Advancing practice level can be reached in England either by training or via submission of evidence to an e-portfolio.
As part of the framework for advancing clinical practice, professionals must be able to evidence additional core capabilities across the four pillars, but they can demonstrate different levels of focus in each pillar. Training options include completing a master’s course, which is made up of credentials. The e-portfolio route can be seen as a retrospective method to becoming an advanced clinical practitioner (ACP).
HEE established the Centre for Advancing Practice to support education and training for ACPs in England by:
- developing agreed national training standards for advancing practice education.
- delivering a programme accreditation process (kitemarking) for training courses for advanced level practice.
NHS England, formerly Health Education England, developed a multi-professional framework for ACPs (PDF) to display the key capabilities for advancing practice and key principles for implementing the role.
Skills for Health, an organisation that supports the development of an improved and sustainable healthcare workforce, developed a core capabilities framework for advancing clinical practice working in general practice and primary care in England.
NHS England also developed a toolkit to provide practitioners with information about AP, the ACP role and advice for employers about building ACPs into the workforce.
The only retrospective method of becoming an ACP is the ePortfolio route. Although this is based in England, practitioners from other nations are welcome to apply.
Current AP courses are made up of different modules which have to undergo credentialing process. This ensures that learning is standardised and focused on high priority areas.
A Centre for Advancing Practice has been developed to oversee workforce transformation by establishing and monitoring standards of education, accreditation, recognising training and embedding advancing levels of practice.
NHS England has also developed an integrated multi-professional approach to practitioner development and supervision: HEE workplace supervision for ACP (PDF).
In Northern Ireland, there is a move towards adopting the advancing clinical practice terminology for job titles and job descriptions, although different trusts are at different stages with this.
Allied health professional ACPs can complete an AHP postgraduate certificate in education course to develop a more educational role specific to their clinical speciality. Advancing practice roles are available at band 7 and above, providing the practitioner has an MSc level qualification or equivalent. There are concerns around the access to MSc opportunities and how to evaluate or accredit existing experience and postgraduate training and there is still work to be done in rewriting titles in job descriptions of SLTs already working at this level.
Northern Ireland framework
The Department of Health in Northern Ireland developed a document with guidance around AP and the core competencies required to practice at this level. It outlines three clear pillars for ACPs including a clinical pillar, managerial pillar and research pillar.
NHS Education for Scotland is promoting a more consistent approach to role development, using the transforming roles model. This is a whole systems approach which encourages service managers to identify the unique contribution of staff at every level of practice. This approach helps services to achieve skills maximisation by encouraging an appropriate skills mix within teams.
Their refreshed development framework sets out the core knowledge, skills and behaviours at each level of practice to help practitioners, managers and educators identify what is required in each of the four pillars of practice. It includes generic and role specific competencies and explains the process for credentialing and future experience. A series of test pilots and a survey took place to
Visit NHS Education for Scotland for resources relating to advancing practice in Scotland to:
- understand what advancing practice means to managers and clinicians working at level 7 and above.
- identify the roles being undertaken by ACPs.
- explore what support is needed to embed and develop advancing practice in Scotland.
Post-survey analysis revealed three main themes identified as barriers to supporting the development of advancing practice:
- Definitions around advancing practice and the difference between advanced practitioner and Consultant posts.
- There are concerns that the creation of advancing practice roles and the regulation of existing level 7 and 8 roles will destabilise the current workforce.
- There is a lack of clarity around academic qualifications or HEI training opportunities to support advancing practice roles, and concerns were raised about funding opportunities and time away from clinical duties to access training.
NHS Education for Scotland developed a paper with information about the ACP role, education requirements and core competencies required to become an ACP.
NHS Education for Scotland also developed a toolkit to support ongoing developments in the role, enhancing understanding of the role.
In Wales, advancing practice is viewed as a level of practice rather than a specific role. Health Education and Improvement Wales (HEIW) recently held a consultation event on the proposed new multi-professional clinical development framework, which aims to support three levels of clinical practitioners, as defined by the Skills for Health framework.
Concerns have been raised about some of the levels expected of practitioners, the extent to which these meet the needs of different clinical groups, the proposed assessment of learning outcomes, and whether the framework may favour practitioners who are more likely to undertake master’s study. The RCSLT is currently feeding back members’ concerns to HEIW and awaiting the final consultation.
HEIW developed a multi-professional framework for nurses, midwives and AHPs which defines the levels of practice, education and provides support for employers, HEIs and clinical practitioners.
There is also a more general framework which includes methods of maximising the ACP role.