What is Advanced Practice?

The Advanced Clinical Practitioner (ACP) role at NUH is mapped to the Health Education England (HEE) 2017 Multi-professional Advanced Clinical Practice Framework. The level of advanced clinical practice is defined in the framework as:

Advanced clinical practice is delivered by experienced, registered health and care practitioners. It is a level of practice characterised by a high degree of autonomy and complex decision making. This is underpinned by a master's level award or equivalent that encompasses the four pillars of clinical practice, leadership and management, education and research, with demonstration of core capabilities and area specific clinical competence.

Advanced clinical practice embodies the ability to manage clinical care in partnership with individuals, families and carers. It includes the analysis and synthesis of complex problems across a range of settings, enabling innovative solutions to enhance people's experience and improve outcomes. ( HEE 2017)

The qualified ACP at NUH can carry out activities historically only undertaken by medical staff including physical examination, ordering and interpreting diagnostic tests, advanced health needs assessments, differential diagnosis, prescribing medication and discharging patients.  They are a source of expert knowledge for both nurses, AHPs, and doctors, they provide leadership by role modelling excellent practice and identifying, researching and developing innovative ways of working. 

ACP training at NUH is supported by an NUH trust-wide training framework and a Master's level award. 

All NUH ACP posts across NUH are underpinned by generic NUH ACP job descriptions is important to draw the differences between staff who are working at an advanced level as defined in the HEE framework e.g. extended scope physiotherapists and those who are working in the role of ACP who also map to this level.

The NHS Long-Term Plan  (2019) and the NHS People Plan (2020) (LINK) highlights how advanced clinical practice is central to helping transform service delivery and better meet local health needs by providing enhanced capacity, capability, productivity and efficiency within multi-professional teams

NUH is already recognised nationally as a leading employer of ACPs and an innovator of ACP services. With over 180 trainee and qualified ACPs across 17 specialties to date NUH has shown a clear intention in the investment of the ACP role and the surrounding governances and assurances, the road map to continue developing this role is detailed in the NUH ACP strategic plan 2020-2025.

Accessing an ACP trainee career

There are two main routes into accessing an ACP career at NUH:

  • Employed as a trainee ACP who then undertakes a structured training program
  • Upskilling a current employee through the structured training program for example the specialist nurse working in oncology who takes on a more expanded autonomous role.

The trainee ACP role is underpinned by a generic NUH ACP trainee personal specification and trainee ACP job description. The ACP role is underpinned by the pillars of advanced practice this allows applicants to come from a variety of career pathways as shown below.

 

Diagram showing the ACP career pathways

NUH runs 3 monthly ACP career breakfasts for trainee and qualified ACPs, dates and details of these workshops can be found on the staff intranet.

Employment of trainee ACPs

To undertake the NUH ACP training pathway, trainee ACPs at NUH are appointed into a funded ACP training post. NUH has a generic trainee ACP minimal personal specification and generic trainee ACP job description. All NUH trainee posts are underpinned by a business case that reflects the training model above and the NUH ACP training framework. Trainee ACPs at NUH are appointed at AFC band 6, as they progress through their training and meet certain milestones the AFC banding will increase.

The apprenticeship in Advanced Clinical Practice

Appointed trainee ACPs at NUH undertake an apprenticeship in Advanced Clinical Practice. The academic element of the apprenticeship is supported by the higher educator institute which maps to the national Advanced Clinical Practitioner apprenticeship standard. The course reflects the four pillars of Advanced Clinical Practice research, education, leadership and clinical practice and was written in partnership with NUH. 

As the training is an apprenticeship, all trainees need to have level 2 Maths and English at point of completion or equivalent and have UK residency for a minimum of 3 years.

ACP Supervision

Supervision is fundamental to the training of an ACP and the completion of the advanced clinical practice portfolio, each trainee ACP will have a named educational supervisor and a buddy ACP.

HEE have released guidance for workplace ACP supervision which has been adopted by NUH. You can find the guidance here.

