Credentials Approach: Briefing paper – November 2022; updated May 2023
The Centre for Advancing Practice’s activity on multi-professional credentials over the last two years has been focused on defining what we mean by credentials; devising a process to assure credentials’ relevance, quality and value; and progressing approaches to credentials’ implementation to achieve their intended benefits. Promoting stakeholder engagement and seeking and acting on stakeholder input and feedback has been integral to this activity.
In addition to our credential activity being rooted in NHS England’s approach to advanced practice, it sits firmly in the context of the NHS Long Term Plan (2019) for England. The plan identified credentials’ role in addressing high-priority population, patient care and system-level needs. Our activity is therefore focused on progressing how credentials develop advanced practice capability and capacity and, more broadly, contribute to accelerating workforce transformation.
This briefing document explains our approach and planned next steps.
Our approach to advanced practice
Advanced practice describes the capabilities developed and deployed by regulated health and care professionals (other than medical and dental practitioners) to exercise a high degree of independence in their clinical decision-making and manage high levels of complexity, risk and uncertainty in their practice. As such, it reflects the demands of level 7 (Master’s level) learning. Its focus is on increasing advanced practice capability and capacity to deliver personalised care, contribute to different approaches to multi-disciplinary teamworking and support and enable new models of service delivery.
The Advanced Practice Framework, published by Health Education England in 2017, seeks to achieve a consistent, shared understanding of advanced practice capabilities. This includes in terms of capabilities’ dimensions, demands and value and their relevance and currency across professions, specialties, roles and settings. It highlights that exercising clinical leadership and management, educating others and engaging in research are integral to advanced practice, in addition to high-level clinical capabilities – so across the four pillars of practice.
Our approach to credentials
We use ‘credential’ to describe defined, standardised components of learning and assessment that are designed to develop advanced practice capability in specific areas. An area can be defined by a population/patient group, a practice/service delivery environment, or a defined specialty/sub-specialty of practice. Our focus is on how credentials contribute to the following:
- Developing area-specific advanced practice capability and capacity within areas of high- priority population, patient care, system-level and service delivery needs.
- Increasing efficiencies in workforce development, including by supporting education providers to respond to priority needs at pace and scale, and with consistency.
- Enhancing local governance arrangements for advanced practice workforce development, deployment and mobility – thereby building trust and confidence in the safety, efficacy and efficiency of advanced practice for meeting population health, patient care and service delivery needs.
Each credential directly aligns with the broad capabilities defined in the Advanced Practice Framework, while being focused on developing the specific advanced practice capabilities – across the four pillars of practice and on a multi-professional basis – required to manage complexity, uncertainty and high levels of risk in that area.
We use the term ‘credential specification’ to describe the open-source documents that define and present a credential by articulating a capability and curriculum framework. Each credential specification forms a ‘blueprint’ document for delivery by higher education institutions (HEIs) as an integral part of their advanced practice education provision. Key characteristics of credential specifications are outlined in Box A.
Box A: key characteristics of credential specifications
They define the following:
- Intended learning outcomes and area-specific capabilities.
- Target group and requirements relating to undertaking the credential.
- Approach to learning and development and workplace-based supervision.
- Indicative learning content.
- Indicative learning effort.
- Approach to assessment.
- Resource requirements.
We respect that other organisations use the term ‘credential’ differently (e.g. as a verb and in relation to individual practitioners) and recognise the importance of being clear about how we use terminology. There is a glossary of terms, which can be accessed below.
We also see multi-professional advanced practice credentials as just one way of meeting workforce development needs in particular areas of practice. Not all needs can or should be addressed by credentials. They can be met by bespoke university programmes and modules, including existing specialty pathways through advanced practice Master’s degrees. We have produced guidance on how we see credentials sitting in the context of other types of area- specific workforce development solutions.
Assuring credentials’ quality
We have developed a cyclical credential approval and assurance process that spans credential development, recognition and review (including evaluation). Our process has a strong focus on continuous improvement and enacting a quality assurance approach that is both rigorous and proportionate. We also have focuses on the following:
- Public and patient involvement as an integral part of all stages of the process.
- Robust, transparent governance arrangements, including through involving independent reviewers (with academic and relevant clinical expertise).
- Evidence-based approaches to how credentials are developed and delivered, including in credentials’ learning and assessment demands and how credential specifications’ currency is kept under review.
