An exploration of the role of advanced clinical practitioners in the East of England
Medical staff shortages in the UK have provided impetus for the introduction of advanced clinical practitioners (ACPs). This case study explored the views of 22 ACPs, managers and doctors in primary and acute settings in a region of England, to understand how the role is used, and barriers and facilitators to its success. ACP roles improved the quality of service provision, provided clinical career development and enhanced job satisfaction for staff and required autonomous clinical decision-making, with a high degree of self-awareness and individual accountability. Barriers included disparate pay-scales and funding, difficulty accessing continuing education and research, and lack of agreed role definition and title, due to a lack of standardised regulation and governance, and organisational barriers, including limited access to referral systems. Facilitators were supportive colleagues and opportunities for peer networking. Regulation of ACP roles is urgently needed, along with evaluation of the cost-effectiveness and patient experience of such roles.
Shortfalls in the NHS workforce, and increasing demands on health in the UK, provided the original impetus for introducing the advanced clinical practitioner (ACP) role, which used and expanded the skills of nurses and other healthcare practitioners into areas traditionally confined to doctors (Imison et al, 2016; NHS England, 2017).
The emphasis was on a generic, higher level of expertise rather than highly specialised expertise, so that ACPs could care for patients as they presented with a variety of undefined and undiagnosed conditions. In 2017, NHS England produced a document outlining a ‘multi-professional framework for advanced clinical practice in England’ that set out an agreed definition for advanced clinical practice, encompassing the ‘four pillars’ of capability (clinical practice, leadership and management, education and research) (NHS England, 2017). The aim of the framework was to ensure, ‘safety, quality and effectiveness’ (NHS England, 2017).
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