Update on Health Education England Advanced Clinical Practice project (August 2016)

Background

In the latter part of 2015, Health Education England started a project in relation to Advanced Clinical Practice aiming to establish an agreed framework with a common definition and core principles with a multidisciplinary application.  A Steering Group was established.  The opportunity was taken to utilise an existing group of LETB representatives and advanced practice health professionals who had been already meeting for a year to share local advanced clinical practice frameworks and guidance.  This group has become the working reference group for the HEE project.

AAPE UK have representation on both groups:  Ruth Pearce (former Chair of AAPE UK) is a member of the Steering Group and Katrina Maclaine (Current Chair of AAPE UK) is on the working group.

Meetings of both groups are being held regularly with good attendance and enthusiastic participation.  The time line for the project has recently been extended from 1 year to 2 years in recognition of the scale of the project, however it is hoped that a definition with principles will be produced as on of the interim outputs.

Thoughts from Katrina Maclaine on themes from recent working group meetings:

The enthusiasm for this project has been high with lots of discussion and debate on issues that have vexed everyone involved in advanced practice for many many years.  As a result achieving a consensus has been challenging but a very interesting process.

For example is the intention to set a standard for advanced clinical practice as a level of practice or rather to define the role advanced clinical practitioner. We have agreed the former (using the reasoning already well articulated in the Welsh Advanced Practice policy) however anxiety in the practitioners in the group remains regarding how this will help the multitude of titles and consistency of terms for patients and colleagues.

Another key aspect that many of us have emphasised is the need to not reinvent the wheel, with high quality UK and international and profession specific work to draw on.   We undertook an exercise where multiple definitions of advanced practice were mapped and key common words highlighted.  This enabled us to synthesis a draft definition which will be put to the Steering group for consideration.  In this we particularly emphasised the importance of the four pillars, not only as separate key aspects of advanced practice but also as integral to and underpinning each other to ensure that the level of practice is significantly different from the standard of a newly qualified health professional.

The most contentious issue has been whether there should be a set standard for educational preparation and if so what this should be.   Some members want “masters level thinking” focusing on demonstrating experiential learning, while others of us are strongly pushing for a full MSc award with the curriculum based around all 4 pillars.

There was some email debate following the last meeting so I thought it might be worth sharing what I contributed (see below).  I would welcome your thoughts to enable Ruth and I to reflect your opinions as AAPE UK members in the group discussions. 

As I said at the meeting I strongly advocate a full MSc ACP for the future standard with agreed themes for content based around the 4 pillars that form part of our proposed definition.

This does not stifle creativity and can be outcome focussed with recognition of prior and experiential learning optimised.

I looked that some of the other Local office standards and also the Scottish, Welsh and Northern Ireland, RCEM and international work.

MSc Advanced Practice is now the common proposed standard and I think any suggestions for England not to act similarly would be a serious mistake in terms of reputation and its impact on reducing inter-country barriers for a mobile global workforce.

Their rationale does refer to international comparisons, however they also importantly emphasise:

  1. The need to establish consistency to sustain the future of advanced clinical practice with a single framework to support employers, service leads and senior clinicians to articulate the role, its function and the education requirements.
  2. Recognition of the level of practitioner that will result from a full MSc with a specific curriculum designed to fully optimise the knowledge, skills and competencies that are characteristic of advanced clinical practice, will be higher than that for a lower masters level award such as a module, PgCert or PgDip.   This is key for delivering the future policy agenda nationally and locally in England.

I know there may be a perception that as an HEI we have a vested interest in advocating for a full MSc, however my experience from the being on the UKCC Higher Level Steering Group (1994) piloted a standard for trying to regulate advanced nursing, subsequently as part of the NMC working group on regulating Advanced Nurse Practitioners (2004), and then on the Department of Health group to define Advanced Nursing (2010) has demonstrated to me that “masters level thinking” is not sufficient to provide a the single standard needed to enable us to move on from the constant debate about the standards needed for preparation of health professionals for advanced practice.

