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Advanced clinical practice

Advanced clinical practitioners come from a range of professional backgrounds such as nursing, pharmacy, paramedics and occupational therapy. They are healthcare professionals educated to Masters level and have developed the skills and knowledge to allow them to take on expanded roles and scope of practice caring for patients.

Advanced clinical practitioners (ACPs) enhance capacity and capability within multi-professional teams by supporting existing and more established roles. They help to improve clinical continuity, provide more patient-focused care, enhance the multi-professional team and help to provide safe, accessible and high quality care for patients.

There is currently, for the first time, a definition of what an ACP is or what the requirements are into entry. To ensure that there is national consistency across the role and to ensure that advanced clinical practitioners, colleagues, employers and patients clearly understand the role, we are developing a competencies framework. This will provide current and future ACPs with guidance and principles that they should follow throughout their professional lives and clearly outlining a career pathway into and through the profession.

We recently spoke to Beverly Harden, Associate Director for Education and Quality and other clinicians about advanced clinical practice.

Charlotte Beardmore, Director of Professional Policy and representing HEE AHP Advisory Group, The Society and College of Radiographers said:

Harmonisation of advanced levels of practice across the professions is important in enabling wider and efficient roll out of advanced clinical practice to continually support improvements in patient care.

Mark Radford, Director of Nursing – Improvement, NHS improvement said:

As a Nurse Consultant myself, I directly saw the patient and organisational benefits of Advanced Clinical Practice delivered care. This programme of work with HEE develops a common understanding across professions and agreed education and competency arrangements, it is the ideal platform to deliver an innovative NHS Workforce solution.

John Clark, Director and Dean of Education and Quality - South of England, Health Education England said:

I am delighted that HEE, working with its partners in NHS England, NHS Improvement, the professional bodies, academics, and our Patient Representatives has been able to develop a definition of Multi-professional Advanced Clinical Practice. The definition is the culmination of considerable work led by our ACP Steering and Operations groups and I would personally like to thank all those involved in the many stimulating debates that took place to help shape our thinking.

Our definition is the foundation for the Multi-professional framework for Advanced Clinical Practice in England and will help employers identify, plan and transform a workforce that makes an invaluable contribution to the delivery of outstanding care. It is as applicable to all healthcare practitioners working across the full range of settings where care is delivered. In addition, it attempts to address the confusion that arises from the many titles and definitions in common use across the English health and care system.

Health Education England (HEE), in association with its multi-disciplinary partners, has developed a definition of Advanced Clinical Practice.

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.

Advanced clinical practice 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.

The ACP definition has been developed to provide clarity for employers, service leads, education providers and healthcare professionals, as well as potential ACPs practising at an advanced level. This is the first time a common multi-professional definition has been developed which can be applied across professional boundaries and clinical settings. The definition serves to support a consistent title and recognises the increasing use of such roles in England.

A series of videos talking through the ACP role, the vision, service development and workforce planning across the health and care system are available to watch online. 

A series of videos featuring trainee ACPs are available to access below. All feature one-to-one interviews with ACPs in practice or training at Derby Hospitals NHS Foundation Trust. Feel free to share these videos with colleagues.

Julia Taylor, who comes from a nursing background, talks about being an ACP/GP Trainer

Chris Smalley, a physiotherapist, talks about being a trainee ACP. 

Alison Martin, who has a background in physiotherapy at Derby Teaching Hospitals NHS Foundation Trust, talks about becoming an ACP.

Simon Baker talks about being a trainee ACP in the Surgical Services department of Derby Hospitals NHS Foundation Trust. 

Lucy Titheridge, who has a background in adult Speech and Language Therapy, talks about being a trainee ACP. 

Kathryn Thomas, who has an Intensive Care nursing background, talks about being a trainee ACP. 

Clare Sutherland, who comes from a nursing background, talks about her role as corporate lead for advanced practice at Derby Hospitals NHS Foundation Trust. 

Lorraine Vallance, who comes from a Paramedic background, talks about being a trainee ACP. 

We have a number of case studies available to read.

The Advanced Clinical Practice Toolkit supports ongoing work to enhance the understanding of Advanced Clinical Practice (ACP). The toolkit aims to benchmark this level of practice and its application to specific roles across clinical practice, leadership and management, education and research.

The toolkit provides general information about the ACP role as well as specific information aimed at the following groups of people: practitioners, educators, employers, commissioners, those planning the workforce across systems and patients/service users.

Content includes:

- A definition and an understanding of the four capabilities that underpin ACP

- Information for practitioners on how the four capabilities that underpin ACP can be assessed

- Advice for employers about how to build ACPs into the workforce (this includes information on governance and supporting the role at all levels in the workplace, recruitment, appraisals, apprenticeships and staff retention)

- Information for commissioners and system leaders, including advice on planning the workforce

- Useful advice about the ACP role for patients and service users, to help them understand the role

It will be helpful to have read the ‘Multi-professional framework for advanced clinical practice in England’ document, which can also be downloaded from the HEE website.

Our aim, through the facilitation of two workshops (one physical workshop and one online workshop) was to explore the issues raised by the emergence of ACPs and to help policy makers consider how best to support the development, deployment and impact of this group of healthcare professionals. This report provides a summary of the key points raised at the workshop in September (which informed the high-level structure of the online conversation) and provides a detailed analysis of the contributions from those participating in the online platform. The online workshop opened on Monday 29 October 2018 and closed on Tuesday 20 November 2018.
Read the full report