What next for advanced clinical practice education?

Advanced clinical practice is a growing and rapidly developing level of practice, influenced by the need to transform pathways, support workforce shortfalls and enable staff to work to their full potential.

Last year, NHS England’s Next Steps on the NHS Five Year Forward View pledged to support new ACP roles, intended to be deployed “where they can make a demonstrable impact in high priority areas such as A&E, cancer care, elective services or reducing locum costs by converting medical posts.”

With ambitions on this scale, the spotlight has turned on ACP education. In 2017, Health Education England, NHS Improvement and NHS England published a Multi-professional framework for advanced clinical practice in England, intended for implementation by 2020.

The framework aims to introduce consistency, clarity and shared understanding around ACP.

This is important because ACP roles and education have developed differently to reflect different population needs across health and social care over the country.

The capabilities

The framework sets out capabilities for ACP across four pillars of practice – clinical skills, leadership and management, education and research.

It also sets out a range of routes to ACP practice, including full masters level ACP education for those new to this level of practice or assessed work based practice, simulation, e-learning or academic modules for professionals who already have masters level education or who can evidence ACP capabilities through previous education or experience.

There is real willingness on the part of universities to provide the education required by employers, but significant challenges remain due to the varying development of roles in different settings across health and social care

The funding for post-registration ACP education is also changing. Courses once commissioned by HEE have been affected by national and local cuts to workforce development budgets, but a new source of funding is now available in the form of an advanced clinical practitioner apprenticeship.

The apprenticeship standard has its own educational and assessment requirements, which will drive change in ACP education over the coming years.

A recent survey undertaken by the Council of Deans of Health (which represents UK university faculties engaged in education and research for nurses, midwives and allied health professionals) found that most universities have already restructured their ACP curricula to accommodate the apprenticeship’s requirements for end point assessment.

Universities and employers delivering the apprenticeship will be putting apprentices through a level 7 master’s programme as opposed to specific modules at master’s level.

As ever, there is real willingness on the part of universities to provide the education required by employers, but significant challenges remain due to the varying development of roles in different settings across health and social care.

Despite the publication of the framework, there is still some ambiguity about the relationship between ACP as a level of practice and ACP as a role within a particular field or setting, and in particular how specialist practice and education relate to such roles.

Transformation needs

HEE is keen to ensure that the skills acquired through ACP education reflect employer and service transformation needs by including specialist competencies relevant to the clinical role of each professional. But how specialist must specialist competencies be and how can they be provided by universities across the full spectrum of clinical roles?

Universities require timely funding decisions, more certainty than the system currently provides and a clear statement of intent for the coming years from healthcare providers and education commissioners

If specific, role related clinical content is to grow in importance in ACP curricula, who will design and deliver this? And how can more specialised education be balanced against the benefits of wholistic knowledge and interprofessional delivery?

Universities will want to ensure that the increasing emphasis on clinical practice does not detract from the other pillars of ACP education – leadership and management, education and research. These are all critical for the future workforce.

HEE believes the creation of a new national Academy of Advanced Clinical Practice could help. It has invited universities, employers, the workforce and interested others to collaborate in designing a supporting infrastructure which can encourage effective routes to ACP and bring together existing quality assurance and accreditation functions for professionals and perhaps for ACP courses.

This will be no easy task and will require widespread professional support if it is to succeed in creating shared understanding and confidence in a highly heterogeneous environment.

Increased collaboration across the system seems to be a prerequisite for progress. Employers and Sustainability and Transformation Partnerships are seeking to take an increasingly place based approach to workforce planning and universities must be part of these discussions. Collaboration between universities may also be necessary to allow the delivery of specialist clinical education at a viable scale.

System, regional or national commissioning of courses or modules could also help ensure that appropriate specialist competencies can be taught to all professional groups as part of ACP education, whilst offering bespoke routes for people to meet local population needs.

For universities this may mean ensuring courses and regulations can accommodate accreditation or recognition of prior learning or experiential learning or incorporation of nationally recognised modules delivered by others, creating a more portfolio based approach to education at this level.

Speaking to universities, one message is particularly clear. If advanced practice education is to expand and evolve to meet changing population need, educators need to be able to invest in capacity, capability and staff.

This can be done, and universities are ready to embrace the challenge, but they require timely funding decisions, more certainty than the system currently provides and a clear statement of intent for the coming years from healthcare providers and education commissioners.