There has been a long history of calls for definitions of, and agreement on, what it means to be an Advanced Clinical Practitioner. Several notable ones have emerged such as the statement of NHS employers which references the Multi-Professional Framework for ACP in England or the International Council of Nursing’s Advanced Practitioner Nursing Network definition (AAPN). This has perhaps paved the way for employers to establish specifications for recruiting to ACP posts and monitoring performance. For commissioners of ACP training this gives a benchmark to choose which education providers to use. For professional bodies and communities of practice this may also provide a set of standards which if met means they can add their stamp of approval and recognition. What this means for the individual seeking to become or be recognised as an ACP though, is that they have to find their way amongst these definitions, specifications, benchmarks and standards to match their knowledge, experience and skills against them.
So is there a clear map to do this? I am afraid that here again the answer is…well it depends! Whenever planning a journey you should ideally know where you are starting from and where you are aiming to get to. It’s common that we start in different places and of course we therefore have to follow different routes to get to where we want to go.
You can control somewhat the starting points by restricting the places of entry. In terms of ACP, the entry point is that they are already working in clinical practice, and recognised as a health care professional.
There is an element of ambiguity here in that globally the heath care professions are defined differently, called different things, have different scopes of practice, and some have professions that are new or emerging or not common in other places. For some professional groups they follow much of the standard route to gain recognition and entry into working in clinical practice but are not yet a regulated profession (for example Sports Therapy). There may still be some debate therefore as to whether there are equal and clearly defined entry points for ACP.
Another of the entry points is the criteria which have to be met in order to commence on an ACP education programme. ACP education programmes are now commonly defined as needing to be at Masters level. As established in my previous post, universities that provide these programmes set differing standards in terms of recognition of previous qualifications or experience as a gateway to these programmes. For some they would require that an undergraduate degree has already been successfully completed. For the majority of health professions that have trained in the UK it is now standard to hold a UG qualification as entry to the profession. However what about those that trained before this was a requirement, or those that have trained in other countries where this was not a basic requirement? This opens up again the question of to what extent experience counts to gain the basic entry to the journey to become an ACP.
In terms of the destination, you could assume this is much easier to agree on; the aim is to achieve recognition as, and employment in, an ACP role. Without an over-arching body that ‘gate-keeps’ who is recognised and who is not an ACP, there is though potential inconsistency and divergence on where we seek that recognition and whether all agree on this so it can be globally transferrable. If we just look at the UK, or even regionally, we would not want a set of criteria for ACP recognition to be one thing in one employer and another in an alternate employer.
Also, what if someone straddles professional groups or specialisms and the criteria for recognition in these are different? What if someone meets all the criteria in one specialism but then moves to another- do they lose the status of ACP?
Currently there are only a few specialisms that have defined the criteria (or list of competencies) that are required to be an ACP in that specialism. (e.g. FICM, RCEM and GPN). As these are very specific to that field of clinical practice, perhaps for those following this prescribed route they would need to add a qualifier to the term ACP such as has been done for ‘Advanced Critical Care Practitioners’. However, it is possible that someone could meet all of the more general criteria for ACP and be working in this field of specialist practice and yet not meet the criteria for that particular specialist body.
If these qualifiers for particular specialisms are therefore to be added as a ‘check point’ on the route to be an ACP, a universally agreed list of additional criteria would need to be created. Otherwise the person may start and end at the right point but will not have picked up a key stamp of recognition along the way.
This is what is referred to as ‘credentialing’. In the NHS Interim People Plan (page 49) it was noted as an expectation that the use of credentialing would increase. This would allow more specialisms to have a clearer defined route to recognition of and employment as an ACP.
However, as we have seen with the Centre for Advancing Practice, work on this appears, not surprisingly, to have stalled with the more pressing matter of a pandemic.
As noted in my previous posts this risks having a two tier system where some groups of people have a clear and validated route to become an ACP and others not. This has already created an environment where only those that have a set of credentials to map against and have completed this successfully are seen as ‘real ACPs’. This of course then leads to inequity for job security, renumeration, career development and feelings of professional value and self-worth.
For me this also creates a nervousness that we are once again getting mixed up between specialist and advanced clinical practice. Surely the aim here is to recognise someone that is working at an advanced level, not just that they can operate well in a very specific specialism? Credentialing perhaps places too much emphasis on the clinical competencies and threatens to overshadow the skills needed to work at an advanced level in a range of clinical contexts.
So where next for ACP? Perhaps the next step is to think about where it might take someone if they follow the road to become an ACP. This will the topic of my next blog post.