- The integration of academic and workplace-based learning and assessment within each credential, with structured approaches to workplace-based supervision embedded into practitioners’ learning and development to uphold patient safety and the management of risk.
- Addressing equality, diversity and inclusion issues in how credentials are developed, designed and delivered (from both a patient and practitioner/learner perspective).
- Achieving and maintaining responsiveness to changing needs and developments, including within models of care and service delivery.
Our endorsement criteria articulate our requirements of individual credential specifications. These are summarised in Box B.
Box B: focuses of Centre endorsement criteria
- Articulate advanced practice capabilities in a specified area of practice.
- Inclusive of professions that can safely and effectively contribute to advanced practice in the specified area, while being clear on pre- and co-requisites.
- Form a standardised component of learning and assessment (by providing a curriculum framework).
- Support safe and effective workforce development and deployment (including by addressing equality, diversity and inclusion issues).
- Draw on and reflect contemporary research and evidence-based practice.
- Responsive to changing population, patient and service delivery needs.
- Developed through collaboration and consensus-building (with public and patient involvement).
We have tested our approach to endorsement by applying it to area-specific advanced practice documents that were previously commissioned by Health Education England in line with priorities identified in the NHS Long Term Plan for England. Once documents achieve Centre endorsement and are finalised as credential specifications, we make them available as opensource resources via the Centre’s website.
Centre-endorsed credentials specifications are intended for use by HEIs to support their curriculum design and delivery and as an integral part of their advanced practice education provision. We have developed standards for considering and approving HEIs’ plans to deliver individual Centre-endorsed credential specifications. We will shortly be testing the application of these.
For new credentials, we will set priority areas in line with national policy and strategic priorities. We have devised Centre ‘gateway criteria’ and a prioritisation matrix to identify new areas. Our approach is designed to optimise use of available resources and capacity to meet priority needs and to optimise credentials’ value and impact. The gateway criteria can be accessed below. Key considerations about whether a potential new credential can or should be supported in development are as follows:
- The nature, scale and scope of the workforce development to meet defined population health, patient care and service delivery need.
- How the identified workforce development need relates to advanced practice, as well as existing credentials and other education provision.
- The feasibility of a credential being developed and delivered and the prospect of its being transformational in developing advanced practice capability and capacity.
We recognise the central importance of focusing on credentials’ implementation (delivery and take-up) to achieve their intended benefits. We are progressing strategic activity to promote and support implementation, underpinned by principles developed through consensus-building. Our approach continues to engage HEIs and employers, with activity co-ordinated at national and regional levels by the Centre and the Regional Faculties for Advancing Practice.
The focus of our approach to credential implementation is on the following:
- Addressing short, medium and long-term needs relating to advanced practice workforce development and deployment.
- Building confidence that credential implementation is practical, responsive and sustainable.
- Measuring progress and identifying, addressing and learning from enablers and barriers.
We intend to measure credentials’ impact on workforce development and deployment, service delivery and meeting population and patient care needs. We have developed an evaluation methodology to inform activity on this.
Links with medical credentials
We are progressing our approach to multi-professional advanced practice credentials in parallel with the approach being taken to medical and dental credentials. We are committed to ensuring clarity on the links and differences between credentials for different parts of the workforce. Our central focus is on upholding safe and effective patient care, while optimising opportunities for workforce development and deployment within multi-disciplinary teams and new models of care.
We are considering the value of joined-up or co-ordinated approaches to credential development and implementation taking account of the following:
- The potential development of complementary (‘companion’) credentials for medicine and other specified professions within the same area of practice (produced either on a sequential or concurrent basis).
- The potential development of a shared credential across medicine and other, specified registered professions, if this could form a safe, effective and expedient way to address workforce development needs in a particular area of practice.
- The development of a credential in a particular area of practice to address workforce development needs either only in medicine or only for specified other professions (again, in response to identified needs).
NHS England’s Credential Development Oversight Group addresses medical and multi-professional credential issues in a joined-up way. The group’s primary remit is to consider workforce development priorities across medicine and multi-professional advanced practice, the nature and scope of priority areas, and how best these can be addressed. It also considers whether and how credentials are the most appropriate intervention to meet specific needs, recognising the different requirements, options and solutions within and for medicine and the other professions.
