The recently published NHS People Plan (NHS England et al, 2020) made reference to continuing professional development (CPD) and in, particular, advanced clinical practice. Work to provide guidance, professional standards, tools and resources to support advanced practice is being produced by various networks (eg Association of Advanced Practice Educators, Advanced Critical/Clinical Care Practitioners Academic Network, Royal College of Emergency Medicine) at a rapid pace. The doors have opened for universities to apply for accreditation of their advanced clinical practice programmes through Health Education England (HEE)'s ‘Centre for Advancing Practice’ (HEE, 2020). In addition, there has been a resurgence of activity as people return from redeployment during the COVID-19 crisis into a new way of working that includes both ‘business as usual’ and dealing with the continuing impact of the pandemic.
As one of its key messages, the NHS People Plan notes that the decrease in bureaucracy in this time has helped people to feel empowered to do what is needed. Is this reflective of the advanced clinical practice experience? Have bureaucratic blockages been removed to allow advanced clinical practice to be implemented effectively? Is the effort needed to push forward this agenda worth it?
The COVID-19 pandemic has forced us to operate in different ways than we had before. However, we need to effectively evaluate whether this was a positive change, and if so how it can be sustained.
As part of my PhD studies I conducted a systematic literature review and found a lot of research on advanced clinical practice highlighting:
However, the barriers remain and there is evidence of ACPs being prevented from achieving their full potential. The principle of removing barriers (particularly bureaucratic ones) is therefore a good one.
We need to ensure that ACPs have equal and easy access to CPD, supervision, and protected time for training. Those who may stand in the way of ACP development need to be ‘enlightened’ to the merits of supporting advanced practice. ACPs should also be given the recognition and autonomous remit to do the work they have the knowledge and skills to do. However, how will 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 (NHS England et al, 2020). Do we have the skilled workforce and the finances currently to facilitate this? The Royal College of Nursing (RCN) report of staff shortages questions this (RCN, 2020). NHS workers (including ACPs) have been reported to have been excluded from the pay rises given to other public workers in the COVID-19 crisis (BBC, 2020). The NHS People Plan refers to 400 extra ACPs in training, but not whether this will translate into new positions, if it is enough for what is needed, and if it recognises the potentially large number of people that are already, or could be working at, advanced clinical practice level (NHS England et al, 2020).
It could be that the pandemic way of working has opened people's eyes and with renewed vigour we can embed more formally the ACP role in our health services. Alternatively, as things return back to more routine work, the re-deployed, newly empowered, advanced practitioners could be returned back to their original boxes.
From my experience of the paperwork required for the accreditation process, and being conscious of competing agendas in the ‘credentialling’ world of ACP, I was initially conflicted as to whether this was 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 ‘Advanced Practice Week’ that occurred in November 2020 highlighted the amazing work being done to push the barriers and strengthen advanced practice in health care. However, it also revealed complexity and uncertainty in the rapidly changing policy context of ACP, which makes it difficult to direct people on a clear path to success.
Conclusion
I'm left feeling there is lots of aspiration here. We have the basis of knowing what ACPs are and what they can offer. We also know the things that may help or hinder that progress. As with many right now I waver between optimism and pessimism, but ultimately I have a lot of hope because of the brilliant, inspirational and energetic ACP champions I have discovered that will keep pushing to overcome the barriers, bureaucratic or not.