As part of a wider programme of workforce modernisation in the North West, NHS organisations identified the need to develop the advanced practitioner role in 2005.
It was recognised that advanced practitioners had the potential to enhance the existing capacity and capability of the workforce, as outlined in, at that time, the NHS Plan, helping to deliver service improvements, achieve European working time directive compliance and address the future demographic profile.
There were however, differences across the region in the use of the title ‘advanced practitioner’ with variation in the role purpose, scope of practice and educational preparation. There was also a lack of national guidance and standards for the role.
It was therefore agreed that there were benefits to introducing a North West-wide approach to developing advanced practitioners, to ensure clarity and consensus. As a result, a concordat agreement was produced in partnership between what were the three strategic health authorities (now the NHS North West), service stakeholders and local education providers.
The concordat agreement is intended for use as part of a strategic approach to workforce planning and modernisation that aims to support organisations’ preparations to introduce new roles, including:
- The requirement that plans for new roles are identified within organisations’ overall workforce strategies.
- A business case template and guidance to help ensure that new roles are clearly defined, based on service development needs, are sustainable and have executive level approval.
- Collaborative working to develop flexible education programmes with a strong focus on work-based learning, to ensure that new roles are fit for purpose.
- A region-wide approach to commissioning new roles to ensure equity and consistency.
- Formal evaluation of the introduction of new roles
The North West advanced practitioner concordat agreement
The aim of the North West advanced practitioner concordat agreement was to provide a summary of the key principles that apply to the development of the role of advanced practitioner. The agreement includes the following:
- Definitions of advanced practice and what is an advanced practitioner
- The characteristics of an advanced practitioner
- The level of education and development required for the role, including entry criteria for the advanced practitioner in training.
- Links to other roles and the NHS Career Framework for Health
Definition – what is an advanced practitioner?
There are two definitions which apply to this new role. The definitions compliment each other and add relevant different dimensions, which together provide the key components that underpin the new role.
1. The Advanced Practitioner has highly specialised or highly developed knowledge and skills beyond those, which are required for registration,
encompassing the breadth and depth of current and future professional
practice. Advanced practice forms the continuum from practitioner to
(Shared Framework, DOH developed by the University of Salford 2004)
2. ‘Experienced non-medicalregistered professional who has developed his or her knowledge to a very highstandard in a specific and often high level of practice. This high standard is such that not only is the individual the expert in the base domain: - but can also accept the full responsibilities for providing those services hitherto undertaken by others, in defined circumstances.’
(J. Sargent Chair of the WDC national forum 2003)
The characteristics of an advanced practitioner
- The advanced practitioner development is aimed at any and all non-medical regulated professions
- The A.P. is a clinical/service role based in practice/service for the majority of their time (over 70% to a maximum of 80% of time in practice).
- Undertakes physical examination and history taking; diagnosis and plans care and treatment.
- Coordinates, manages and signpost patients/clients according their assessed need
- Clinically accountable in the framework of clinical governance and risk management.
- In many cases manages medications, including assessment, review and prescribing.
- In many cases, will have their own patient/client caseload with decision making responsibilities e.g. referral to others, discharge of patients etc.
- Works across organisations and different agencies
- Provides advanced levels of practice, knowledge and skills
- Continues to develop skills, knowledge and practice in the context of service needs, through CPD, research and supervision.
- Undertakes research mapped to service need
- Practice is undertaken to meet the needs of services working as required to fulfil the full 24 hour and seven day week
- Is self-directed, manages risk, has high levels of communication skills and is a member of a wider clinical/ service team.
- Defines their scope of practice within the context of the wider clinical/service team.
- Client centred role.
As outlined in the NHS North West Concordat for Advanced Practitioners, 2006.
The advanced practitioner framework for the North West includes three levels of
Proficiency: Post Graduate Certificate, Post Graduate Diploma and Masters Qualification.
The framework will support development of such proficiency by practitioners providing that their roles are required by service, that they are clinically based and require the level of learning that comes with Post Graduate education.
