What is the value & impact of Advanced Clinical Practitioner Training?
“It’s helped me progress in my career and stay in the NHS”, “It gave me recognition for the knowledge and skills I have developed over years of experience”, “It enhances patient satisfaction”, “It improves clinical effectiveness”, “It’s the only way we can maintain a service when we can’t recruit into medical roles”, “It’s a cash cow for the University”.
These are just some of the proposed benefits that have been pinned to Advanced Clinical Practice (ACP). We appear to be at a moment in time when there is a clamour for policy, funding, and ACP education products in response to what may appear at times to be a panacea for a variety of problems that are trying to be solved in the health care system.
However, do we actually know what the value and impact of ACP training actually is? Does this vary amongst the key stakeholders (ie the employer/ service provider, the individual health care professional, the education commissioner and the education provider)?
As health care professional educators working within HE we should of course be the first to ask what is the evidence and how can we use this to inform our decision making? We can point to several studies that provide example of clinical effectiveness in particular specialities using people that have been identified as an Advanced Clinical Practitioner. Some are able to point to this as adding value to a service rather than just being more cost effective than employing a doctor to do it. However we also know that just because something has been proven to be clinically effective, it is not always implemented universally or effectively.
For many years reference has been made to ‘Advanced Clinical Practice’ and ‘Advanced Clinical Practitioners’ (or other similar titles). In 2017, for the first time, a number of professional bodies collaborated with Health Education England to develop the ‘Multi-Professional framework for Advanced Clinical Practice in England’. This sets out the definition of ACP, the scope of practice and practitioners this applies to, and the standards and capabilities that are expected in order to practice under this title. Work is also underway, through Health Education England to launch the ‘Academy of Advancing Practice’.
Whilst this currently falls short of regulation, it has now provided a benchmark or toolkit by which education and training providers can badge their products as leading to advanced clinical practice. Employers can use this to select individuals to work in ACP roles or undertake what they believe to be ACP related tasks and individuals can provide evidence against the framework to support their credentials as an ACP.
The introduction of this framework, along with additional funding being released specifically for the support of ACP, as well as the development of the Interim NHS people plan which makes specific reference to ACP, the approval of an Apprenticeship route for ACP, and the prospect of potential governance/ regulation through the Academy has led to an increase in activity around ACP.
Many education providers have undertaken to map their programmes to the framework and promote their courses as ‘ACP’, with some also developing new ACP apprenticeship programmes. From my experience as a Dean and a CPD programme lead, the release of funding and this being tied to ‘ACP’ has led to an increase in enquiries about the opportunities for ACP training and education. In response I, like many others have reviewed, refreshed or created new ACP products.
Employers are also now having to review those that currently hold ACP roles or undertake what they believe to be ACP related tasks to ensure they meet the framework expectations. They have also looked to create new or additional ACP posts in the workforce. In some cases, this is to provide further career routes and retention opportunities for their highly skilled staff. This offers the opportunity of ACPs to ‘add value’. However, potentially for many others, it has also been seen as a way to reconfigure or develop service provision in particular areas, especially where there are shortages of supply of other professionals. This has led to ACP being seen as purely a way to supplement or replace where Doctors would normally operate (ie we are back to the mini doctor, maxi nurse debate!). As you can imagine this is creating controversy regarding the actual aim and impact of ACP and nervousness for those that may be working or wanting to work in this field.
Health care professionals are now expected to have longer working lives than ever before. The fragility of long term careers in a particular service, field of practice or employer has increased with a higher pace of service reconfiguration, development of specialisms and creation of new roles within the field. This creates a perceived pressure on health professionals to ensure they have the ‘right qualifications’ to allow them to progress in their career or maintain job security.
So this is a sensitive and potentially explosive topic. There appears to be a strong belief in the benefits that ACP training can provide and lots of activity happening around ACP education provision. So this looks like a good moment to evaluate the actual value and impact ACP training has for employers, individual healthcare professionals, commissioners of training and the training providers. Fortunately it’s also a moment when I am able to start a PhD on the topic!
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