Advanced practice in mental health implementation guide
Mental health implementation guide published 2022
Scope and purpose
The intended audience for this implementation guide is health and care employers who work in a range of primary, secondary, community and emerging settings, and people in strategic teams who are supporting workforce planning and development. It has been written by an expert group comprising advanced practitioners in mental health, regional and national strategic leaders, and Regional Faculties for Advancing Practice Leads, all of whom are supporting the development and implementation of roles aligned to this level of practice.
The implementation guide provides an overview of advanced practice in mental health and offers insights into topics including education and training, workforce planning, governance, supervision, and career development. Links to other resources and case study examples are also included.
Introduction
NHS England’s, ‘Next Steps on the Five Year Forward View,’ (2017) clearly sets out the current challenges faced by the NHS, in terms of resources available to deliver safe, quality, effective care, and the patient and public demands and expectations in the way services are commissioned in the future. They signal how the health service needs to change, arguing for a more engaged relationship with people and communities to promote well-being and prevent ill-health. This requires workforce transformation and a consistent approach to the expansion of new roles and new ways of working, which includes the development of advanced practitioner roles as set out in the NHS Long Term Plan, (2019) and the interim NHS People Plan, (2019).
A key driver for the implementation of advanced practitioner roles is to enable practitioners to work at the top of their license, reaching their full potential and optimising their contribution to meeting population, individuals,’ families,’ and carers’ needs through different models of service delivery and multi-disciplinary working.
The Centre for Advancing Practice and the Regional Faculties for Advancing Practice have been established to lead and promote advanced practitioners as part of the workforce solutions that support service change and work with local systems to identify demand, commission high quality education and training and vitally to support the supervisory needs of learners. NHS England acknowledges that by embracing the continued development of advanced practitioners across our organisations it will enable us to further improve the standards of care that we provide our patients by:
Building services and teams based on population need and developing advanced skills in areas to reflect local patient demand.
Supporting career development and subsequent retention of skilled professionals.
Strengthening multi-professional teams, which in turn improve safety, patient experience, productivity, and the working lives of clinicians.
Enabling improved outcomes for patients through the development of research, technology and practice delivered through advanced practitioners.
Increasing skill mix in multi-disciplinary teams.
Improving team working across traditional professional boundaries.
Allowing advanced practitioners to strengthen leadership in clinical teams through a higher level of accountability and responsibility, and thereby leading to delivering more complex patient care.
Provide workforce stability, which allows assurances in rota planning thereby reducing agency spend and managing rota gaps.
Helping build the senior clinical decision making and partnership working in the multi-professional team.
Enabling holistic high-quality patient care delivery and improved outcomes.
What is advanced practice?
Advanced practitioners have been introduced successfully and the numbers continue to grow due to service needs and drivers. Traditionally these roles have been implemented as a reactive service response, rather than with a planned and coordinated approach which has led to large variations in how organisations have deployed these roles and their scope and level of practice. In recognition of this, in 2017 the Multi-professional framework for advanced clinical practice in Englandwhich provides a clear definition of advanced practice.
‘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.’
Multi-professional framework for advanced clinical practice in England
It clearly defines that advanced practice should be delivered by an experienced health care professional, it is a level of practice not a job description, underpinned by master’s level education or equivalent and which is characterised by breadth of capabilities and competencies, not depth of expertise or specialism. Key principles include safe, effective, autonomous decision making in complex and uncertain situations, within the practitioner’s own scope of practice.
All registered health and care professionals working at the level of advanced practice within the mental health workforce should have developed their skills and knowledge to enable them to meet the minimum capabilities and competencies across all 4 pillars of advanced practice as outlined in the Multi-professional framework for advanced clinical practice in England.
Advanced practice refers to a level of practice. Currently many titles are used for health and care professionals who work as this level such as ‘Advanced Clinical Practitioner,’ ‘Advanced Nurse Practitioner’ and ‘Advanced Practice Radiographer.’ It is important to note that some professionals have been given the term ‘advanced’ in their role descriptor but may not be working at this level for various reasons. It is advised that organisations review their current advanced practice workforce and ensure that practitioners can map effectively against these capabilities. If gaps are identified such professionals should be supported, developed, and facilitated to work across all four pillars of advanced practice.
Advanced practice mental health curriculum and capabilities framework (Centre endorsed credential)
A key element of the preparation for individuals to practice at the level of advanced practice will be a formal assessment of achievement of the capabilities, specific to the context of their practice. It is critical to the implementation, acceptance, and sustainability of advanced practice that health and care professionals working at this level are widely recognised as having a consistent level of competence. They must also be equally capable of fulfilling the specialist requirements of functioning at this level.
