What are Advanced Practitioners?
Advanced Practitioners (APs) may also be known as Advanced Clinical Practitioners (ACPs). ACPs can come from a range of healthcare professional backgrounds including nursing, pharmacy and allied healthcare professional (AHP) roles. A detailed section on AP/ACP under the additional roles reimbursement scheme (ARRs) can be found in the ARRs repository at ARR Repository Archive – Gloucestershire Primary Care Workforce Centre (glosprimarycare.co.uk). This section of the website is to cover advanced practice in primary care more generally.
WT&E define advanced practice as:
‘Advanced practice is delivered by experienced, registered healthcare professionals. 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 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.’
Advanced practice is different from specialist and enhanced practice. Specialist and enhanced practitioners are experts in their chosen clinical area, working mainly in the clinical practice pillar. For example a diabetic specialist nurse may have a depth of knowledge in the area of diabetes. Advanced practitioners have a breadth of knowledge across all four of the pillars of:
- Clinical practice
- Leadership and management
A short video on advanced practitioners is below.
What can Advanced Practitioners do in Primary Care ?
The roles and responsibilities of the AP may vary by professional background. Below are some generic roles that APs might undertake (noting this list is not exhaustive):
- Triage patients
- Manage undifferentiated and undiagnosed conditions, including identifying red flags and underlying serious pathology
- High-level complex decision making to inform investigation, diagnosis and complete management of episodes of care
- Onward referral within scope of practice
- Provides multi-professional clinical supervision and education within scope of practice
- Provide teaching, education and verification of ARRs funded roles at both FCP and ACP level in order to complete the WT&E Roadmap requirements.
- Leads audit and research projects
- Promotes, enables, facilitates and develops change across care pathways
ACP role from a patient perspective:
ACPs require a minimum of 5 years of postgraduate experience. The healthcare professional must be registered with the relevant organisation (HCPC or GPhC, depending on background). ACPs are educated to master’s level in a relevant subject/area of expertise or equivalent, demonstrating masters level across all 4 pillars.
A multi-professional framework for advanced practice has been developed. This can be found below by clicking the green button under the diagram. The toolkit includes the following ACP development route diagram:
Further details of the WT&E roadmaps for practice by role under ARRs, can be found at the link above for the ARRs repository (and please click on advanced practitioners). The WT&E roadmaps for practice detail the route towards FCP and AP by role.
A national multi-professional framework for advanced clinical practice in England has been developed and can be downloaded by pressing the button below:
Recognition of prior learning (RPL) or Accreditation of Prior Learning (APL)- the majority of universities will recognise prior learning where appropriate. This enables students to use formal academic and experiential learning towards a formal AP Masters Level programme award. Please seek advice from the university you are applying to.
Advanced Clinical Practice Apprenticeship Route
For further information on the apprentice route for AP please visit: Advanced Practice Toolkit | 6 ACP Degree Apprenticeship (e-learningforhealthcare.org.uk). A 25 minute video below provides a guide to AP Apprenticeships for Primary Care employers.
WT&E offer a supported e-portfolio route. This route is designed to enable recognition with the Centre of Advancing Practice of existing, experienced advanced practitioners, regularly working clinically AP roles, who have normally completed their advanced practice experiential and educational learning before 2017 (when WT&E multi-professional framework for advanced clinical practice was published). Further information on this route can be found at: ePortfolio (supported) Route – Advanced Practice (hee.nhs.uk). An expression of interest form for the portfolio route can also be found at: Expression of Interest for ePortfolio (supported) Route – April 2023 forward (office.com).
This will include completing a Learning Needs Analysis (LNA) and having the support of their educational supervisor in practice. It is expected that the person applying via this route will be able to meet all the capabilities and learning criteria for submission of this e-portfolio within a 12-month period. You will be allocated an academic supervisor at the chosen university who will go through the LNA with you and suggest areas for evidence and appropriate submission of a critical narrative of approximately 3,500 – 5,000 words with supporting documents.
On completion of a Centre for Advancing Practice accredited programme or the portfolio (supported) route a digital badge can be applied for to standardise recognition of the quality assurance of AP education, training and experience. More information can be found at: Digital badges – Advanced Practice (hee.nhs.uk).
WT&E provide some funding annually to support AP development for eligible individuals. Full details can be found at: South West Resources for Organisations – Advanced Practice (hee.nhs.uk) and the handbook can be found at: WT&E SW Advancing Practice Faculty Handbook 2022-23. Please contact the training hub if you wish to consider applying and we can advise further. The time line and available funding is below.
Supervisors for ACPs are usually expected to be at, as a minimum, an experienced advanced practitioner or specialist registrar. In Primary Care this is likely to be a GP or other experienced ACP. The level of supervision will vary according to stage of training. To note once trained ACP/APs can provide significant supervision of other multi-professional learners and staff. Further information regarding supervision can be found at: https://advanced-practice.hee.nhs.uk/advanced-practice-supervisor-capabilities/.
A longer video below (37 mins) provides more information about supervision in advanced practice.
Employers need to work in partnership with the chosen educational provider to agree on the expectations and commitments required to support trainees APs in their work-based learning. Subject area-specific knowledge, skills and competencies will be required for specific context or roles, and will be clearly defined by relevant organisations or frameworks.
Job descriptions will vary by type of AP role. Job descriptions for paramedics, occupational therapists, physiotherapists, dieticians, clinical pharmacists and podiatrists can be found in the relevant section of the ARRs repository. Please note these JDs are aimed at a First Contact Practitioner (FCP) level (with the exception of clinical pharmacists who do not have an FCP level). The table below, taken from the WT&E roadmaps, shows the key differences between roles at an FCP and AP level, and may be useful to amend job descriptions as required to develop an FCP role into an AP role. The job description will also need an associated appropriate job plan to support delivery of all four pillars of advanced practice (for guidance a minimum of 20% of non-clinical time should be allowed once in an established AP/ACP post). A generic job description can be found in the resources below.
WT&E Roadmaps to practice (landing page): Roadmaps to Practice | Workforce Transformation and Education (hee.nhs.uk).
WT&E Advanced Practice site: Welcome – Advanced Practice (hee.nhs.uk).
ARRS FAQs on Advanced Practice ARRS FAQs – Advanced Practice (hee.nhs.uk)
Southwest faculty for Advanced Practice: Regional Faculty for Advancing Practice – South West – Advanced Practice (hee.nhs.uk)
South West Advanced Practice podcast series: South West Podcasts – Advanced Practice (hee.nhs.uk).
SW Advanced practice latest news and events: South West News and Events – Advanced Practice (hee.nhs.uk).
Job description below: