ACP- Bureaucratic Blockages?

In my last blog post I asked what next? Well its been a bit busy since then in the ACP education world with the doors opening for Universities to apply for accreditation of their ACP programmes and the freshly published People Plan making specific reference to CPD and ACP. One of the largest regulators of health care professionals in the UK (the HCPC) has signalled their intention to look again at the evidence for potential regulation of ACP. And we’ve also had NHS workers (including ACPs) excluded from the pay rises given to other public workers in the aftermath of the C-19 crisis. The people plan notes as one of its key messages that bureaucracy falling away in this time has helped people to feel empowered to do what is needed. So is this context reflective of the ACP experience? Have bureaucratic blockages been removed to allow ACP to be implemented effectively? I’m not sure it has.

In my last post I gave an example of how I witnessed first hand an ACP work really effectively and in more extensive and expert ways than even she realised. However I am not sure if this was because the barriers that may have previously been in her way had thoughtfully and systematically been removed due to policy change. Was it just necessity as there was no-one there to tell her otherwise, and would her position and scope of practice that she was ‘awarded’ in this time be sustained? I would like to think so.

Covid-19 has forced, nudged, or more generously, allowed us to operate in different ways than we had before. But the hard work now may be to effectively evaluate whether this was a positive change, and if so how this can be sustained.

I’ve been reading a lot of research on ACP, where….

1. we know what benefit ACPs can bring

2. we know the principles of how to effectively implement ACPs

3. we also know the barriers that prevent ACPs working well

….but…….the barriers are still there and there is still evidence of ACPs being prevented from achieving their full potential.

The principle of removing barriers, (particularly bureaucratic ones which arguably are there not for any sound justification) is a good one. In ACP this could be ensuring people have equal and easy access to CPD, supervision and protected time for training. It could be ensuring people that may stand in the way of ACP development, potentially out of an undue sense of needing to protect a profession are ‘enlightened’ to the merits of supporting ACP development. It could also be making sure people are given the recognition and remit to do the work they have the knowledge and skills to do by creating jobs, teams, clinical pathways to allow this to happen. This all sounds good, right, what’s needed.

What I’m not sure of is how some of the recent changes in policy, context or practice help us to get there.

Equal, easy access to CPD with protected time for training requires backfill, as the People Plan highlights. Do we have the skilled workforce and the money currently to do facilitate this? A large amount of the media such as the recent RCN report of staff shortages questions this. My own experience is that working through NHSP to continue to support colleagues in ITU past the peak of Covid, has been stopped due to financial concerns of agency staff costs. But this is still whilst they are facing staff shortages due to sickness, sheilding or self-isolation, and the ‘normal’ work of ITU ramps again.

Ensuring colleagues understand the merits of ACP and the full scope they can offer so they become a facilitator rather than a barrier may go either way. It could be that the crisis way of working has opened people’s eyes and with renewed vigour we can embed more formally the ACP role in our services. Or it could be that as things return back to more routine work, the ‘re-deployed’ are returned back to their original boxes.

Recognition can happen in many ways. A clap on a Thursday was nice whilst it lasted but appears to have turned sour and momentary, spurring many on to campaign for such gestures to turn into something of more solid value. Will the accreditation of ACP programmes provide that recognition? From someone going through the paperwork required for this process, I am conflicted as to whether this is just another bureaucratic barrier for ACPs to pass through or whether it may actually remove a barrier by facilitating national recognition against a set of ‘guaranteed’ standards. The HCPC makes the promise that any measures taken as a result of their current investigations regarding additional regulation of ACP “should enable, and never restrict or serve as a barrier, to effective development of registrants advancing their practice.” Will this translate into creation of more ACP jobs?

The people plan refers to 400 extra ACPs in training but not whether this will translate into new positions and whether that is enough for what is needed and to recognise the potentially large number of people that are/ can work at ACP level?

So I’m left feeling there’s lots of aspiration here. We have the basis on knowing what ACPs are and what they can offer. We also know the things that may help or hinder that progress. But is this just full of promises without the opportunity and right ingredients to make it happen? As with many right now I waver between optimism and pessimism but ultimately a lot of hope that there is enough energy left for us to overcome the barriers, bureaucratic or not.