The evolution of advanced clinical practice roles within the UK began in the 1980s (Leary and MacLaine, 2019) and has continued to develop in various forms internationally since. The NHS Long Term Plan (NHS England and NHS Improvement, 2019) has been the most recent key driver for advanced clinical practice within England, along with a multiprofessional framework that outlines the capabilities expected of practitioners working at advanced level across the four key pillars of clinical practice: leadership, management, education and research (Health Education England (HEE), 2017). Both documents acknowledge that advanced clinical practitioners (ACPs) are central to transforming service delivery to meet dynamic local healthcare needs (HEE, 2017; NHS England and NHS Improvement, 2019), and as such there has been a large investment in the training and development of these roles.
Increasing life expectancy, complexity and disease burden, the European Working Time Directive and a subsequent shortage of medical personnel have often been cited as drivers for the implementation of advanced practice roles (Boulanger, 2008; Evans et al, 2020a; Torrens et al, 2020). However, caution is advised when rationalising their introduction and development to that of the medical substitution paradigm. Advanced practice roles complement existing medical models and are not designed to replace them. Since their inception, there has been great diversity in ACP roles and also some controversy surrounding them. Nevertheless, a colossal effort from professional bodies such as the Council of Deans of Health (CoDoH), the Association of Advanced Practice Educators (AAPE UK) and the royal colleges as well as HEE has led to a huge investment in workforce development in this area of service delivery, in order to meet patients' needs in the future. Development in this area has also included the introduction of a multiprofessional definition of advanced clinical practice, the first of its kind, to provide clarity for employers, service leads, education providers, health professionals and ACPs themselves (HEE, 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.’
Before the release of the NHS Long-Term Plan, the CoDoH was commissioned by HEE, as part of the development and implementation of the multiprofessional framework for advanced clinical practice in England (HEE, 2017), to revolutionise the interface between HEE and universities. Since the seminal CoDoH (2018) report, and in line with the Five Year Forward View (NHS England, 2014; 2017), there have been several important developments for the advanced clinical practice arena. As a result of significant investment and infrastructure, multiple initiatives are either well-established, or underway, including:
Advancing the advanced clinical practitioner
A recent scoping review by Evans et al (2020a) sought to support the multiple initiatives listed above to promote a consistent to ACP workforce development. The findings of this work will provide key stakeholders and ACPs with vital information to shape the way in which we deliver, develop and diversify these important roles. Initial data suggests that, where data exist, the provision of ACP-led care is safe and effective and has a positive impact on patient care and experience, and service efficiency and capacity. However, the review has highlighted that a lack of continuing professional development (CPD) opportunities and unclear career pathways exist (Evans et al, 2020b). A recent national evaluation of the ACCP role has also highlighted these issues (Diamond-Fox et al, 2020) and as such, a new academic network has recently launched—the Advanced Critical/Clinical Care Practitioners Academic Network (ACCPAN). The aim of this new, all-inclusive network is to support ACCPs and ACPs, both qualified and in training. ACCPAN aims to promote collaborative working in a safe and supportive environment, to ensure high-quality education, mentorship, networking and research opportunities for its members (Table 1).
| Network aim | Activities |
|---|---|
| 1. To provide educational opportunities and continuing professional development activities that map to national curricula |
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| 2. To provide opportunities to contribute to and engage in national research activity |
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| 3. To provide peer support and mentorship across all specialties through shared learning and experience |
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The launch of a national service evaluation as a scoping exercise will soon be distributed to multidisciplinary members currently working in a role that is concerned with advanced clinical practice (clinician, educator, researcher, strategic or leadership role). The evaluation will be based on a modification of validated tools used to assess training needs analysis and the data gathered will be used to inform the production of a rolling annual timetable of CPD events that align to the network's aims (Table 1). Advanced practitioners and advanced practice educators from all multiprofessional fields are welcomed and encouraged to join and contribute to the network's activities.
Conclusion
Exciting times lie ahead for the development of new ACP roles and the expansion of existing ACP posts within the NHS. We still have a way to go when considering the long-term workforce development support for this group of clinicians, who, by nature of the career path they have chosen, are inherently driven to progress. The launch of the HEE Centre for Advancing Practice (https://tinyurl.com/y3a4eyju) will no doubt prove to be the hub for such activity, but there are also smaller networks that can provide support for both clinicians and educators.