Guidance

What is Advanced Clinical Practice

According to  Health Education England Advanced clinical practice (ACP) is a defined level of practice within clinical professions such as nursing, pharmacy, paramedics, and occupational therapy. This level of practice is designed to transform and modernise pathways of care, enabling the safe and effective sharing of skills across traditional professional boundaries. 

It is a level of practice characterised by a high degree of autonomy and complex decision making. 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.

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What are the Benefits of Advanced Clinical Practice

  • Having healthcare professionals at advanced level increases capacity and capability within services.
  • By integrating into multi-professional teams, advanced practitioners provide clinical leadership and enable collaboration across the multi-disciplinary team through complex decision making and managing risk.
  • This also gives organisations a flexible workforce to meet changing population, patient, and service delivery needs.
  • Advanced practitioners help to improve clinical continuity and provide high-quality care for patients.
  • They enable workforce transformation to initiate a wider range of advanced clinical care being provided by a varied range of multi-professional clinicians rather than focusing on medical doctors as the sole providers of advanced clinical care.
  • Advanced practitioners can accelerate access to care for patients and help to improve outcomes.

(Taken from NHS Employers)

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Advanced Clinical Practitioners

Advanced clinical practitioners (ACPs) are healthcare professionals, educated to master’s level or equivalent, with the skills and knowledge to allow them to expand their scope of practice to better meet the needs of the people they care for. 

ACPs are deployed across all healthcare settings and work at a level of advanced clinical practice that pulls together the four ACP pillars of clinical practice, leadership and management, education, and research.

 

A definition of ACP, its underpinning standards and governance, can be found in the Multi-professional framework for advanced clinical practice in England. The framework ensures there is national consistency in the level of practice across multi-professional roles that is clearly understood by the public, advanced clinical practitioners, their colleagues, education providers and employers.

The roles undertaken by advanced clinical practitioners are determined by the needs of the employer and how they require the level of practice to be deployed within their setting.  

A series of video’s and Case studies have been made available by HEE that focus on the ACP role, training and features one- to- one interviews and written case studies from ACP outlining their journey.

For an overview of the role, click here.

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What is a First Contact Practitioner (FCP)

First Contact Practitioners (FCP) are a diagnostic clinician working in Primary Care at the top of their clinical scope of practice at Agenda for Change Band 7 or equivalent and above.

It is the minimum threshold for working as a first point of contact with undifferentiated undiagnosed conditions in Primary Care. With additional training, FCPs can build towards advanced practice.

To become an FCP, recognition is required through Health Education England, whereby a clinician must have completed a taught or portfolio route.

FCPs refer patients to GPs for the medical management of patient presentations and pharmacology outside their agreed scope of practice.

FCPs work at a master’s level (level 7) in their clinical pillar of practice but have not yet reached an advanced level in all four pillars of practice to be verified at AP level.

The clinician must typically have 3-5 years post preceptorship experience before starting Primary Care training to become an FCP (HEE).

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Roadmaps to Practice

Allied health professionals (AHPs) can become first contact practitioners (FCPs) or advanced practitioners. Health Education England has developed a Roadmap for Practice for AHPs to show evidence of their capability for these roles. AHPs who have demonstrated these capabilities will be able to see and manage more clinically complex patients. They will also be able to work independently in primary care, within their scope of practice.

The Network Contract DES provides role descriptions for allied health professionals employed through the reimbursement scheme. Most AHPs will be working at a master’s level clinically. Paramedics will have an option to be reimbursed at a lower level in a rotational scheme. These paramedics are not first contact practitioners.

CQC, 2023

Clinicians completing the capability framework will be recognised by  Health Education England’s Centre for Advancing Practice and will be placed on a First Contact Practitioner directory in due course.

The capability framework clearly articulates capabilities so that employers and workforce planners can understand what the clinicians can offer to the multi-professional team to enable the best care for their patient population. It also provides clear guidance of the expected supervision needed to support the roadmap to practice and outlines the bespoke supervision training that a supervisor needs to have completed.

The Centre uses ‘credential’ to describe standardised, structured units of assessed learning that are designed to develop advanced-level practice capability in a particular area. Please click here to find out more.

Any first contact practice queries, you can contact the first contact practice team directly-  fcprecognition@hee.nhs.uk

Example of a job description for a FCP physiotherapist / MSK.

