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:
- 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.
- 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 firstname.lastname@example.org
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.