Advanced practice in mental health has existed for many years but lacks the parity of esteem in comparison to physical health settings. The focus was sharpened with the co-creation and subsequent launch of the Advanced Practice Mental Health Curriculum and Capabilities frameworkin 2022. The Framework has subsequently been endorsed as a credential specification by The Centre for Advancing Practice.
Education and Training
The Advanced Practice Mental Health Framework has six domains (see figure 1) recognising, primarily, the importance of the person-centred therapeutic alliance. The broad overarching learning outcomes must be applied to the individual’s sphere of practice to ensure relevance and safe and effective practice. The programme is delivered at academic level 7 master’s level and incorporates academic and experiential learning. It is anticipated to take a minimum of two years to complete (based on whole-time equivalence), although it will normally be completed in three to five years for individuals in a full-time trainee role.
Figure 1: the Six domains within the Advanced Practice Mental Health Curriculum and Capabilities Framework (2022)
There are a growing number of universities delivering the content of the Advanced Practice Mental Health Framework and information about these can be sought via the Regional Faculties for Advancing Practice. The infrastructure within NHS England continues to form to support this work. There is an established national Advanced Practice Mental Health Steering Group and an Education Forum which includes representatives from the early adopter sites (academic and learner perspectives). The final part of the tripartite infrastructure is an Advanced Mental Health Community of Practice (AMHCOP), to support the advanced practice mental Health workforce and ensure that forums exist for all voices to be represented as this work is embedded into the system.
There are two main audiences for the Framework: the first is as described above and for people who identify the need to undertake the whole programme. The second audience is for experienced advanced practitioners in mental health who can use the capabilities as a framework to map their existing experience and academic study in part to support recognition of their level of practice via the NHS England ePortfolio (Supported) route (see section Professional registration and regulation).
Workforce planning
The development of an advanced practitioner role should initially be driven by an analysis of service need and scrutiny of the capabilities and capacity of the existing and available workforce. Improving population health, experience, and outcomes, tackling unequal access to services, enhancing productivity and value for money are priorities for Integrated Care Systems (ICS). The partnership between health and care organisations will allow the development of joined up services to improve the health of people who live and work in that area. Designing and developing services and the workforce within them allows us to co design and co-produce efficient solutions to existing skills gaps, considering practitioners with different professional skill sets and levels of practice e.g., registrant, enhanced, advanced and consultant level practitioners.
The development of advanced practice roles should be inextricably linked to workforce development plans, business intelligence and workforce commissioning working collaboratively with local organisations, patients with experience, professional groups, Higher Education Institutions (HEIs), Workforce Transformation Leads, workforce planning and the ICS. Crucially, expectations regarding the level of practice and the specific capabilities required in the context must be seen as a key element linked to competence assessment.
It is advised that the following documents should be held by NHS organisations to provide an audit trail of local decision-making:
There are additional roles and responsibilities that clinicians can undertake with further training in mental health services. These do not form part of the advanced practitioner training. A glossary of roles can be found in Appendix 4 including for Approved Clinician/Responsible Clinician and Approved Mental Health Professional (AMHP).
Business case Development
Key indicators that should be evidenced in a robust business case:
What outcomes are expected from the advanced practice role?
When will these outcomes be achieved and how will these be measured pre and post implementation?
What risks and unintended consequences might there be to the introduction of this role and how may they be mitigated?
What resources and support are required for role development (clearly include any work based and educational supervision requirements) and succession planning?
Is the workforce optimised e.g., nursing, and allied health professions to ensure clinical and financial benefits are maximised?
How will on-going competence and capability be reviewed and enabled?
What reporting and line management structure will be in place?
What processes will identify gaps in performance and/ or shortfalls in implementation and how will these be addressed?
Has a quality assurance model been considered to measure this e.g., CQC (Care Quality Commission) 5 key lines of enquiry which will support inspection?
The Lead for advancing practice in each provider organisation should be aware of staff currently working in advanced practice roles. They should be able to help managers understand the need for these roles and how they may transform services. To establish advanced practice roles, you will need to articulate the business case for this investment, in collaboration with your advanced practice lead, to consider population and system need. Job descriptions should be mapped to the Multi-Professional Framework (An example Job description and role specification criteria can be found in, Appendix 2 and job plans should include time for clinical supervision and be representative of the four pillars of advanced practice.
It is advised that employing organisations who currently have, or are considering advanced practice roles undertake the Advancing Practice Readiness Checklist (Appendix 3)to help with commissioning and business cases for new posts.
Recruitment
Advanced 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. Therefore, the recruitment process for trainee/advanced practitioner posts should be robust, and evidence supports that the success of advanced practitioner roles is synonymous with a candidate with the right attitude.
Essential requirements to apply for a trainee advanced practitioner post are:
Hold a current professional healthcare registration
Extensive experience post registration and in the relevant specialty area
Evidence of effective people management and leadership skills
Evidence of extensive professional /clinical knowledge in the relevant specialty
Effective communication skills and ability to communicate complex and highly sensitive information.
