The Same Day Emergency Care service at Gloucestershire Hospitals NHS Foundation Trust has included advanced practitioners in its workforce since the inception of the service in 2013. The team has since expanded to 11 qualified and trainee advanced practitioners from multi-professional backgrounds. They see a range of patients with the aim of preventing hospital admissions when it is safe and appropriate to do so.
What inspired the decision for the service to include advanced practitioners in its workforce?
There was a national drive in 2013 to develop effective processes for managing urgent care in a same day clinical environment. This was in order to improve outcomes for patients and use NHS resources more effectively. Gloucestershire Hospitals NHS Foundation Trust (GHNHST) supported a business case to pilot the concept of a Same Day Emergency Care service (SDEC), which later secured funding for this as a permanent service due to its positive impact on patient care.
Advanced Practitioners were identified as senior staff who would have the training and skills to support the delivery, development and ongoing transformation of the service, which has increased from 4 patients per day initially seen on the Gloucester Royal site in 2013, to over 100 per day across both Cheltenham and Gloucester sites in 2025. Referrals come directly from other healthcare professionals (70%) or from the emergency department (30%).
Advanced practitioners training has allowed them to work across all four pillars of practice. Clinically they provide treatment and care plans for patients and referring to other services as well as being a consistent element of the SDEC workforce. Working across the other pillars of advanced practice, the team has demonstrated their value and evolved the service alongside population need, whilst supporting colleagues across the Trust.
What does having an advanced practitioner in the service bring to the wider team?
Advanced practitioners have brought consistency to SDEC. They understand the processes that underpin the approach to patient care and provide support to wider team who provide care to patients, some of whom may be new to working in these areas or within the Trust. They manage approximately 1,500 patients (77%) of all SDEC attendances per month, with 90% able to be managed within the service or discharged. This approach to the service, coupled with their training, has enabled other senior clinical decision makers to focus their support towards other areas such as the Acute Medical Unit and Emergency Departments, whilst still being accessible to the Same Day Emergency Care team. This not only ensure patients are seen in a timely manner but improves patient safety and outcomes across the organisation.
The advanced practitioners also support the whole multi-disciplinary team, such as by identifying and delivering education to individuals and teams. They provide leadership support to the SDEC service on a departmental level and support divisional and organisational senior leaders with the delivery of strategic objectives. The service has benefited from the ability of the advanced practitioners to conduct and act upon quality improvement project outcomes to understand the needs of the local population and ensure that service provision can meet these needs.
They have found that an open culture in which they discuss clinical cases – both where outcomes were as expected and where there was learning has created a safe environment for both patients, and the SDEC team as a whole.
What is the most challenging part of developing/integrating advanced practice into your service? How do you address these?
The most challenging part has been ensuring that staff outside of the immediate team, both within the division and the wider organisation, understand what advanced practice is, but also what it is not.
Addressing this remains an ongoing process, that relies upon the tenacity and perseverance of the team, ensuring that we are consistent in our language. The whole team have taken every available opportunity to clarify what advanced practice is, whilst also supporting each other as we have developed.
How are you utilising the four pillars of advanced practice within the service, or wider organisation?
Clinical
- Assessing, treating and discharging undifferentiated patients autonomously.
- Procedures such as lumbar punctures and blood-transfusion authorisation.
- Implementing and embedding Rapid Assessment in our Gloucester unit which improved patient flow, reduced length of stay, as well as improving positive patient experience and safety. This came from a Quality Improvement project led by one of the advanced practitioners, there is more information on this pilot below.
- Development of an electronic portfolio and departmental specific advanced practice capability framework
- Coordination of ongoing work with radiology to develop an Advanced Practitioner Non-Medical-Referrers policy to enable the advanced practitioners to request diagnostics such as CT scans, which once successful, will roll out to all Advanced Practitioners across the Trust, with the aim of improving patient flow and experience.
Leadership
- Recognition of an Advanced Practice Lead post in Same Day Emergency Care to support ongoing service-development in line with local population needs and organisational plans
- Creation of an organisational culture where our Same Day Emergency Care Units are not used for additional inpatient bed capacity during periods of escalation. We have subsequently participated in a national NHS England podcast on how we have achieved this.
- Participation in a Trust-wide podcast (as part of a locally led ‘8 days of Spring’ Clinical Vision of Flow project) sharing how rapid assessment and advanced practice has helped with our service provision. Listen here – The 8 Days of Spring – Hosted by Gloucestershire Hospitals NHS FT
- Contribution to the ongoing development of our Trust Advanced Practice policy and governance processes.
- Support with the implementation of a Standard Operating Procedure for the General Medicine Virtual Ward, which includes daily engagement from Advanced Practitioners
- Supporting other NHS Trusts by sharing development and evolution of our Advanced Practice team
Education
- Design and implementation of a Trust-wide Advanced Practice Supervisor training course, led and coordinated by one of our Advanced Practitioners
- Recognition of an education gap within team, resulting in the Advanced Practitioners teaching and supporting our Same Day Emergency Care nursing team with the knowledge base and skill set required to identify patients who are appropriate for Same Day Emergency Care.
