Reflections on Advanced Practice Week

Credentialing, confusion, communication, collaboration, and country lanes.

This month I have been reflecting on the various activities and conversations that happened in the ‘Advanced Practice Week’ that occurred between the 9th-13th November.

This included the Health Education England ‘Advancing Practice-Taking Centre Stage‘ conference, Twitter chats, Facebook queries, and making new connections with people working in this area. There was a lot that provided encouragement about advanced clinical practice.

Consensus on the place of research in ACP was clearly voiced. Supervision as a way to support ACP was welcomed. Some brilliant examples of the positive impact ACPs can make to clinical effectiveness were also shared. (For example Heather Rimmer’s service evaluation of ACP’s experiences of emergency redeployment to intensive care during Covid-19). This appears to show significant progress being made in the world of ACP. The fact that the conference had to close to offering places due to its popularity means that there is a large body of people that are engaged in ‘all things ACP’.

However, there is of course the concern that we are ‘preaching to the converted’. Those that signed up for the conference or got talking on Twitter are people that are already invested or ‘sold’ on the idea of the positive impact that ACPs can provide and are aware of the work that needs to happen to make the most of this body of health professionals. In comparison, it was interesting to see the questions that keep popping up in other forums, (e.g Facebook groups) that are populated by those that maybe on the shop floor of ACP rather than those you will see on more ‘academic or managerial forums (such as national conferences and Twitter feeds). Repeatedly questions continue to arise about what is required to be able to be recognised, gain employment, and be supported in ACP roles. This indicates the answers to these questions are not being clearly communicated or are not yet known.

In a recent on-line workshop that gathered over a thousand responses from ACPs, “concern was expressed that a degree of certainty was needed about the future of advanced clinical practitioners if professionals were to invest their time in developing their skills and qualifications and if employers were to provide their investment and planning.”   From the literature review I have recently conducted, the certainty that is being asked for here is far from being present in the current empirical evidence.  This evidence is dominated by descriptions of ACP and highlights the barriers and diversity of the ‘in practice’ reality of ACP. 

In response to the specific call made in the NHS people plan, there now appears to be a ramping up of the development of ACP credentials. As noted in one of my previous blogs, this may start to fill some gaps in the current situation of some specialisms, professional groups, or fields of practice being left out from the current patchy set of credentials already out there.

And yet… there remains calls of what about me and how far do we go? For example one participant in the ‘Taking Centre Stage’ conference asked “Credentials feels like CPD but also puts people into little boxes with fixed scope. If we have pelvic health where does this stop? Are we going to have one for every system!?”

Does this mean that a whole new industry is being created where every minutiae of clinical practice will need a credential to validate against? How sustainable is that, when we know that part of the role of ACP is to be innovative and to develop practice? The credentials we produce now are unlikely to be fit for the future in the long term. Perpetual writing and re-writing of ACP credentials could become a major industry!

Alternatively having just broad credentials to cover the main fields of practice might give the majority a place to call home. However, it is unlikely to fully reflect the complexity, intersectionality and diverse community that is ACP. This will always leave someone out that doesn’t quite fit, and will not provide the detail of knowledge, skills, capabilities, and competencies that are required to do that ACP role, in that service, in that place at that time. For this, the situatedness or localisation of ACP (as discussed by DeBont et al) remains a clear feature, and one that will need addressing at a level much closer to home between ACPs and the people they work with than a nationally produced credential could ever achieve.

And yet… people continue to ask but what about this route, or do I need to get that piece of paper, or follow that process to be able to work and be a valid ACP.

This is compounded by the different bodies that appear to be offering a route to recognition, and trying to demonstrate that their one is the best way to go. It was encouraging to hear of the promises being made regarding collaboration between these bodies to try to reach agreement about transferability. (The idea being that if you have completed a process through one, like the RCN credentialing process, this would also be recognised by the other, like the Health Education England’s accreditation, and won’t be superseded by a change made by a regulatory body such as the HCPC). However, so far nothing definite has been confirmed. The concern therefore remains that each body, who have their own personal interests (such as control of ownership of setting standards, and retaining a funding pipeline to support their work), do not really have the commitment to come to an equitable solution to this, and we may have put the cart before the horse.

So has the call for certainty to allow people to make the right decisions about their development in ACP been addressed? I think it is too early to say; there is more work to be done. My advice, to anyone that asks, is therefore to tread carefully. Look at all the options, scan the horizon, get objective advice, and weigh up the alternatives that work best for you within the resources and constraints you have. (i.e. it’s not so simple, it’s more like a network of country lanes to navigate than a nice, straight, fast, 4 lane motorway!)