Evidence regular CPD
Ability to demonstrate an understanding of the level of advanced practice
Ability to study at master’s level and associated academic qualifications for role within a set time frame. This includes both clinical and academic criteria to become an advanced practitioner
Any practitioner with limited degree level study will require discussion with the Higher Educational Institute to assess suitability to study at master’s level. Apprenticeship requirements also state the need for level 2 (GCSE or equivalent) maths and English.
It is recommended that the following criteria are met in relation to the interview and selection process.
Shortlisting and Interview panel should as a minimum include a senior clinician, organisational advanced practice lead or equivalent and managerial representation.
Following selection, candidates can ask for feedback relating to their profile and/or performance at interview which will be provided by those involved in the interview process.
Successful applicants who are considered to have relevant prior experience will have their evidence mapped to the relevant curricula / capabilities identifying any gaps and additional training required and appropriate banding level.
Professional registration and regulation
All advanced practitioners will remain under the regulation of their professional bodies and must continue to comply with the relevant standards of proficiency.
The Centre for Advancing Practice will also recognise advanced practitioners in the form of a digital badge. This digital badge recognises that a practitioner’s education and training is considered equivalent to the standards of education training outlined in the 2017 Multi-professional framework for advanced clinical practice in England. Currently practitioners can gain recognition via the following routes.
Undertaking an Centre accredited Advanced Practice MSc programme
Undertaking the NHS England ePortfolio (supported) route
The digital badge is a tripartite agreement across the individual, employer, and education provider. This confers no inference at all regarding any specifics of the level of a practitioners individual focused scope of practice which is dictated by the agreements in place within the employing organisation.
This forms the core building block for advanced level practice upon which registrants can, where appropriate and if/as needed, undertake additional focused credentials to refine their specialty specific skill recognition. This may include, for example: undertaking the advanced level mental health credential which, in conjunction with the core digital advanced practice badge confirms scope specific advanced practice recognition. It must be noted that credentials in isolation do not do so.
It is the expectation that all advanced practitioners will be working towards or already hold a Centre for Advancing Practice digital badge. This will enable organisations and advanced practitioners to demonstrate that they are working at an advanced level of practice and meet the national minimal standards. This therefore promotes public and peer confidence in the practitioners’ level of practice and supports safe, effective, high-quality care for patients.
Medicines mechanisms including Independent and Supplementary prescribing
Where required as part of the specific role, advanced practitioners in mental health from multi-professional backgrounds with prescribing rights can address medicines related issues and support people with the supply, administration, and management of medicines, within their existing scope of practice. This may be via an independent or supplementary prescribing route or using the mechanisms where available for Patient Specific Direction (PSD) and Patient Group Direction (PGD).
It is not a pre-requisite or a mandatory requirement for all advanced practitioners in mental health to prescribe medicines. Being a prescribing practitioner is only one of the ways that some professional groups extend their skills and advance their practice, but certainly not in all cases. However, other core professions without legal prescribing rights, and even some that have them already have identified many other ways in which to enhance their knowledge, skills, and expertise to a recognised advanced level. Employers and workforce planners are encouraged to consider the needs of the specific population they serve when designing the requirements of individual posts.
Organisational commitments / Governance
Accountability is a preparedness to give an explanation to relevant others for ones’ s judgement, intentions, acts, and omissions when called upon to do so. At the core of professional accountability, and within all profession specific standards or codes of practice is the concept that each practitioner is personally and professionally responsible for their own practice. It is expected that all advanced practitioners are equipped with a detailed and confident knowledge of their professional standards, to apply those standards rigorously to the additional demands of advanced practice.
Risks to patient safety may arise when professional practitioners take on roles, responsibilities, or tasks which they lack the competence and capability to carry out safely and effectively. Risks may also arise where they practice with inadequate safeguards, which could expose service users to risk of harm.
It is inherent in advanced roles that new responsibilities, skills, and tasks are taken on and therefore there is a need for organisations to ensure that robust governance arrangements, encompassing all types and levels of practice, are in place prior to their establishment.
Good governance regarding the development and implementation of advanced roles must therefore be based upon consistent expectations regarding the level of practice required to deliver the service. This can be achieved through the benchmarking of such posts against nationally agreed standards and processes. Concerns about ‘new roles’ is both prudent and understandable and it has been argued that a risk to service users’ safety arises when professionals take on roles and responsibilities for which they lack competence or where they practice without adequate safeguards.
As a minimum, any organisation which already employ or are looking at implementing advanced practice roles should have an advanced roles governance framework that can evidence and provide guidance on the following, and which should be agreed and supported at board level:
Evidence clear corporate leadership/governance for advanced and consultant practice
Evidence a robust organisational structure in place at clinical/speciality/divisional and corporate level.
