For many years, as an employer, I was concerned by the host of roles and levels of practice that surrounded job titles of ‘advanced’ or ‘specialist’. Given the potential risk to both individuals and employers, in a bid to achieve a systematic approach and have access to the apprenticeship levy as one of the routes available for funding, I chaired the Institute for Preceptorships and Technical Education's Advanced Clinical Practice Trailblazer group in 2017/2018. The employer-led group worked alongside Health Education England (HEE) and Skills for Health and was responsible for ‘developing occupational standards which form a key component of an apprenticeship’. This led to the approval of the Advanced Clinical Practitioner (ACP) Integrated Degree, setting out an occupational profile, responsibilities, and duties (https://tinyurl.com/45ty8sey).
HEE (2017) published the Multi-professional Framework for Advanced Clinical Practice in England with the aim of ensuring a much-required national consistency on ACP roles and providing some common understanding across health professions of the role, with an agreed education standard and governance arrangements. HEE stipulated that health professionals in ACP roles have to be educated to master's level and have developed the skills and knowledge to enable them to take on an expanded scope of practice in their delivery of patient care.
It also stipulated that, while studying for their master's degree, which includes academic learning in a university and workplace-based learning, the clinicians are to be classified as trainee ACPs. The university develops the competencies and capabilities to reflect the required knowledge, skills, experiences, behaviours and values in relation to advanced practice, and some universities embrace the various Royal College curricula, for example, those of the Royal College of Emergency Medicine.
Several years on, although I was very happy with the output of the approved apprenticeship standard operationally, I am not sure if we are much further on from a governance and assurance perspective, which may be one of the barriers to implementing this role across multiple services as part of workforce planning cycles.
Fothergill et al (2022) undertook a cross-sectional survey, developed by a research team with colleagues from HEE. It was distributed across primary and secondary levels of care, with a total of 4365 surveys returned from ACP staff, NHS provider organisations and trusts, and primary care organisations. The results showed considerable variation in role titles, with at least 14 job titles identified. Many respondents reported that their job description did not actually cover the level of practice they were undertaking, and differing approaches to governance and supervision were also noted.
Although participants to the survey highlighted the importance of appropriate governance, they suggested that there was a lack of a defined formal structure and provision for ACPs, leading to an inconsistent framework and dissatisfaction among those in ACP roles. The majority were trained to at least bachelor's degree level and more than half to master's, however, the subjects studied varied considerably.
Some ACP respondents shared positive examples of educational support and training, and the improvements in educational opportunities over the past few years. Although ACPs reported that the role had evolved over the years in terms of support, there was significant inconsistency across organisations, and a mismatch between the views of organisational representatives and ACPs regarding the amount of supervision offered, and the processes for how it was provided. A further challenge highlighted was committing time to work across the four pillars of advanced practice, particularly the research pillar.
Respondents' level of knowledge about the HEE's multiprofessional framework for ACPs was reported to be on a scale ranging from ‘a great deal’ to ‘never heard of’. Most secondary care NHS organisations had a greater knowledge of the framework compared with primary care settings, where it was particularly poor, with most respondents stating that they had never heard of it or had heard of it but knew nothing about it.
Fothergill et al's survey highlighted several critical areas for improvement if organisations are to be successful in considering and implementing the ACP role as part of future workforce planning. There clearly is some retrospective work to be undertaken to support colleagues who already hold the title of ACP but who may not have been afforded the support required to meet the HEE standards.
However, looking forward—and in response to the significant known variations in the development of the ACP role—HEE's South East Faculty of Advancing Practice (2021) has published a robust guide that pulls together all elements for employers and individuals to consider their readiness. It provides a refresher about the role's purpose and its progress through the requirements for training and supervision, as well as the funding cycle. This is a key document to work through for organisations supporting existing, and developing future, ACP roles.