The issue of affordability came up last Thursday.  This is a challenging one but I don’t think we should modify our goals based on this.

I realise there are other views but wanted to share my thoughts so they could be included in information for the Steering group to consider.

Katrina’s contact email is maclaik@lsbu.ac.uk 

 

We will provide further updates on this work.  

Our conference in March 2017 will also include a presentation from Mark Radford who is co-chairing the Steering Group for this important project. 

Coventry University 4th NATIONAL CONFERENCE ON ADVANCED CLINICAL PRACTICE – The Advanced Clinical Practice Kaleidoscope

Wednesday 13th July 2016 9:00AM – 5:00PM
CLINICAL SCIENCES BUILDING
UNIVERSITY HOSPITALS, COVENTRY

NHS Trust in partnership with Coventry University are hosting the
4th National Conference on Advanced Clinical Practice. This event will
provide opportunities for professional growth and practice, as well as a
great way to network with other Advanced Clinical Practitioners within the
wider health economy.
This event is aimed at Advanced Clinical Practitioners and those with an
interest in the role from Acute and Primary Health Care
Don’t miss the opportunity for:

Presentation by leading health policy authorities
Updates on Advanced Clinical Practice
Surgical Training Centre Clinical Skills Workshops
Advanced Practice Development Workshops
To take part in ACP Educate podcast

PLACES ARE LIMITED
The event is FREE for UHCW staff.
To register email: anne.delacerna@uhcw.nhs.uk
External delegates will be charged at £50 per person

The COST for external delegates to attend the day including lunch and refreshments is
£50.00 each. (This is non refundable once a place has been booked)
BOOK YOUR PLACE NOW SO YOU DON’T MISS OUT: Please contact
Anne Dela Cerna, Practice Development Office, 5th Floor, East Wing, University Hospital,
Clifford Bridge Road Coventry, CV2 2DX.
Regrettably we are unable to invoice you for the cost of the conference.

New Chair of AAPE UK

I have great pleasure in introducing myself as the new Chair of AAPE UK.  I have taken over from Ruth Pearce who has stepped down due to a change in her academic remit.  Ruth has been an excellent Chair and the committee really appreciates her contribution and enthusiasm.

I am Associate Professor (Advanced Practice) at London South Bank University. I’ve been involved in Nurse Practitioner education for 15 years, following graduation from the RCN Institute NP programme in 1994 while I was working in General Practice in Newham, East London. I’ve been a long-term advocate for collaboration between providers of advanced nursing education and contributed to the establishment of AANPE by chairing the first seminar for UK NP education representatives in 2001.  Subsequently I’ve actively lobbied for UK-wide standards for advanced nursing education and practice as an AANPE committee member and as the RCN NP Adviser (2002-2007), member of the Department of Health (England) Advanced Nursing Practice Steering group (2010) and more recently membership of Health Education Englands (HEE’s_ national Local Education and Training Board (LETB) group working to develop HEE standards for advanced clinical practice across England.

These have reinforced my belief in the value of AAPE UK for influencing development and implementation of policy at local and national level within all four countries and internationally.  I look forward to working with the committee and wider AAPE UK membership at such a significant time for advanced practice.

2016 has started well for AAPE UK with an excellent conference in March in Salford. The caliber of speakers was evaluated highly – their presentations are available on the Conferences section of this site.

The agenda included the AGM which fed into the updated action plan for 2016 -2017 – you can read more on this website.  Leads are identified but please contact us if you want to contribute to one of the activities.

At the conference, we took the opportunity to co-opt representatives from allied health professionals to strengthen the interprofessional focus of the committee.   This is important for enabling the committee to better reflect the multi-professional mix that now exists within the majority of advanced practice programmes across the UK.

