Workforce experience of the implementation of an advanced clinical practice framework in England: a mixed methods evaluation

Abstract

Background This study aims to understand how the implementation of the advanced clinical practice framework in England (2017) was experienced by the workforce to check assumptions for a national workforce modelling project. The advanced clinical practice framework was introduced in England in 2017 by Health Education England to clarify the role of advanced practice in the National Health Service. Methods As part of a large-scale workforce modelling project, a self-completed questionnaire was distributed via the Association of Advanced Practice Educators UK aimed at those studying to be an Advanced Clinical Practitioner or who are practicing at this level in order to check assumptions. Semi-structured phone interviews were carried out with this same group. Questionnaires were summarised using descriptive statistics in Excel for categorical responses and interviews and survey free-text were analysed using thematic analysis in NVivo 10. Results The questionnaire received over 500 respondents (ten times that expected) and 15 interviews were carried out. Advanced clinical practice was considered by many respondents the only viable clinical career progression. Respondents felt that employers were not clear about what practicing at this level involved or its future direction. 54% (287) thought that ‘ACP’ was the right job title for them. 19% (98) of respondents wanted their origin registered profession to be included in their title. Balancing advanced clinical practice education concurrently with a full-time role was challenging, participants underestimated the workload and expectations of employer’s training. There is an apparent dichotomy that has developed from the implementation of the 2017 framework: that of advanced clinical practice as an advanced level of practice within a profession, and that of Advanced Clinical Practitioner as a new generic role in the medical model. Conclusions Efforts to establish further clarity and structure around advanced clinical practice are needed for both the individuals practising at this level and their employers. A robust evaluation of the introduction of this role should take place.

Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review

“…This sometimes led to inter-professional tensions, role overlaps, misunderstandings of the role purpose and scope and a sense of dissonance around professional identity. 61 Similar issues have been reported in other (international) reviews. 190 191 Another key factor influencing ACP implementation was identified as the variability in the education and training pathways underpinning ACP roles.…”

“…[58][59][60] Moreover, the definition and understanding of advanced roles have differed both within as well as between professions. 61 This variability and lack of consistency gives rise to concerns for patient safety and impedes workforce planning at scale. [62][63][64] In England, the NHS workforce transformation agenda is being supported by a national non-departmental public body, 'Health Education England' (HEE).…”

“…A key action that could be taken to bring clarity and to aid mutual understanding of the ACP role would be to standardise job titles as appropriate to particular settings and professions. The multiplicity of titles currently in use appears to reflect an ongoing lack of clarity about whether ACP denotes a role, a level of practice or both 61 (HEE's 2017 definition of ACP affirms that ACP reflects a level of practice, not a role). 65 For example, within primary care, HEE has recently developed a core capability framework for advanced nursing practice in primary care, using the role title Advanced Clinical Practice (Nurse)-thus denoting the professional group.…”

“…Thus, the evidence suggests that as the ACP workforce grows, there is a clear need to provide structured ongoing CPD opportunities as part of a structured career pathway. 61…”

Diagnostic radiographer advanced clinical practice in the United Kingdom – A national cross-sectional survey

“… 15–17 This disparity is also evident in other healthcare professions. 18 Many advanced practice roles have evolved over many years to incorporate a range of clinical settings. These roles developed without a set standard, resulting in inconsistency in expectation for qualifications, titles and level of practice.…”