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Advance practice policy

Contents

  1. Introduction
  2. Scope
  3. Definitions
  4. Roles and responsibilities
  5. Training and education
  6. Recruitment
  7. Ongoing support and governance
  8. Implementation or clinical care delivery
  9. Equality impact assessment screening
  10. Monitoring
  11. Links to any other associated documents
  12. References
  13. Glossary
  14. Appendices

Thank you to Solent NHS Trust and Birmingham Women’s and Children’s Hospital NHS Foundation Trust for sharing their policies which have been used to construct this policy.

1 Introduction and purpose

This policy aims to describe the progression of clinical specialism for non-medical clinical members of staff at RDaSH. As clinicians progress and develop greater depth and breadth of knowledge this policy sets out how that development should be supported.

This policy uses the four pillars of clinical practice as a basis for description of level of specialism, these are:

  • clinical practice
  • leadership and management
  • education
  • research

Although roles may be developed which articulate levels of specialism more granularly, the standard progression for members of staff is from qualified clinician to specialist clinicians, enhanced clinicians, advanced clinicians (advanced clinical practice) and consultant clinicians.

Enhanced clinical practice is characterised by significant autonomy and complex decision making which is underpinned by significant experience and optional post graduate qualifications. This may be in a single pillar or multiple but not in all four.

Advanced clinical practice (ACP) 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 area specific clinical competence. The Health Education England (now integrated with NHS England as the, workforce, training and education directorate), ACP multi-professional framework provides a clear and consistent approach to the development of advanced clinical practice across England.

Consultant clinical practice (CCP) is an expert level of practice that progresses from ACP to include the strategic influence across the health care system. The Health Education England multi-professional consultant-level practice capability and impact framework provides the framework for staff working at this level.

Practitioners at ACP and CCP level come from a range of professional backgrounds such as nursing, pharmacy, social workers and allied health professionals.

The objective of this policy is to ensure that there is a consistent and standardised approach to the development, training, recruitment, governance and title and identity for staff working in these roles in the trust.

The Nursing and Midwifery Council (NMC), the Health and Care Professions Council (HCPC), and the General Pharmaceutical Council (GPhC) all have standards for the professions they register which outline the need for continual development of practice, whilst ensuring the public are protected with the practitioner working within the scope of practice for which they have been trained. All staff must work to their professional code of conduct.

The purpose of this policy is to outline the stance and expectations taken by Rotherham, Doncaster and South Humber NHS Foundation Trust to comply with NHS England, professional regulatory bodies, and local initiatives in relation to enhanced, advanced and consultant clinical roles.

2 Scope

This trust wide policy applies to all non-medical clinical staff (Agenda for Change bands 5 to 9 or equivalent) registered with the Nursing and Midwifery Council (NMC), Health and Care Professions Council (HCPC), Social Work England (SWE) or General Pharmaceutical Council
(GPhC) who are locum, permanent, and fixed term contract employees (including apprentices) who hold a contract of employment or engagement with the trust.

Medical staff are outside the remit of this policy as they have national professional guidance which encompasses the remit of specialist and consultant level practice. The importance of the policy for medical staff is in terms of their role as supervisor for some advanced roles.

3 Definitions

3.1 Enhanced practice

Enhanced practice is a discrete knowledge and skill base additional to the recognised scope of practice of a profession and regulatory body. Staff may have masters level qualifications, such as a postgraduate diploma (PGDip) or postgraduate certificate (PGCert) but this usually sits within one pillar only. There is no standard training route into enhanced clinical practice and therefore no “trainee enhanced clinical practice” role exists.

3.2 Trainee advanced clinical practice (tACP)

Staff who are working under the job title trainee advanced clinical practice, underpinned by the trust-wide generic trainee ACP job description and undertaking an masters of sciences (MSc) in advanced clinical practice (ACP) or equivalent portfolio route.

3.3 Advanced clinical practice (ACP)

An advanced clinical practitioner role requires the post holder to deliver advanced clinical practice in each specialty. Advanced clinical practice is defined in the multi-professional framework for Advanced Clinical Practice in England published by Health Education England (HEE) in 2017 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 experience. 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).

It is important to note that having a master’s level degree does not grant the practitioner advanced clinical practitioner status. Evidenced achievement of the capabilities against the Health Education England framework and a clearly funded role to move into are all essential components.

The 2017 publication by HEE of the Multi-professional framework for advanced clinical practice (HEE 2017) in England provides a definition and framework of what advanced clinical practice is and what the requirements for accreditation are. It provides current and future advanced clinical practices with guidance and principles that they should follow throughout their professional lives, clearly outlining a career pathway into and through the profession. Some clinical areas are developing specific frameworks, such as primary care, learning disabilities and autism, and staff working in those clinical areas will be required to work within those frameworks as they become endorsed.