Ensure there is a clear understanding of advanced and consultant practice at clinical and operational level.
Evidence that the planning and recruitment of advanced and consultant practitioners across all divisions map to the workforce plans, ensuring workforce plans are developed to meet local and regional needs.
Organisational governance and assurances are in place to ensure advanced and consultant practitioners feel safe to practice at the top of their licence, only limited by professional registration and agreed scope of practice, with the organisation taking all appropriate steps to ensure patient safety.
Advanced and consultant practitioners’ recruitment and training is consistent and equitable across the organisation.
Advanced and consultant practitioners across the organisation undertake standardised, equitable, supported, and resourced training and assessment.
Advanced and consultant practitioners are supported to follow national, regional, and local recognition and, or accreditation processes.
Robust organisational governance for clinical supervision is demonstrated and aligns with NHS England national guidance.
Continued professional development governance and assurance structures are in place to ensure advanced and consultant practitioners are retained through continued development and thus providing high quality, safe and effective care.
There are feedback mechanisms for evaluating the impact of advanced and consultant roles that utilise quality improvement and data to identify the impact on service provision, access, patient outcomes, pathways, and the teams in which they work.
NHS England general organisational advanced practice readiness checklist can be found in Appendix 3. Regional specific NHS England advanced practice readiness checklists can be found in the regional sections of the Centre for Advanced Practicewebsite. The Centre for Advancing Practice is also in the process of developing a governace maturity matrix which will be designed to support employers review and plan how to optimise advanced practice roles in workforce development, service delivery and patient care.
Clinical supervision
High quality supervision for healthcare professionals moving into trainee advanced practice roles are essential for supporting the development of confidence and capability which underpins patient and practitioner safety.
NHS England has produced two supporting documents that should be reviewed by all organisations who already have or are looking at developing advanced practice roles.
NHS England is supporting the development of advanced practice roles by offering a package of funding and support for trainee/advanced practitioners. Employers are invited to put forward requests for funding, subject to NHS England budget constraints.
More information regarding regional funding offers can be found in the regional section.
Appendix 2 Example – Mental health advanced practice job description and personal specification
Job description
This job description has been developed to provide a general overview of the responsibilities that you would expect to see within an ‘Advanced practitioners’ job description. It is not an exhaustive list, and it can be tailored and adapted to meet the speciality requirements.
[INSERT NAME OF HOSPITALS/NHS TRUST]Job description
Job title: Advanced Practitioner
Department: [INSERT DEPARTMENT/SPECIALTY]
Band: Band 8a
Hours of duty: [INSERT HOURS]
Contract type: [INSERT TYPE]
Responsible to: [e.g., Advanced Practice Lead]
Reports to: [e.g., Consultant/Clinical Director/Associate Director (TBC)
Base:[INSERT SITE]
Job summary
The post holder will be practising as an advanced practitioner within their designated specialty/directorate. The role will encompass the skills of assessment, examination, diagnosis, treatment, and evaluation, within an agreed scope of practice. The post holder will assist in the safe assessment, treatment, referral, and discharge of patients within their own professional boundaries.
The post holder will be able to demonstrate advanced level critical thinking in the clinical decision-making process. They will work with the medical team to meet the needs of the service users and provide clinical professional leadership to the team.
The advanced practitioner will demonstrate an expert knowledge base, complex decision-making skills, and competences for expanded scope of advanced clinical practice ensuring they are able to meet the competencies as set out in NHS England ‘Mental Health Curriculum and Capabilities Framework’ (2020). The specific characteristics of the advanced practitioner role are shaped by the clinical context that the individual practices. They are part of the multiprofessional team.
The post holder will:
Complete full system and physical or psychological/psychiatric exams
Operate within the legal requirements of the Mental Health Act and able to exercise independent judgement in the assessment and diagnosis of mental health conditions.
Taking systemic and/or psychosocial patient or service user history
Making diagnostic decisions based on consultation, history, presentation & pathology.
Initiate, prescribe and monitoring the impact and outcome of treatments and medication including efficacy, side effects, contraindications, and risk
Devising an individual clinical management plan that includes all aspects of multidisciplinary care
Screen patients for early signs of disease and risk factors and relapse indicators
Draw on a diverse range of knowledge in their decision-making to determine evidence based therapeutic interventions, which will include prescribing medication where legally allowed and actively monitoring the effectiveness of therapeutic interventions.
Carry out where appropriate, invasive, and non-invasive diagnostic and therapeutic procedures with due regard to mental capacity and advance decisions
Plan and manage complete episodes of care, working in partnership with others, delegating and referring as appropriate to optimise health outcomes and resource use, and provide direct support to patients and clients.
