Student Article Series

What is Advanced Practice?

Advanced Practice is a level of practice within statutorily regulated health and care professions, requiring practitioners to develop their expertise and broaden their experience and skills across various disciplines to ensure safe and effective care.

It involves a high degree of autonomy and the ability to make complex decisions across diverse healthcare settings, with the goal of improving the quality of care and patient outcomes.

To be recognised as a qualified advanced practitioner working at an advanced level it is recommended to be an experienced registered health professional with core capabilities (discussed later in the article) and clinical competence in your specialty underpinned with a master level education.

Advanced practitioners must demonstrate the ability to integrate capabilities across four pillars (1):

• clinical
• leadership and management
• education
• research

These practitioners are essential to workforce transformation, as their expanded roles allow them to take on additional responsibilities within a multidisciplinary team that were traditionally held by other healthcare professionals. This helps optimise resource utilisation, enhance service delivery, and enhance patient care.

Routes into Advanced Practice

For those seeking to advance their careers, there are two routes into advanced practice. Advanced practitioners are individuals who have achieved a high level of education through an NHS England-accredited Level 7 practice master’s program or with a portfolio. These can be pursued through the following routes (2) (3):

E-Portfolio (supported) Route:

This route is for practitioners already working at an advanced level who meet the requirements of the Multi-Professional Framework (MPF). They follow a supported portfolio route using an ePortfolio. This allows them to demonstrate their competencies and achievements in practice. It requires completing a minimum of 3500-word critical narrative and four reflections at level 7 of 800 words each minimum. ePortfolio (supported) Route – Advanced Practice (hee.nhs.uk)

MSc Programme Route:

This is often undertaken while working as a Band 7 professional and can be pursued in three ways: Programme Route – Advanced Practice (hee.nhs.uk)

• Apprenticeship: This is often the preferred pathway. It involves completing an Advanced Practitioner (Integrated Degree) at Level 7. In some cases, individuals may be eligible for non- apprenticeship route, subject to approval by their local faculty of advancing practice.
• A three-year, part-time master’s in advancing practice from an NHS England-accredited provider as a non-apprenticeship route
• A “top-up” option for those with previous master’s-level modules. Individuals can join partway through the programme (reduced MSc in advance practice programme), acknowledging previous learning and degrees. These modules can be considered for Accreditation of Prior Experiential Learning (APEL) or Recognition of Prior Learning (RPL), depending on the university’s discretion.

Types of Advanced Practitioners

The routes stated above are the same for everyone however the programme might vary depending on the specialist area with all courses being underpinned by the multiprofessional framework. The specific role an advanced practitioner will take on depends on the needs of the employer and ultimately the population, with both types of roles having a need to maintain the four pillars of practice.

Generalist Advanced Practitioner

A generalist advanced practitioner will often take on a role that requires a broad set of skills. These will go into a more specific specialty such as gastrointestinal, critical care, oncology, surgery and many more. The role would involve more medical management of these conditions while drawing on their unique skills from their specific profession, ensuring they continue to meet the professional standards and guidelines set by their statutory and regulatory bodies. Supervision and continued professional development are critical to maintaining the high standards required in these roles.

Hyper Specialist Advanced Practitioner

These practitioners focus on a specific area within their original profession. They develop deep expertise and advanced skills in a narrow field, for example an advanced practitioner who is a physiotherapist focusing on hyperspecialist areas such as musculoskeletal disorders.

Combination of both

An advanced practitioner can serve as both a generalist and hyperspecialist for example, a primary care centre may require a generalist advanced practitioner to manage a broad range of conditions and patient groups with the same advanced practitioner being hyperspecialist in a specific area from previous experience in their registered profession. Supervision and continued professional development are critical to maintaining the high standards required in these roles.

Future Developments

There are new profession specific programmes that have been developed which allows for a more hyperspecialist advanced practitioner workforce e.g. Radiography and podiatric surgery programmes in the North East and Yorkshire region.

Advanced Practitioners in the patients journey

Advanced practitioners can be at multiple touch points on a patients journey and different settings such as an acute hospital, community, primary care, social care, general practice and other areas.

This would be similar to the settings you work in as a healthcare professional before qualifying to the higher level of an advanced practitioner. Although their academic pathway will have reflected the multiprofessional framework the clinical delivery can significantly vary.

There are many statutory health and care professions that can qualify to this level of practice through the relevant routes in which includes nurses, pharmacists, paramedics, midwifery and other allied health professionals (2). As an advanced practitioner general guidelines suggest you could be working at a band 8a once qualified and a band 7 while training (4).

Four Pillars of Practice needed as an Advanced Practitioner

Skills and knowledge need to be developed as part of the training towards this level of practice and maintained throughout your career. There are four common themes to create standardisation for anyone working at this level however it is a complex area therefore supervision and regulation is necessary and will often be multiprofessional. To find out more information please follow this link Multi-professional framework for advanced practice in England (2017) – Advanced Practice (hee.nhs.uk)

The four pillars of practice include:

Clinical practice

Clinical practice which is ensuring you are working in line with your professional body and scope of practice. You should understand your role within the care of the patient and seek help from others when needed.

As part of your clinical practice good communication skills should be used with colleagues, patients and families to explain clinical reasonings for the care provided. This leads onto working collaboratively as a multidisciplinary team which is key within healthcare to provide the best care possible for patients.

As an advanced practitioner you need to understand your broadened level of responsibility and autonomy specifically when working with complex situations. Furthermore, becoming a clinical role model to support the development of care to patients based on health needs.

Leadership and management

Leadership and management are important for leading the plan for patients care, for example you could be the most knowledgeable on the specialty due to your training in advanced practice. Healthcare is huge for multidisciplinary working therefore effective relationships and understanding everyone’s individual role is vital.

As part of a good leader within healthcare a person-centered approach should be adopted while sharing your knowledge to allow the patient to make an informed decision. A final point on this pillar of practice is managing unfamiliar, complex and unpredictable situations which is key for advanced practice due to you being the professional who is qualified to deal with this meaning you will likely lead and manage these situations with input from other professionals.

In the advanced practice level this pillar should focus on the ability to lead and understand yourself which in turn allows you to become a better leader to others. Compassionate leadership is key because it involves, understands and empathises with everyone to reach a common goal of supporting and helping one another.

Education

Education is important for any healthcare professional in every speciality but specifically for advanced practitioners because these are educators who develop others and the wider team. It is there to ensure that clinical skills and knowledge are continually up to date with current research and guidelines.

Professional development should be undertaken by any healthcare professional to enable you to work within your scope of practice and provide the best care possible to all patients. Specifically for advanced practice, education is needed and as above there is certain routes that need to be taken to confirm you are qualified to this level.

Research

Research also links to all healthcare as there is lots of research always ongoing about diseases, conditions, diagnosis, methods and treatments within healthcare. All healthcare professionals should have knowledge on the current research within their speciality and maintain good research practice in line with the guidance. This supports evidence-based patient care to improve the safety, quality and productivity.

Another skill as part of this pillar of practice is being able to critically appraise a piece of research and using their findings to apply to your own practice, evidence based. Identifying areas that need further research and acting on these through research studies and service improvement projects(1).

What is the difference between Advanced Practice and advancing practice?

Advancing Practice

Advancing Practice describes the career progression and professional development journey across various levels of practice, from enhanced level of practice to advanced level of practice to consultant level of practice. This progression involves increasing autonomy, responsibility, and influence in healthcare delivery (2).

Advanced Practice

Advanced Practice is a specific level and type of practice within advancing practice where healthcare professionals work with a high degree of independence and expertise in clinical care, leadership, education, and research (2).

Disclaimer: The information provided in this article is accurate and up to date as of the time of writing. However, please be aware that this information is subject to change. Please consult up-to-date resources and professional guidance for the latest information. Article written August 2024.

References

1. NHS England (2017) Multi-professional framework for advanced clinical practice in England. Available at: https://www.hee.nhs.uk/sites/default/files/documents/multi-professionalframeworkforadvancedclinicalpracticeinengland.pdf (Accessed: 8^th August 2024).
2. NHS Employers (2023) Advanced practice. Available at: https://www.nhsemployers.org/articles/advanced-practice#:~:text=Those%20working%20at%20an%20enhanced%20level%20of%20practice,with%20advanced%20practice%20come%20from%20all%20multi-professional%20backgrounds. (Accessed: 8^th August 2024).
3. Whelpton, H (2024) Advanced Practice. Allied Health Professions Myth Busting Webinar. Specialty Advisor, Learning Disability and Autism – North East & Yorkshire Faculty for Advancing Practice NHSE. [PowerPoint Presentation] 9^th July 2024. Unpublished.
4. Health Education England (2023) Advanced Clinical Practice Programme Handbook 2022/2023. Available at: https://www.hee.nhs.uk/sites/default/files/documents/Yorkshire%20and%20the%20Humber%20Advanced%20Clinical%20Practice%20Framework.pdf (Accessed: 8^th August 2024).