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Educational Pathway into Primary Care

There are two main educational pathways to practice in Primary Care:

  • FCP portfolio and taught routes with onward portfolio route or a taught AP master’s to AP in Primary Care.
  • AP portfolio or taught routes with the addition of the required Primary Care KSA training and e-learning HEE

Primary Care does not traditionally use AfC  pay bands to determine rate of pay but AfC is useful as a guide to a minimum rate of pay in relation to a clinician’s level of practice

Source – HEE

 

Table to show capabilities across Band 7 and Band 8a (AfC) in Primary Care-HEE

First Contact Practitioner Band 7

Advanced Clinical Practitioner Band 8a

  • Manages undifferentiated undiagnosed conditions.
  • Able to identify red flags and underlying serious pathology and take appropriate action.
  • Works within practice, across PCN, multi-organisational, cross professions and across care pathways and systems including health, social care, and the voluntary sectors.
  • High level complex decision making to inform the diagnosis, investigation, management, and referral across broad aspects of service delivery, within scope of practice.
  • Actively takes a personalised care approach to enable shared decision making with the presenting person.
  • Contributes to and co-creates audit and research projects.
  • Contributes to education and supervision within their scope of practice for the multi-professional team.
  • Facilitates and co-creates interprofessional learning in area of expertise.
  • Promotes and develops area of expertise across care pathways and systems.
  • Can be working toward Advanced Clinical Practice (level 7 across all pillars)

 

 

 

 

 

 

  • Manages undifferentiated undiagnosed conditions.
  • Able to identify red flags and underlying serious pathology and take appropriate action.
  • Works within practice, across PCN, CCG and ICS, multi organisational, cross professionals and across care pathways and systems including health, social care, and the voluntary sectors.
  • High-level of complex decision making to inform diagnosis, investigation, complete management of episodes of care within a broad scope of practice, taking responsibility for service delivery.
  • Flexible skill set to adapt to and meet needs of the PCN Population and support public health.
  • Manages medical complexity and unpredictable contexts.
  • Actively takes a personalised care and population- centred care approach to enable shared decision making with the presenting person.
  • Actively engages in care from a Population care viewpoint.
  •  Leads audit and research projects taking responsibility for overall delivery.
  • Provides multi-professional AP clinical and CPD supervision across all four pillars with relevant training.
  • Leads education in their area of expertise, taking responsibility for overall delivery.
  • Enables, facilitates, and supports change across care pathways and traditional boundaries at regional and national level.
  • Working toward level 8 across all 4 pillars.

 

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Clinical Supervision

Health Education England have a webpage –  Workplace Supervision for Advanced Clinical Practice : An integrated multi-professional approach for practitioner development.

According to HEE  in order to be able to supervise FCP or advanced practitioners, supervisors must have undertaken the approved HEE Multi-Professional Primary Care Roadmap Supervision Course.

This course will include:

  • The role of the Clinical Supervision and CPD supervision
  • An overview of educational theory
  • Creating an educational culture
  • Feedback
  • The journey to FCP or AP roles
  • Supporting trainees in/with difficulties
  • How to use WPBA
  • Supporting FCP/AP with their portfolio of evidence
  • The verification process.

The HEE Centre for Advancing Practice holds a directory of practitioners who have completed the HEE Multi-professional Primary Care Supervision Course.

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E Learning for Advanced Clinical Practice

Please click on the images below to find out more:

NHS Health Education England – E Learning for Healthcare ACP

Advanced Practice Toolkit

 

  The Open University – Postgraduate Diploma in Enhanced Clinical Practice

 

 RCGPLearning – The RCGP’s eLearning website containing courses and updates for general practice.

 

Smart Health Solutions – Learn with Nurses. Learn With Nurses is free webinar-based training for ALL health care professionals, by nurses.


Skills for Health-
Healthcare eLearning that meets UK legislation

 

 

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Advancing Practice Conference

This conference is aimed at aspiring, advanced, FCPs, and consultant practitioners.

 

 

Taking place online, the Centre for Advancing Practice Conference will include a blend of inspiring and thought-provoking speakers, networking, and a range of leaders from the community.

The theme for this year: A Future Worth Advancing

Date: Wednesday 8 November 2023 and Thursday 9 November 2023

Location: Online/Virtual

Registration opens soon, more info can be found here

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Last Reviewed Date
07/12/2023