The development of our approach to multi-professional advanced practice credentials has valuably been informed by stakeholder input on an incremental basis. Early in 2022, we undertook a focused stakeholder engagement exercise, sharing our approach and seeking feedback through eleven round-table discussions with different stakeholder groups (involving c.140 participants), open-access webinars and an online survey (to which we received 27 responses; 12 from organisations and 15 from individuals).
The policy and regulation team (then within Health Education England) undertook a thematic analysis of the responses to the online survey, while we captured key points from the round-table discussions. Themes from both strands of the exercise are summarised below.
What was valued
Stakeholder responses were broadly positive, with the specific elements outlined below particularly welcomed.
- About the exercise itself – its
- Open, inclusive approach to seeking feedback, including from public and patients.
- Timeliness, including because of stakeholders’ own focus on accelerating safe, effective advanced practice workforce development and enhancing related governance.
- Our intended approach to credentials – its focus on
- Addressing high-priority population, patient, service delivery and workforce needs.
- Sensitivity to changing contexts and high levels of complexity.
- Securing and enabling public and patient involvement (including within Centre governance arrangements for credentials).
- Supporting greater workforce flexibility, mobility and portability.
- Contributing to advanced practice governance arrangements.
Feedback gave us useful steers on what we should address to progress our approach to credentials. It particularly highlighted the importance of the following:
- Clear, simple and regular communications, with material shared in a range of formats and via different media to optimise its reach and accessibility.
- Clarity on the Centre’s distinct approach to multi-professional credentials, including in relation to other organisations’ approaches, other workforce development solutions and profession-specific initiatives.
- A focus on credential implementation to promote and support delivery and take-up, recognising credentials are a new workforce development solution for most stakeholders.
- On-going opportunities for stakeholder engagement, so that the Centre’s approach continues to be informed by stakeholder feedback and learning is optimised and shared.
Feedback indicated the logic of the following:
- Seeking a four-nation approach to share learning and best practice and increase workforce mobility, while remaining focused on progressing credential developments in England (in line with HEE’s remit).
- Co-ordinating links with medical credentials, including to optimise workforce development, while being clear on the different reference points and contexts for credentials for medicine and the wider workforce.
- Being mindful of the regulatory reform agenda, while not making assumptions about any potential future links between credentials and regulatory developments.
Where we need to build greater confidence
Feedback highlighted the following areas in which we need to strengthen stakeholder confidence:
- The value of ‘credential’ as a term and reducing the scope for confusion, given both the complexity involved in credentials and different use of the term by other organisations.
- Capacity and ‘system readiness’ for credential delivery and take-up, particularly in terms of workplace-based supervision and in the context of service delivery and wider workforce pressures (including in a post-Covid context).
- Credentials’ currency, with their value and practicality – as a new, unfamiliar workforce development intervention – yet to be tested and demonstrated.
- The value of digital badges to denote practitioners’ successful completion of a Centre- endorsed credential – with this depending on clarity and practicalities of approach and linked to whether and how credentials gain a currency.
Planned next steps
Informed by stakeholder feedback, we are taking forward a five-step plan to progress our approach to credentials. This is outlined below.
Our five step plan
1. Develop and enact a credentials communication plan
Through this, we will
- Update our communications on the Centre’s approach to credentials, seeking to be clearer about what we mean and don’t mean.
- Share information in a range of formats and through different media, including to enhance its accessibility to different stakeholder groups.
- Provide regular updates on credential developments, including as new credentials become available for delivery and take-up.
- Continue to seek feedback on our communications approach, with a view to improving its clarity, accessibility and usefulness on an on-going basis.
2. Launch our full credential approval and assurance process
Before this, we will
- Test and share our full approach to priority-setting for future credential developments.
- Develop an evaluation methodology for application within an evaluation study.
3. Provide on-going opportunities for stakeholder engagement
In this way, we will
- Continue to seek active involvement in shaping our approach.
4. Progress our strategic plan for implementation
Through this, we will
- Seek to achieve Centre-endorsed credentials’ full implementation within broader advanced practice developments and workforce planning, development and deployment processes, including by providing practical support and guidance.
5. Keep our strategic position on credentials under review
In this way, we will take account of
- Changing needs and opportunities.
- Wider advanced practice workforce development solutions.
- Broader initiatives to accelerate safe and effective workforce transformation.