings, enabling innovative solutions to enhance

people’s experience and improve outcomes.”

Four pillars which underpin

Advanced Clinical Practice:

• Clinical practice

• Leadership and management

• Education

• Research

Physiotherapy

• Been talking and writing about it for many years – the

Extended Scope Practitioner

• Advanced Practice in Physiotherapy (Mel Stewart, 1998)

– “Advanced Practice in Physiotherapy has developed

with scant acknowledgement of its meaning, and

hence little understanding of the standards by which it

is measured.”

– Advanced practice assumes that better outcomes are

achieved by its administration. If it is to be used as a

standard measure of skill within the profession then

attention to its definition is required.”

Credit level descriptors – 2016

www.seec.org.uk• Level 7:

• Setting – Operates in a complex and unpredictable

and/or specialised contexts requiring selection and

application from a wide range of advanced techniques

and information sources

• Personal evaluation and development – Uses

personal reflection to analyse self and own actions.

Makes connections between known and unknown

areas, to allow for adaptation and change

Physiotherapy -

four pillars (Dec 2016)

1. Massage

2. Medical Gymnastics (exercise and movement)

3. Electrotherapeutics

4. Kindred methods of treatment

– “facilitates the inclusion of related areas of practice

into scope. This enables members and the

profession to move into new areas of practice and

respond to changing population needs, healthcare

environments and the evolving evidence base,

within the parameters of patient safety, patient

centredness and effectiveness.”

Context

Five Year Forward View

• Health & Wellbeing

• Care & Quality

• Funding

NHS Delivery Plan

• Urgent & Emergency Care

• Primary Care

• Cancer

• Mental Health

Sustainability and Transformation Plans

• Strengthening primary and community services

• Integrating NHS and Social Care around the needs of patients

• Improving broader health and wellbeing of populations

@NHS_HealthEdEng #ACPfit4thefuture

Collaboration – Academics/HEI’s + Clinicians

National ACP framework

• Comprehensive national

framework

• Aligned with devolved

nations

• Co-produced with system,

academics, patients,

services users and policy

leads

• Multi-professional focus and

support

• For the NHS

@NHS_HealthEdEng #ACPfit4thefuture

Governance

• Adherence to legal and

regulatory frameworks

• Professional and

managerial pathways of

accountability

• Organisation/System

approach for recruitment

and retention

• Robust workforce and

succession planning

focussed on required

skills/expertise

@NHS_HealthEdEng #ACPfit4thefuture

Advanced Clinical Practice

by 2022

Pathways to develop:

• Nationally recognised specialty/role specific routes:

– Apprenticeship (M level)

– Employer/HEE/Self funded route (Modular M level)

– Equivalence route (M level).

• Quality Assured programmes that meet the national

standards held by the HEE Academy of Advanced Practice.

Advanced Clinical Practice

by 2022

How we make this work at scale:

• There is now a menu of nationally recognised meaningful

qualifications and development routes for all roles

• ACP’s will use all their skills and patient pathways rely on

them being fully integrated team members

• Individuals have a formal career pathway as opposed to

‘just a job’ or working it out as an individual

Advanced Clinical PracticeDeveloping nationally recognisable M Level training pathways to

underpin Advanced Clinical Practice working with employers,

ACPs, Professional Bodies, Royal Colleges and HEI partners.

Pathway developments include:

Surgery

Radio-

graphy

Developing national training pathways, qualifications and governance structures to

ensure consistent ACP practice and development.

Musculo-

skeletal

Mental

Health

Learning

Disability

The four pillars

that underpin

ACP practice:

Clinical Practice

Leadership &

Management

Education

Research

ACP training

pathways place the

service user at the

centre and are

based upon the

knowledge, skills

and behaviours

needed to fulfill the

level of practice

required by the

role.

FrailtyEye Health

Other

pathwaysMedicine,

Paramedics,

Primary Care

Nursing,

Paediatrics and

Therapeutic

Radiography.