The Qualified ACP

NUH has appointed a number of qualified ACPs from other organisations or supported the movement of an NUH ACP into a different specialty. There are 18 ACP speciality teams across NUH to find out more about these services 

The qualified ACP role is underpinned by the generic NUH ACP personal specification and trainee ACP job description. All qualified ACPs across NUH are rostered six hours a week continued professional development (CPD) time. Four hours of this CPD is to ensure ACPs continue to evidence and develop capability across the pillars of practice and maintain competence in their clinical competence. The remaining two hours is for the ACP to support service development in their clinical area examples being:

  • Quality improvement projects
  • Teaching and education activity
  • Membership in clinical groups e.g. governance
  • Development of protocol, policy and guidelines
  • Supporting the local, regional and national ACP agenda

Careers for the qualified ACP

The NUH ACP strategic plan (LINK) has an emphasis on supporting the careers of our qualified ACPs and work is ongoing in supporting this agenda. A number of new ACP posts have been implemented across the trust, below are some examples of these roles;

  • Specialty lead ACP
  • Senior clinical ACP
  • Inter-professional ACP educator
  • Trust lead ACP

NUH have ACP pillar steering groups for the three non-clinical pillars of practice,  The purpose of these groups is to support the development of qualified ACPs through pillar specific CPD strategies, supporting career progression, facilitating education, promote the profile of ACPs and provide pillar specific supervision for qualified and trainee ACPs.

Meet the ACP team

James Pratt

James Pratt

James Pratt - Consultant Advanced Clinical Practitioner Lead

James is the Consultant Advanced Clinical Practitioner (ACP) Lead at Nottingham University Hospitals NHS Trust (NUH), a large acute care NHS organisation. James is responsible for the development and leadership of ACPs across NUH. James has led on the development of implementing a multi-professional, organisational ACP strategy and associated pieces of work. James has led on the Nottinghamshire Integrated Care System ACP agenda and supported multiple national pieces of work related to advanced practice. James is currently supporting the HEE ACP governance and assurance agenda. James continues to work in emergency medicine as a senior clinician.

Chris White

Chris White

Chris White - ACP Supervision and Assessment Project Lead

Chris is a Registered Paediatric Nurse who qualified from the University of Southampton in early 2010. After spending some time working clinically on the children’s surgical ward and paediatric intensive care he moved to NUH in 2014 to work in Children’s ED. He has subsequently gone on to train as a Children’s Advanced Clinical Practitioner (ACP), and sits on the trusts ACP Research and Innovation steering group.

Chris’ role is looking at how trainee ACP’s are supervised across NUH and how we can improve it. He is using this work to shape a new document of guidance on supporting trainee ACP’s

Jennifer Parrish

Jennifer Parrish

Jennifer Parrish - Senior Leadership Fellow CNS Project Lead

Jennifer Parrish is a Haematology Outreach Clinical Nurse Specialist (CNS) at the Centre of Clinical Haematology, Nottingham University Hospitals NHS Trust (NUH). She completed her training at Keele University and after working on a Haematology Ward at University Hospital of North Staffordshire for a few months she moved to Nottingham in 2006.

Jenny has continued to work in Haematology since, initially as a staff nurse on a busy ward then as a Myeloma Clinical Nurse Specialist, initially as a part-time Band 6 trainee, working her way up to a full-time Band 7 CNS after developing experience in the field and completing her non-medical prescriber training.

In 2016, Jenny left the Myeloma team and with her colleague set up the Haematology Outreach Service, delivering specialist haematology treatments to patients in their own homes. This Service has been an overwhelming success, completing over 4600 home visits in the last year alone, and increasing its workforce from the initial 2 nurses to 6 nurses and 2 CSW’s. As a result Jenny has enjoyed sharing her experiences with other centres nationally and supported them in developing their own bespoke services using a similar model.

In September 2022, Jenny came into post as CNS Project Lead for NUH. She sees this as an exciting opportunity to scope current practices across the Trust and celebrate successes of CNS teams, ensuring that their perspective is heard by members of the senior nursing team.