Refer to other health professionals as appropriate
Discharge from hospital or services as required
Run independent out-patient clinics seeing new and review individuals as required
Work in partnership with patients and support them to manage and live their lives.
The post will be structured around the 4 pillars of advanced practice, available time allocated as indicated in brackets:
Expert clinical practice (0.7)
Professional Leadership and consultancy (0.1)
Education, training, and development(0.1)
Practice and service development, research, and evaluation (0.1)
Principal responsibilities
Clinical
Uses specialist knowledge and specific training to act autonomously in assessing, planning, implementing, and evaluating treatments and interventions presenting to the service with complex and undifferentiated or undefined presentations. Working to autonomously formulate appropriate management plans and often complex treatment plans to manage acute mental or physical illness and acute episodes of chronic illness including at referral, admission, or discharge, within their defined scope of practice.
Autonomously formulate appropriate management plans, formulate clinical decisions, and often complex treatment plans to manage acute mental or physical illness and acute episodes of chronic illness including at referral, admission, or discharge.
Complete observe physical and mental health examination as indicated by the presenting individuals condition; autonomously analysing complex clinical signs and investigation results to consider differential diagnoses and diagnose conditions, initiating treatment as required.
Analyse multiple sources of data including patient / service user history, physical examination and investigation findings when making diagnoses, clinical judgements and evaluating care provided; presenting this information, to speciality /senior medical staff for advice, as necessary, when scope of practice is exceeded.
Carry out clinical procedures appropriate to the history and physical examination of the presenting individual including further invasive testing and treatments requiring highly developed skills and precision
Learn the analyses of multiple sources of data including patient / service user history, physical examination and investigation findings when making diagnoses, clinical judgements and evaluating care provided; presenting this information, to speciality /senior medical staff for advice when scope of practice is exceeded.
Assess and prioritise patients undergoing treatment.
Demonstrate continual evaluation of the patients and use expertise to recommend adjustments/amendments to treatment plans, in consultation with the patient and members of the multi-professional team.
Make direct referrals to other members of the health care team.
Request and perform (within scope of role) investigations such as blood, urine and other laboratory tests, electrocardiographs (ECGs), ultrasound scans, XRays, and computed tomography (CT) scans, as agreed locally and within agreed scope.
Chase, view and Interpret results and report findings.
Discuss and agree assessment outcomes with patients, carers, and other health care professionals to enable patients to make an informed decision regarding their treatment.
Communicate highly complex information to patients, carers, and families during the consent process prior to commencement of treatment plans and invasive procedures including explaining treatment options.
Authorise the decision to admit patients and/or proactively initiate discharge.
Actively supports patients and their families through communicating difficult and highly complex sensitive information using a variety of methods to ensure effective understanding in a timely manner.
Proactively supports patients, carers, and families.
Communicate effectively with patients / service users, carers, colleagues, and others using appropriate communication styles. Anticipate barriers to communication and ensures the individuals significant others are kept fully informed and consent to treatment.
Provide empathy and reassurance through understanding the quality-of-life issues associated with their illness/conditions and treatment related side effects. Ensure that accurate, essential, and appropriate written and verbal information is conveyed to the wider multidisciplinary team (MDT) to ensure effective management of patients.
Participate / observe in the assessment of patients with mental health needs using local policy and guidelines and refers to the appropriate services.
Ensure dignity, privacy and cultural and religious beliefs are always respected.
Adheres to professional code of conduct, works within the boundaries of their scope of practice and always manage associated clinical risk effectively.
Professional leadership and management
Act as a role model by demonstrating high standards of holistic care.
Act in such a way as to be a credible, effective leader, demonstrating effective clinical leadership daily.
Take key responsibility for supporting the wider MDT.
Effectively manage own diary and workload.
Ensure that documentation is of a very high standard reflective of advanced practice, adhering to local and national guidelines.
Identify the skills set and terms of reference required of the Advanced Practitioner role, ensuring they reflect the individual, holistic needs of patients undergoing care.
Work in collaboration with the MDT to investigate clinical incidents associated with patients in their care.
Assess and monitor risk in own and others’ practice, acting on results, thereby ensuring safe delivery of care.
Diffuse potential complaints and hostile situations with staff, patients and carers using highly developed negotiation and interprofessional skills
Provide representation, as appropriate at various local and national meetings, providing feedback to the organisation on clinical and professional issues which have an impact on care and standards of practice within their sphere of responsibility.
Develop formal and informal links outside the organisation, sharing good practice, innovative ideas, and promote staff and service development.
Establish and maintain a regional and national network of contacts relevant to the service.
Promote the service through formal and informal presentations within and outside the organisation through study days, conferences, and written papers.
Work in partnership with the existing senior medical, nursing and AHP (Allied Health Professions) teams in driving departmental development and change.