HEE National UEC Programme (2018-19)

- Pilot: Clinical Leadership in Emergency Medicine – Pilot and evaluation

- Pilot: Clinical Educators in the Emergency Department – Pilot and evaluation

- Physician Associates in Emergency Departments – Workforce development

- SAS Doctors in Emergency Medicine: Recruitment and Retention Programme

- Pharmacist Clinicians in Urgent & Emergency Care (PIED) – publishing outcomes

- Pilot Phase 2 Rotational Paramedic Programme and evaluation

- Upskilling the Paramedic workforce (degree up-skilling)

- Paramedic Prescribing – Recommendations and workforce planning

- Paramedic Evidence-based Education Programme (PEEP)

- Paramedic national communication strategy

- ACPs in Emergency Departments – Phase 2 pilot (RCEM-led)

- ACP workforce (defining roles, curriculum guidance, rollout of framework)

- ACP conference (Nov 2018)

- NHS digital coding – ESR and multi-professional ACP ePortfolio

- Independent evaluation of national ACP framework – workforce impact

- Communication activity – partner working and joining-up approaches

- SCRIPT Elearning for Safe Prescribers – national development

- UEC regional-national Assurance Board and cross-ALB partner working

- Urgent and Emergency Care Workforce Strategy development (new)

- Rotational placement programmes in Urgent and Emergency Care (new)

UEC Workforce

Transformation

Projects

National Advanced

Clinical Practice

Programme

Paramedic Workforce

Transformation

Programme

Securing the Future of

the ED Workforce

Strategy (2017)

The 2018-19 HEE Urgent and Emergency Care (UEC)

programme will join up and include deliverables arising from:

Advanced Practice is it new?No Yes

The idea and aspiration for career

development always there

Agreement of what it means among

professions – M level

Individuals aspire to be proactive and

responsive to changing population

needs, evolving evidence base and

workforce issues

Breadth and Scope – 4 pillars, applicable

to all settings

Happened in ad hoc and informal way

at individual level, but little

consistency or transferability

National recognition among all

professions and national bodies of its

value and contribution to patient care

Consistency and recognition of

knowledge and skills

Formal development pathways agreed

Ed

uca

tion

Su

pp

ort

Wo

rkfo

rce

Tra

nsfo

rma

tion

Education

Support

Quality

Assurance

Workforce

Planning

and

Intelligence Workforce

Transformation

• Work-based learning

• With PGME and HEIs

• Educators

• Ed/Clin Supervisor

• Mentors

• Core

Leadership/Research./

Education pillars

• Portfolio evidence

• Career Progression

• System support -

LWAB/STP

• Staff Retention

• Mid career upskilling

Work

forc

e P

lannin

g a

nd

Inte

lligence

Qu

ality

HEE Local Support

HEE National/ Regional Support

HEE Advanced Practice Academy

• Apprenticeship

Framework

• ACP Investment Plan

• National NHSE/I Plan

• Workforce

planning/modelling

• STP

• Pathways

• Programme monitoring

• Programme

accreditation

• Improved consistency

• Improve work-based

clinical learning and

assessment

• Capability progression

• Oversight

• Regulators

• Learner surveys

Adapted from KSS

Seec.org.uk• “Display mastery of a complex and specialised area of

knowledge and skills, employing advanced skills to conduct

research, or advanced technical or professional activity,

accepting accountability for related decision-making,

including use of supervision.”

• “Has a deep and systematic understanding within

specialised filed of study and its interrelationship with other

relevant disciplines. Demonstrated an understanding of

current theoretical and methodical approaches and how

these affect the way the knowledge base is interpreted.”

Seec.org.uk• “Autonomously implements and evaluates improvement to

performance, drawing on innovative or sectoral best

practice.”

“Works effectively with multiple teams as leader or member.

Clarifies tasks and make use of the capacities of team

members, resolving likely conflict situations before they

arise.”

• “Incorporates a critical ethical dimension to their practice

managing the implications of ethical dilemmas. Works

proactively with others to formulate solutions.”

• “Uses personal reflection to analyse self and own actions.

Makes connections between known and unknown areas, to

allow for adaptation and change.”

Definition (2017)