3.4 Consultant clinical practice (CCP)

The 2020 publication by HEE of the Multi-professional consultant-level practice capability and impact framework (HEE, 2020) provides further clarity that the Consultant level also includes putting expertise in place across the systems of health and social care. Defining the additional capability and impact practitioners working at this level should have.

The consultant practitioner role requires the postholder to deliver the highest level of expert clinical practice in their specialty and to strategically lead in that specialty in practice, education, and research across systems. This often requires advanced practice qualifications, credentialing and, or evidence of senior level training and experience commensurate with the speciality in focus.

The multi-professional consultant-level practice capability and impact framework published by HEE in 2020 state this level of practice required across the four pillars at this level are:

  • expert clinical practice, help firmly establish values-based professional practice across pathways, services, organisations, and systems, working with individuals, families, carers, communities, and others
  • strategic and enabling leadership, provide values-based leadership across the care pathway, services, and systems in complex and changing situations
  • learning, developing, and improving across the system. develop staff potential, add to and transform the workforce, and help people to learn, develop and improve (in and from practice) to promote excellence
  • research and innovation, develop a “knowledge-rich and inquiry” culture across the service and system that contributes to research outputs and has a positive effect on development, quality, innovation, increasing capacity and capability, and making systems more effective
  • consultancy in all pillars across the system, share expertise across the system by using consultancy approaches and opportunities that have the biggest effect on practice, services, communities and populations, and add to and sustain the capacity and capability of the workforce

It is important to note that having a doctoral level qualification does not grant the practitioner consultant practitioner status. Evidenced achievement of the capabilities against the Health Education England
consultant framework and a clearly funded role to move into are all essential components.

4 Roles and responsibilities

4.1 Executive medical director, executive nurse director and director for therapies

The executive medical director, executive nurse director and director for therapies have authority and responsibility for medical, nursing, allied health professional, social worker, pharmacy and psychological professional clinical practices and outcomes; professional regulation and clinical standards; staff training and development; governance (including compliance, risk management, patient safety and experience). They have a duty to ensure that this policy is appropriately implemented and periodically reviewed.

4.2 Senior clinical, quality and operational leads

To develop the operational and governance objectives concerning advanced clinical practice and consultant clinical practices there is a need for clinical, quality, and operational leaders across the trust to be familiar with this policy.

4.3 Care group clinical directors, operational director

Responsible for the individual service line workforce strategic development plans, including the development, governance, implementation, and monitoring of advanced clinical practices within their services and for aligning the role for the benefit of the service and patients.

4.4 Individual enhanced practitioners

Responsible to work within the agreed set job description and their own professional scope or standard of practice. Commitment to maintain continuing professional development (CPD) to maintain level of practice and evidencing within the profession specific frameworks available.

4.5 Individual consultant clinical practices and advanced clinical practices

Responsible to work within the agreed set job description and their own professional scope or standard of practice. Commitment to maintain and complete their portfolio, working and evidencing across the four pillars of advancing practice, and ensure registration with the Centre for Advancing Practice, when able.

4.6 Individual trainee advanced clinical practices

Responsible to work within the agreed trainee advanced clinical practices (tACP) job description and plan and their own professional scope or standard of practice. Commitment to maintain and complete their portfolio, working and evidencing across the four pillars of advancing practice, and ensure registration with the Centre for Advancing Practice, when able.

4.7 Partner organisations or stakeholders

Work with education commissioners that sit under NHS England (since the merger of Health Education England) and Higher Education Institutions (HEI’s) regarding training of advanced clinical practices.

5 Training and education

Three different routes must be considered for enhanced, advanced clinical practice and consultant level practice. These routes are:

  • formal training courses
  • credentialing
  • portfolio route related to clinical specialism

All routes are valued in the trust.

There is National guidance on the minimal standards of education and supervision for staff to train to become an advanced clinical practice. This is required to assure employers, patients, carers and families that the advanced clinical practice has had their education and training recognised at an advanced level.

When planning for any advanced role there is a need to consider the trainee role (including supervision, training and sign-off) and also the completed role. In these considerations protected time for learning and course attendance requires factoring in as well as supervisor capacity or cost (in training and post qualification) and job planning. A trainee advanced clinical practice role post should not be advertised if the appropriate supervision, and a role at the end of the course has not been provisioned.