Education and training
Has obtained the theoretical knowledge; MSc in Advanced Practice or equivalent, in conjunction with practical experience; evidenced in a supporting portfolio, to a level that allows the job responsibilities to be delivered at a high standard.
Has obtained non-medical prescribing, if appropriate to registered profession.
Identify own personal developmental and educational needs to work at an advanced level and beyond. Ensure appropriate action is taken to maintain and further develop skills.
Maintain a professional portfolio and participate in continuing professional development.
Maintain competencies and attend mandatory lectures and training as required by the Trust.
Receive clinical supervision to clinically improve knowledge and the quality of care delivered to patients.
Utilises professional knowledge and skills, underpinned by theoretical and relevant practical experience to teach, motivate, and support junior staff on a range of clinical practices.
Participates in the delivery of specialist training and development of other healthcare workers within the Trust.
Develop and organise study days and training sessions for self and others within the clinical team.
Participates in the supervision and mentorship of multi-professional students and junior staff.
Undertake clinical supervision for trainee advanced practitioners.
Carry out training needs analysis, using the results to design, develop and deliver a teaching programme promoting practice development for those staff caring for patients within the speciality. This will include the development of links with other organisations and innovative approaches to staff development.
Research, service development and audit
Maintain up to date knowledge in the specialist field, using information to affect change in practice and ensuring effective dissemination of new knowledge.
Participate in service development. Writes protocols, guidelines, and procedures for own remit which, impacts on other members of the multi-disciplinary team.
Participate in the development and evaluation of protocols and guidelines and procedures using current literature and research.
Participates in the development of patient information to improve patient care.
Liaise with the MDT, including consultants, senior nursing colleagues and management in the development of services, contribute ideas and make recommendations for service improvements.
Implement policies informing members of the multidisciplinary team of any changes.
In collaboration with the MDT ensure that clinical practice is patient centred and research based, in accordance with professional practice, guidelines, and national and local benchmarks.
Support relevant audit activity in the specialities to evaluate the effectiveness of care interventions and disseminates outcomes with any potential changes to clinical practice which improves health outcomes.
Engages in self-reflection, audit and quality initiatives thus contributing to the development and improvement of the clinical services.
Where appropriate, participate in research projects and/or support the wider MDT with research initiatives.
Promote and disseminate research and audit findings relevant to the service.
Continue to develop and promote the Advanced Practitioner role through professional publications and conference papers
Multi-disciplinary liaison
Ensure effective communication is maintained between members of the multidisciplinary team to ensure appropriate individuals are informed of changes in patient conditions or treatment plan.
Be a core member of the multidisciplinary team providing specialist knowledge and advice.
Establish and maintain excellent communication with individuals and groups exploring complex issues relating to care options and decisions.
Promote collaborative working relationships and effective communication between all members of the team.
Responsibilities for financial and physical resources
Responsible for reporting faults with equipment and removing from the clinical area until repaired
Uses specialist equipment to assist in the monitoring, diagnosis, and treatment of patients.
Influence decisions regarding the allocation of financial resources through consultation, service redesign, participation in meetings and audits.
Responsibilities for human resources
Allocates work and advises junior staff within their clinical area.
Participates in the Trust’s appraisal process and professional revalidation if appropriate.
Undertake clinical and educational supervision with assigned consultant supervision
Report sickness and return to work promptly in accordance with organisational policy.
Freedom to act
Directed by national guidance as well as local protocols and guidelines, can analyse each clinical situation and formulate a management plan.
Practitioners are accountable for their own professional actions within a locally agreed scope of practice.
Responsible for ensuring accurate interpretation and dissemination of local and national policies within speciality.
Practitioners are responsible for managing and prioritising own workload against the needs of patients and service requirements.
Uses own initiative, acts independently, and takes appropriate action.
Physical effort
Performs physical examination and clinical skills.
Manging patients who are unwell and thus periods of intense physical effort are required on a regular or as per shift basis.
Moving and handling of patients and equipment.
Frequent use of a computer to record, review and order results / tests.
Mental effort
Required to perform procedures in the management of unwell patients.
Regular concentration required during clinical procedures.
Daily concentration on patient assessment and delivery of care.
Required to respond instantaneously to patient’s needs, thus sometimes unpredictable work arises.
Emotional effort
The practitioner is required to deliver clinical support via a range of treatments and experiences, which can be highly distressing and challenging. i.e.
Frequently dealing with agitated / sedated patients
Discuss diagnosis with patient and their relatives.
Provides advice and support to patients/ carers who may be concerned about an aspect of their plan of care.
Explaining possible diagnoses for unfavourable test results.
Responsible for the counselling and information giving to patients and families within their care.
Working conditions
Work involves bodily fluids, i.e., blood / faeces and sharps.