Therefore there will potentially be three tiers of advanced practice; however possession of a Masters Qualification will be essential to identify those working as advanced practitioners. The remit of their role will require the individual to work beyond their initial level of registration and to undertake skills; competencies and knowledge that are outside their own base profession. The role itself is determined by the needs of service and will be located at band 7 or 8 of the Career Framework for Health (Skills for Health, 2006).
The education required for advanced roles across the North West will be provided within a multi-professional modular portfolio, which in the majority of cases will be part of the three levels of proficiency described above. Individuals who already have a relevant Masters Qualification will not be required to undertake another Masters degree. They will be assessed against their new role to identify if any additional learning is required for the post.
The portfolio of education developed to support advanced practice should be delivered within a robust governance framework, which is intended to be both responsive to service needs and include a focus upon:
- Flexibility - Providing Service with choice and flexibility delivered through a
- modular portfolio of education shaped by service need
- Accessibility - Providing service with innovative systems of delivery including work-based learning
- Portability - Enabling academic credit and shared skills and competencies to be transferred between HEIs and NHS organisations
- Value for Money - Achieved by robust auditing of module uptake, pass rates and attrition rates combined with evidencing responsiveness to student and service feedback.
The advanced practitioner in training
Students wishing to undertake advanced practice modules will be required to meet entry criteria set by service and the HEI which will include being:
- A practitioner who is from a statutorily regulated profession.
- An experienced senior practitioner [normally with at least five years post registration clinical experience OR proof of equivalent experience].
- A practitioner with a first degree or evidence that they can study at this level.
- Students will come from different professional backgrounds depending upon the role required and their individual skills, knowledge and experience.
Links to Other Roles and the Career Framework for Health
Practitioners are most frequently registered practitioners in their first and second post registration/professional qualification jobs. They will normally be located at level 5 of the Career Framework for Health.
Senior or specialist practitioners may include practitioners who have a higher
degree of autonomy and responsibility, than practitioners in the clinical environment. They will normally be located at level 5 or 6 of the Career Framework for Health. These staff may have some elements of advanced practice within their roles, however this does not necessarily mean that they are fulfilling the role of an advanced practitioner in its entirety.
This level of specialist /senior practice provides in-depth knowledge and experience within a specific clinical area that enhances the clinical practice and responsibilities of the role.
Specialisation denotes learning beyond registration and a level of
practice in a speciality that is more advanced than the competencies associated with initial registration.
Advanced Practitioners are experienced clinical professionals who have developed their skills and theoretical knowledge to a very high standard. They are empowered to make high-level clinical decisions and will often have their own caseload. They will normally be located at level 7 or 8 of the Career Framework for Health.
Consultant practitioners are staff working at a very high level of clinical expertise and/or have responsibility for the planning of services, normally employed at level 8 of the Career Framework for Health. The consultant practitioner role requires four key functions:
- Expert clinical practice (at least 50%)
- Professional Leadership & Consultancy
- Education Training and Development
- Practice and Service Development
The advanced practitioner would spend more time (approximately 70 to 80%) in practice and the level of leadership and service development required of the consultant role is beyond that of the advanced practitioner. The level of research activity and education of others is again beyond that of the advanced practitioner.
The challenge for organisations is to recognise that the development of the advanced practitioner role will ultimately prepare staff for new opportunities and roles at consultant practitioner level.
The APF is driven by the requirement to develop new roles and new ways of working that deliver safe, modernised and personalised services to patients in line with the direction set out in the NHS Improvement Plan, governance and risk management agendas.
The North West concordat agreement has proved to be a useful starting point to develop advanced practitioners in a strategic and supportive manner.
The current position, as of June 2009, stands at 240 qualified and 160 in training (training numbers to include September 2009 commissioned cohort.)
To maximise the potential of the role however, there are some continuing challenges including:
- The need for more clarity about demand for these roles within organisations’ workforce strategies
- Development of robust infrastructures to support work-based learning
- Harmonisation of different approaches to education and commissioning across the region
- Professional issues such as regulation and continuing professional development
These challenges will require collaborative working between commissioners, employers and education providers to embed and sustain advanced practitioner roles in the future.
Juliette Swift, the workforce modernisation development manager at NHS North West