6 Recruitment

When recruiting to a trainee advanced clinical practitioner position, the managers guide provided in appendix A must be utilised. When recruiting to a qualified enhanced, advanced or consultant role the recruitment panel must consist of the line manager and also a clinical expert in the field from the same professional group as recruited to. It is also strongly recommended to have a clinician from an equivalent level of practice (enhanced, advanced, consultant). It may be therefore that the expert panel member is from within the trust, but expert panel members may also be used from outside the trust or via partner agencies.

6.1 Standardised job description

If a new role in the organisation is being considered, the existing roles concerning level of specialist, enhanced, or advanced and consultant level practice must be considered and standardised job descriptions used where possible if there is an aligned area of practice. Service managers and the recruitment team have a role in ensuring governance around this.

6.2 Consistent banding

6.2.1 Banding and terminology

Below are suggested bandings for the roles. These should be considered as guidance and will vary depending on the exact role, following an assessment under Agenda for Change job matching or evaluation. However, remuneration from other providers should be considered when seeking to attract applicants to a role. For all roles, length of time qualified, experiential and academic learning should be considered.

Specialism Banding Notes
Qualified clinical practitioner 5 For allied health professional, social worker and nurse (this band would vary for psychological professionals and pharmacy practitioner due to the level of qualification).
Specialist clinical practitioner 6 Specialist training or roles are undertaken above and beyond qualified practitioner. There would also be an expectation of enhanced clinical autonomy.
Enhanced clinical practitioner 7 Specialist qualification with experience in defined role, for example, dual diagnosis practitioner.

This is a newly qualified banding for a pharmacist, psychological practitioner or psychologist.
Trainee advanced clinical practitioner 6 or 7 Entry band 6 dependant on experience, usually increased to band 7 following completion of year one where more autonomy would be expected in the second year after first core modules completed and Clinical and Academic Support Panel (CASP) assessment.

A trainee allied health professional would need to complete their end point assessment and a period of consolidation of learning following course completion and a CASP assessment to enable further pay progression.
Advanced clinical practitioner and nurse consultant in training Band 8a Qualified nursing or allied health professional advanced clinical practice (or accreditation via portfolio route), having completed masters of science (MSC) and service required experience.
Consultant clinical practitioner Band 8b or 8c Banding will depend on a number of factors including the complexity of duties. Consultancy may be gained either via:

  • advanced clinical practice qualification with advancement of skills and experience
  • credentialing
  • a defined portfolio route (for example, palliative care specialism)

The post registration training level would typically be a masters or doctorate programme alongside of substantive clinical experience.

7 Ongoing support and governance

All staff in advanced clinical roles are required to undertake a yearly performance development review (PDR) which must include evidence of their activities across the four pillars of practice and maintain an up-to-date portfolio that is reviewed at their annual PDR.

All clinical practitioners require ongoing supervision and governance of their roles in compliance with the trust clinical supervision policy and the safeguarding supervision manual.

It is advantageous to consider supervision requirements in 4 parts:

  • what supervision requirements (that is trainees have an enhanced supervision requirement different to qualified clinicians)
  • who is required to supervise (that is in reference other policies such as the non-medical prescribing policy, or the multi professional preceptorship policy)
  • who can provide testimonies and sign competency observations
  • supervision agreements, considering internal and external supervision (appendix B supervisor checklist)

7.1 Specific cases

7.1.1 Non-medical prescribers

As per the non-medical prescribing policy those with non-medical prescribing status must have their prescribing reviewed yearly.

7.1.2 Advanced clinical practitioners

Job planning for advanced clinical practitioners should consider a minimum of 80% clinical time with 20% time to meet the other demands of the advanced or consultant level role, this would include continuing professional development (CPD) and supervisory time.

Staff should continue with portfolio following qualification aligned with professional body recommendations. Should a fee be required in terms of this portfolio, this is to be factored into the recruitment and retention of the role. Currently this is funded centrally from CPD, if this changes care groups will be required to find funding for the e-portfolio.

7.1.3 New procedures

Where enhanced, advanced and consultant practice expand into new areas of work, it is likely that new procedures and therapeutic processes will be required, and the trust and staff will need assurance on the safety and quality of any new processes. In this case the practitioner alongside the team and their manager should:

  • check to see whether the new procedure or intervention exists in an existing policy. If this is a minor change to the governance, they should contact the policy owner directly and request the change or discuss. If this is a significant change, it will need full assurance through the trust policy approval process
  • if the new procedure does not exist, a paper will be required written to go to the relevant policy approval meeting to either be integrated into an existing policy or a new policy created

7.1.4 Supervision

Supervision must be incorporated into any trainee or qualified role, and it must be financed for people to maintain their professional qualification and specialist, advanced, or enhanced or consultant level practice. The supervisor must be suitable for the specialism, this may not mean that they are of the same clinical discipline (for example, medical staff may supervise nurse consultants).