The practitioner will have direct patient contact, delivering direct patient care in a variety of settings in accordance with the need of the patient.
Frequent exposure to uncontained bodily fluids / foul linen during general patient care.
Potential exposure to patients with infectious conditions.
Health and safety
In addition to the Trust overall responsibility for your health and safety you have a personal responsibility for your own health and safety. As such, you are required to inform your line manager of any safety issues that you identify that could affect you or others within the workplace. You must always co-operate with management and colleagues in achieving safer work processes and workplaces, particularly where it can impact on care.
As a Trust employee you will be trained in the correct use of any equipment provided to improve safety and health within the Trust. You will be required to use equipment when necessary and as instructed which will include checking the equipment is safe to use and to report any defects immediately to your line manager.
Person specification
Person specification
(*To be adapted for the role as required)
Education/Qualification
Essential
Desirable
Assessment criteria
Professional Registration with either NMC, GPhC or HCPC.
X
Cert/PIN
Evidence of continuing education
X
Cert/Port
Possession of 1st degree in a clinical field e.g., Nursing, physiotherapy at a minimum 2:2 classification
X
Cert
MSc in Advanced Practice or equivalent (i.e., Centre for Advancing Practice recognition)
X
Cert
Significant post qualification experience in a relevant clinical field.
X
Cert
Non-Medical Prescribing if appropriate to registered profession.
X
Cert
Leadership/management
X
Cert
Experience
Essential
Desirable
Assessment criteria
Significant experience of working as a registered practitioner and within a relevant specialty [4-5 years Minimum]
X
App/Ref
Evidence of recent teaching, mentorship, and supervision of staff
X
Port/Int
Evidence of audit experience
X
Port/Int
Evidence of involvement in change management
X
App/Int/Ref
Evidence of multi-professional working
X
App/Int/Ref
Skills and Ability
Essential
Desirable
Assessment criteria
Evidence of both theoretical and practical skills and competency in patient
management
X
App/Port/Cert/ Ref/Int
Strong leadership skills
X
App/Int
Effective communication both written and verbal
X
Int/Ref
Presentation Skills
X
Int
Ability to develop protocols and guidelines
X
Port/Ref
Ability to write reports for senior management
X
Int/Ref
Works under own initiative with strong organisational skills and can work to deadlines
X
Int/Ref
Able to use problem solving skills
X
Int/Ref
Time management ~ able to prioritise
X
Int/Ref
Able to manage change both personally and leading others
X
Int /Ref
Computer skills (i.e., for radiology, pathology, microbiology ordering as per Trust protocols, utilising patient systems)
X
Cert/Port
Knowledge
Essential
Desirable
Assessment criteria
Demonstrate an understanding of current developments in the relevant speciality
X
Int
Demonstrate the ability to utilise current research finding in practice
X
App/Int
Understand, encourage, and support clinical supervision
X
Port/Ref
Knowledge of current NHS, professional and educational issues
X
Int
Knowledge of clinical governance and risk assessment/management
X
Int/Ref
Knowledge of infection control issues
X
App/Int/Ref
Disposition
Essential
Desirable
Assessment criteria
Visionary – motivated
X
App/Int
Creative/innovative and adaptable
X
App/Int/Ref
Demonstrates enthusiasm and flexibility
X
App/Int/Ref
Approachable/receptive and assertive
X
App/Int/Ref
Other requirements
Essential
Desirable
Assessment criteria
Must be flexible with working environment and shift patterns
X
Int
Able to develop scope of roles and responsibilities for self and other trust staff
X
Int
Able to care for both physical and emotional needs of self and others
X
App/Int/Ref
This job description is not meant to be exhaustive. It describes the main duties and responsibilities of the current post. It may be subject to change in the light of developing organisational and service need, and wherever possible change will follow consultation with the post holder
Appendix 3 Advanced practice readiness checklist
Advanced Practice Checklist
Advanced practice is delivered by experienced, registered health and care practitioners, characterised by a high degree of autonomy, complex decision making and leadership within their area of practice. 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 competence. Professionals working at the level of advanced practice will exercise autonomy and decision making in a context of complexity, uncertainty, and varying levels of risk, holding accountability for decisions made.
Currently, there is a lack of consistency in how the titles ‘advanced practitioner’ and “advanced clinical practitioner” are used. In this document the term advanced clinical practitioner/ practice (AP) is used. NHS England’s national Centre for Advancing Practice has been established to lead the advanced and consultant practice agenda. Its aims are to:
Establish and monitor standards for education and training
Accredit advanced practice programmes
Support and recognise practitioners
Grow and embed advanced practice and consultant workforce
The Regional Faculties for Advancing Practice have been developed to work with local systems (ICBs and NHS providers) to identify demand, commission high quality education and training and support the supervisory needs of learners.