- Continuing to identify and address educational needs of the Advanced Practice team with bimonthly team education days
- Many of our Advanced Practitioners support and teach on Trust-wide courses
- Supporting development of trainee Advanced Practitioners in other scopes of practice within the Trust as well as the wider Gloucestershire Integrated Care System, including South West Ambulance Service NHS Foundation Trust.
Research
- Coordination and leadership of a journal club for the multi-disciplinary team
- Provide representation of advanced practitioners on a Trust-wide scoping research project
- Submission and subsequent acceptance of an abstract for a poster presentation of the Quality Improvement Project with Rapid Assessment delivered at the Society of Acute Medicine conference in May 2025 (see bottom of page)
- Provide advanced practice representation at the ethics Health Research Authority for the Black Country
- Article on the topic of Advanced Practice productivity submitted for consideration of publication in the International Journal of Advancing Practice
- Quality Improvement project currently in progress that is supporting work across the organisation to develop a Trust-wide COPD pathway
- One of the Advanced Practice team currently undergoing GOLD Quality Improvement coach training, with ambitions for others to complete this in the future.
Additional Information
Can you give some examples of the impact of advanced practice roles?
Pilot of Advanced Practitioner led Rapid Assessment in Same Day Emergency Care
This pilot reassigned existing resources to allow one of the advanced practitioners to provide a rapid assessment service for new patients presenting to the Gloucester Unit between 11:00 and 16:00 over a three-month timeframe and was compared with the seven-month baseline measured prior to the trial.
The results showed a reduction in length of stay for all patients who attended the unit during the trial, resulting in 50 saved patient hours per day, creating capacity for an additional 12 patients per day. The results suggest that patient safety was also improved due to the reduction in time taken to see a clinician, however this was not possible to definitively measure.
Wider Service Impact
77% of patient attendances are managed by the Advanced Practitioners, this is approximately 1,500 patients per month. 70% of these patients are referred direct into the service, for example from primary care, which means that these patients do not need to attend the Emergency Department first.
The remaining 30% of patients are re-directed into the service from the Emergency Department, freeing up space for other patients to be seen there.
For patients seen and treated in SDEC, 90% are assessed, investigated and treated within the service without the need for an admission to a hospital bed.
How have you developed supervision for advanced practice?
Initially the service only had two advanced practitioners who met the criteria to be Coordinating Educational Supervisors. The remaining qualified advanced practitioners became associate workplace supervisors to ensure that our trainee advanced practitioners are always supported, as well as beginning to upskill our qualified advanced practitioners towards becoming future co-ordinating educational supervisors. We ensure the co-ordinating educational supervisors have no more than two trainees at any one time. This ensures quality for the individual trainee but also reduces the risk of overload for the supervisor. We allow four hours dedicated supervision time for the supervisors per 4-week rota as opposed to an hour a week thus allowing for flexibility to meet trainee and supervisor needs.
For advanced practitioners, we also provide ongoing support in the form of peer supervision. Each advanced practitioner is allocated 2 hours per 4 week rota, as part of their job plan.
What has been the patient/service user & relative feedback on advanced practice within your service?
These are a few direct examples of feedback the service has received as part of the Friends and Family Test:
- “All the staff, especially the trainee advanced practitioner and one of the staff nurses were absolutely amazing from start to finish. I can’t thank them enough for what they did and how they helped me after coming to SDEC with Atrial Fibrillation. Thank you so much for support”
- “The staff nurse was lovely and the trainee advanced practitioner was so helpful and knowledgeable, they really went the extra mile.”
- “The advanced practitioner helped me and was kind, caring and went above and beyond to make sure I understood and was helped.”
- “The advanced practitioner was lovely and all the staff were very friendly and helpful. I was dealt with quickly and had a follow up phone call.”
What is your future vision for Advanced Practice in your service?
The service currently has a five-year plan, which includes:
- Increasing the advanced practice establishment to permanently introduce Rapid Assessment in the Gloucester Unit, and increase the service offered in the Cheltenham Unit to a 7-day service
- Expand the role of the advanced practitioners to support referrals via the Synapsis (electronic referral system) to increase direct referrals to the service from South Western Ambulance Service NHS Foundation Trust, as well as extending the service to support advanced practitioners in community-based services.
- Continued investment in the wider multi-disciplinary team, including supporting aspirations of team members who wish to develop into advanced practice roles as the service expands and requires these roles.
What advice would you to service considering developing advanced practice roles?
The desire for all health care professionals is to provide the best care for our patients, with the best outcomes. Advanced practice is one ‘flavour’ within a multi-disciplinary team that may facilitate this for your service. Our advice is that once you have established that advanced practice is the right fit, believe in them, give them the resources, the time and the investment to develop not only themselves as individual practitioners but empower them to use their leadership, research and education skills to grow the service and develop care provision for the benefit of patients.
A day in the life of an Advanced Practitioner – Jemma Baker
We join Jemma Baker, an Advanced Practitioner working at Gloucestershire Hospitals, for a behind-the-scenes look at her day. Follow how she manages urgent cases, avoids unnecessary admissions, and provides patient care throughout a busy day.