Advanced Clinical Practitioners in London NHS Trusts 2020 HEE

Synthesis: Executive Summary
This executive summary reports on a synthesis of three evaluations undertaken in 2019 in London National Health Services to investigate:

i) The extent of adoption of advanced clinical practice (ACP) roles
ii) Factors facilitating or deterring the development of the roles
iii) Future plans for the development of new and existing staff in ACP roles across nursing, midwifery, allied health professions and health scientists.

The evaluators were also asked to identify any published or unpublished evaluations of the involvement of ACPs in service provision.

Following the publication of the ‘Multi-professional framework for advanced clinical practice in England’ (Health Education England [HEE] 2018), IPSOS Mori undertook an online national census of ACPs on behalf of HEE in summer/autumn 2019 (due to report early 2020), to provide insights into the development of ACP roles. The national survey will be shared with all NHS Trusts later in 2020.

To complement the national survey two higher education institutions (HEIs) and the National Workforce Development Unit were commissioned by HEE London to conduct a qualitative evaluation of ACP roles in the NHS workforce in London. Interviews were conducted in Autumn 2019 with stakeholders employed in NHS organisations providing community, acute (secondary and tertiary services), mental health and emergency services and other organisations with roles in supporting ACP development. The details of the research are given in the individual reports in appendices.

This executive summary reports the findings common across the three studies. The synthesis suggests that ACP roles are clustered around a small number of services, such as urgent and emergency care, musculoskeletal services, critical care and podiatric surgery, with very limited workforce planning about the future role of ACPs. There was found to be a low level of familiarity with the NHS advanced clinical practice multi-professional framework in trusts and with the concepts of advanced clinical practice more generally. However, all three evaluations identified enthusiasm from a wide range of professionals and senior managers around the potential of these roles to make a significant contribution across services, in terms of enhancing patient care, in line with current national policies, and staff career pathways. Some participants saw ACP posts as a means of addressing staffing shortages, particularly of trainee doctors in the acute sector. However views varied: some participants considered that ACPs were expected to work at an advanced level for their profession, bringing considerable experience to the role and as such ACPs’ practice was viewed as fundamentally different to that of trainee doctorsIdentification of funding sources for ACP posts was seen a major factor in future planning with some opportunities arising through commissioning and business planning processes, but otherwise the absence of ring-fenced finance for ACP posts was an inhibitor. Factors supporting and inhibiting the development of such roles varied to some extent between types of professions, but overall demonstrated an interplay between: the resource environment, the extent of knowledge about ACPs, the receptiveness of the service environment and pro-active change management.

Participants argued that ACP roles might contribute to addressing challenges related to: increasing patient demand for health services and changing patterns of morbidity; poor retention and recruitment into health care professions and challenges of embedding technological innovations into health care service delivery in the future. Uncertainty about the evidence of the value of ACP roles in different types of services was reported to be an inhibiting factor and local evaluations were rare or undertaken in the past and not available. No participants were able to identify any local reports on patient and public views of ACP roles.

Some participants expressed concern that there are currently few staff with appropriate experience and academic ability ready to progress into ACP roles in the near future and that there was a need for long term developmental pathways to allow staff to develop the required skills.

Report accepted by Health Education England. Awaiting information as to online publication. Freedom to disseminate summary agreed by HEE. No permission from other authors to share this version of the report yet.