Is my organisation ready to implement and support advanced practice?
Many employers have expressed a wish for support to develop advanced practice roles and this Advanced practice readiness checklist has been developed to help employers to self-assess their organisational readiness for advanced practice trainees and identify possible next steps. The Checklist is based on the key principles of the Multi–professional framework for Advanced ClinicalPractice in England and has been developed for advanced practice leads (or other senior education leads responsible for advanced practitioners) at an organisational level, with input from individual trainees and supervisors.
Organisations should rate their readiness on a scale of 1 to 4 for each domain, where 1 signifies there is no evidence and 4 signifies that the factor is fully embedded within the organisational infrastructure and governance. It is anticipated that the results of the checklist may help employers and advanced practice leads identify areas for improvement to help ensure both the success of advanced practice training for their staff and fully realise the potential benefits of embedding new advanced practice roles within clinical pathways.
Factors suggesting readiness for Advanced Practice
Examples of evidence in your organisation
Extent to which these are in place 14
Explain your decision
Organisational level
There is clear support and commitment for AP roles at executive and director level of the organisation
Named executive sponsor e.g., Head of directorate
To ensure patient safety, we have clear governance and support arrangements for AP
Governance systems, policies, strategies
The title of AP is defined and used consistently
Mapping exercise, current job descriptions and/or job plans
AP is actively promoted across the organisation
Plan for AP communication and engagement in place, led by AP lead and includes support for AP forum
There is understanding of advanced practice (across the 4 pillars) and the value these roles bring at ICS, PCN, Trust and service manager level.
There is understanding of advanced practice across medical and non-medical professionals involved with the process
Stakeholders engaged in the planning, development, and support of AP roles, including utilisation of the skills offered across the 4 pillars
We have surveyed our staff to establish where enhanced and advanced roles already exist and have mapped existing roles against the Framework to establish where development is needed for transition to AP roles
Workforce reviews, local AP database, AP mapping tool
There is a business case to underpin the workforce planning for AP level roles to maximise their impact, including standardised titles and banding and a succession plan where appropriate
Business cases, workforce plans
We have clearly defined substantive AP posts for trainees to move into on completion of their training
Job descriptions, job plans, workforce plans
We have robust processes for recruitment, and selection into AP level roles and for monitoring progress and certifying completion of training. (Engage with tripartite selection process between employer, HEE, and HEI where appropriate),
AP strategy / governance document
We have opportunities for trainee APs to develop capability across the four pillars via placements or rotations in other areas, supported by skills-specific supervision
Examples of rotations or placements, communication, minutes of meetings
There is a planned approach to supporting those seeking AP status via portfolio or credentialling
Individual learning plans, business cases
We have discussed our plans for AP with our ICB, Local Workforce Action Board (LWAB) and HEE Faculties of Advancing Practice.
Communications, minutes of meetings
There is a commitment to review regularly (minimum annually) the readiness for advanced practice as an organisation
AP Readiness Checklist, supporting action plan
Appendix 4 Glossary of roles
Approved Clinician/Responsible Clinician
An Approved Clinician (AC) is “a person approved by the appropriate national authority to act as an approved clinician for the purposes of the Mental Health Act” Responsible Clinician is the ‘Approved Clinician who has overall responsibility for a patient’s case.’ In simple terms, Responsible Clinicians are recruited from a pool of Approved Clinicians. An RC can grant and revoke Section 17 leave; renew detention; initiate holding powers; discharge from detention; discharge onto community treatment orders (CTOs); extend, revoke and discharge CTOs and oversee Guardianship Orders. An AC/RC is required to be a senior professional, sufficiently experienced to capably and with authority, exercise the autonomous decision making required of an Approved Clinician. Assurance that the required level of competence is achieved is via a portfolio and panel review process.
Approved Mental Health Professional (AMHP)
The AMHP is a statutory role created with the enactment of the MHA 2007. Eligible professionals undertake the AMHP role on behalf of local authority social services departments, who are legally responsible for the AMHP service. The role is closely linked to NHS Mental Health Trusts, who provide many of the services that AMHPs require to undertake their role. The AMHP has a responsibility to organise and undertake an assessment and if the legal definitions are met, to authorise detention under the Mental Health Act. AMHPs have specific responsibilities to uphold the human rights of people assessed under the Act, consider the social perspective, and follow the guiding principles of the MHA, which includes applying the least restrictive principle. The AMHP is also responsible for organising the complex inter-agency arrangements required to undertake the assessment and communicating with everyone involved, including the person’s Nearest Relative (NR). Social Work England is the responsible regulator, approving and reapproving all AMHP training courses, and it holds legacy guidance for the knowledge criteria AMHPs must meet to qualify. This guidance, and the regulatory framework around AMHPs, is due to be revised in 2023.
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