Advanced practice is making headlines regularly now, being heralded by some as the solution to the medical workforce and emergency care crises.  This has attracted national press and debate with the usual questions about the risks of “dumbing down medicine”.  There is not doubt that innovative solutions are urgently needed to meet the challenges of an aging workforce, recruitment and retention difficulties and social trends with an aging population and escalating numbers of patients with complex health needs.  There are now examples of Advanced Practitioners providing safe and effective high quality patient care across all health settings and the benefits to the multi-disciplinary team and wider organisation are also evident in recent evaluations.  These successes are driving a significant escalation in demand for advanced practice programmes, which is particularly notable in a time of reduced funding for education.

However a key issue central to the future direction of advanced practice and associated education across the UK is whether  advanced practitioners should prepared as “medical-substitutes” or have a more rounded scope and focus that values the leadership, educator and researcher aspects, alongside the advanced clinical dimension.   This latter approach is widely advocated in multiple examples of advanced practice literature and national and international policy, but seems to be disregarded in the drive for a quick and cheap solution.

AAPE UK is lobbying at every opportunity to avoid a reductionist, limited approach to the education of health professionals to work at an advanced level of practice. Anything less is a missed opportunity for the future impact and full return on investment for advanced practice.

The committee also has four country representation so we plan to provide regular updates on what the impact of our discussions in England, Scotland, Wales and Northern Ireland.

Best wishes

Katrina Maclaine

maclaik@lsbu.ac.uk

 

Advanced Nursing Practice: Changing Healthcare in a Changing World. Edited by Dave Barton and Douglas Allen

Advanced Nursing Practice: Changing Healthcare in a Changing World is edited by two ex-Chairs of AAPE-UK. The book has many contributions from AAPE-UK committee members and is a comprehensive overview of pertinent issues and topics that affect advanced practice.

The publishers state that Advanced Nursing Practice is a topical and emergent area of developing health practice, but as an area that is still developing it can also be seen as one of uncertainty.

Advanced Nursing Practice seeks to pave the way to a better understanding of ANP by providing a comprehensive overview of its evolution, including practice, theory and core concepts. Written by leading experts with extensive experience in the field it provides practical guidance as well as a review of the current clinical, strategic, educational and research developments. Chapters range from exploring the organizational challenges in ANP and the impact of technology, to assessment, clinical decision making and career development.

This is an essential resource for Advanced Nurse Practitioners, their educators and mentors, and is a valuable resource for undergraduate student nurses, registered nurses and service managers. For more details go to the Palgrave MacMillan website.

Queens Nursing Institute Conference 28th September 2015

Katrina Maclaine and Ruth Pearce attended the Queens Nursing Institute Annual Conference as guests of Hallam Medical. The theme of the conference was ‘Inspire, Innovate and Implement’. Keynote speakers included Jane Cummings – Chief Nursing Officer for England, Rob Webster – Chief Executive NHS Confederation, Christine Hancock – Founder and Director of C3 Collaborating for Health as well as a host of other well known names.

The conference was a platform for the launch of the QNI/QNIS’s Voluntary Standards for District Nurse Education and Practice. The voluntary standards have been developed through working with leading experts from across the UK and are designed to build on and enhance the NMC standards for specialist education and practice, not replace them. The proposal is that all education providers who currently offer the NMC approved Specialist Practice District Nurse programme adopt the QNI/QNIS voluntary standards for District Nurse Education and Practice. The standards are available from the QNI website. The voluntary standards have adapted the four domains or pillars that underpin advanced practice to articulate their practice standards.

The QNI/QNIS now aim to develop voluntary standards for GP nursing and AAPE-UK have asked for a seat at the table – watch this space!

Enabling Excellence

Enabling Excellence
Autonomy and Accountability for Healthcare Workers, Social Workers and Social Care Workers
Download from Documents and Publications

Advanced Level Nursing

Advanced Level Nursing – A Position Statement – Dept. of Health – Sunday, November 21, 2010
Go To Strategic Documents 2010