8 Implementation or clinical care delivery

8.1 Recording

Advanced and consultant practitioners should be able to request investigations appropriate to their scope of practice. Work underway with secondary care to explore non-medical referral for medical imaging or diagnostics. Clinicians need to agree a scope of practice, and this limits the investigations to only those within their practice area.

8.2 On-call cover

Consideration should be given to the cover the role is delivering. If advanced clinical practitioners or consultant practitioners are covering roles which would otherwise be carried out by an on-call medical member of staff, cover arrangements should reflect the role covered.

9 Equality impact assessment screening

To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.

9.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, “not just clinically but in terms of dignity and respect”.

As a consequence the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

9.2 Mental Capacity Act (2005)

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

10 Monitoring

The following is to detail all advanced and consultant level practice courses for all different practitioners.

10.1 Human resources (learning and development to complete)

  • How often should this be undertaken: As the policy is updated and as colleagues are appointed.
  • Length of training: Various.
  • Delivery method: Update messaging and formal courses dependent upon the role.
  • Training delivered by whom: Relevant training provider.
  • Where are the records of attendance held: Electronic staff record (ESR).

As a trust policy, all staff need to be aware of the key points that the policy covers. Staff can be made aware through a variety of means such as:

  • all user emails for urgent messages
  • continuous professional development sessions
  • daily email (sent Monday to Friday)
  • group supervision
  • intranet
  • local induction
  • one to one meetings or supervision
  • posters
  • practice development days
  • special meetings
  • team meetings

10.2 Monitoring arrangements

10.2.1 Nurses

Advanced, enhanced, specialist and consultant level practice will be monitored via nurse directors in care groups, working with the Nurse Consultants Forum in terms of clinical expert advice.

10.2.2 Allied health professionals

Allied health professionals (AHPs) across the organisation meet 3 times per year. These meetings are used to discuss and advise on matters which affect the discipline. These groups then feed into the lead allied health professionals meeting which feed into the wider governance structure. Where issues regarding advanced clinical practice are identified in these groups they will be communicated back or escalated to the appropriate group. If the number of AHPs in advanced clinical practice (ACP) roles requires it and there are sufficient issues, an AHPs in ACP subgroup may be established, however it would be expected that AHPs primarily work with other ACPs through the relevant forum.

10.2.3 Psychological professionals

Advanced, enhanced, specialist and consultant level practice will be monitored via directors for psychological professionals in care groups, working with the psychological professional leads in terms of clinical expert advice.

12 References

13 Glossary

Acronym Long form
ACP Advanced clinical practice
CCP Consultant clinical practice
NHS National Health Service
HEE Health Education England
HEE-SE Health Education England Southeast
NMC Nursing and Midwifery Council
HCPC Health and Care Professions Council
GPhC General Pharmaceutical Council
tACP Trainee advanced clinical practice
MSc Master of science
PGDip Post graduate diploma
PGCert Post graduate certificate
PAG-AP Professional Advisory Group Advanced Practice
ESR Electronic staff record
AHP Allied health professional
SWE Social Work England

14 Appendices

14.1 Appendix A Managers checklist

14.2 Appendix B Advanced practice supervisor readiness checklist (supplied by the Centre for Advanced Practice)

Document control

  • Version: 1.
  • Unique reference number: 1104.
  • Approved by: Education and learning CLE group.
  • Date approved: 30 November 2024
  • Document developed in consultation with: Advanced Practice Group including:
    • professional advisors
    • director of therapies
    • deputy director of nursing
    • chief allied health professional
    • trust lead social worker
    • advanced practitioners
    • nurse consultants network
    • deputy medical directors
    • medical supervisors
  • Name of responsible individual: Director for psychological professionals and therapies.
  • Date issued: 23 April 2025.
  • Review date: 30 April 2028.
  • Target audience: This trust wide policy applies to all non-medical clinical staff (Agenda for Change bands 5 to 9 or equivalent) registered with the Nursing and Midwifery Council (NMC), the Health and Care Professions Council (HCPC), and the General Pharmaceutical Council (GPhC) who are locum, permanent, and fixed term contract employees (including apprentices) who hold a contract of employment or engagement with the trust.
    Medical staff are outside the remit of this policy as they have National professional guidance which encompasses the remit of specialist and consultant level practice. The importance of the policy for medical staff is in terms of their role as supervisor for some advanced roles.

Page last reviewed: April 24, 2025
Next review due: April 24, 2026

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