Introduction

To response to the need to better serve evolving community needs and expectations the NHS has published several plans. The NHS Long Term Plan aims to give people accessing services more options, better support and properly joined-up services at the right time, in the right setting. The NHS People plan focuses on making best use of the full range of staff skills and experience. Together these plans seek to achieve the best possible outcomes and experiences for the public.

The NHS Long Term Workforce Plan sets out intentions to modernise career pathways. To support their uptake, new opportunities are emerging for staff to develop across enhanced, advanced and consultant levels of practice. This will support staff retention and expand the number of senior decision makers. Active engagement of health and care practitioners in, and with, research is of central importance. It is key to:

1. ensuring safe evidence-based practice,
2. further strengthening and developing the evidence base, and
3. informing service design, clinical reasoning and shared decision-making with the people and communities they work alongside.

This theme is embedded in other national strategies. For example,

• A central ambition of the Chief Nursing Officer for England’s (2021) Strategic Plan for Research is to create a people-centred research environment. This will empower nurses to lead, participate in and deliver research fully embedded in practice and professional decision-making.
• Similarly, Health Education England’s (2022) Allied Health Professions’ Research and Innovation Strategy for England addresses the need to build the capability and capacity of the Allied Health Profession (AHP) workforce to engage with, implement, undertake and lead research and innovation in practice. It aims to establish a broad culture within which research and innovation is ‘everybody’s business’.
• The Chief Midwifery Officer for England’s (2023) Strategic Plan for Research centres on ensuring quality evidence and evaluation are embedded within maternity policy and programmes. It also aims to ensure that midwives’ contributions to research and building the evidence base are visible, valued, and supported by strengthening research capacity.

The central importance of engaging in, and with, research in contemporary practice is emphasised by the four pillars of practice:

1. clinical (or professional) practice;
2. leadership;
3. facilitation of learning, and
4. evidence, research and development.

Successfully transforming the workforce and service delivery requires active engagement with all four pillars by all practitioners. What that looks like, varies for individual practitioners at different stages of their careers, reflecting their particular circumstances and contexts.

There is no single ‘correct’ path to follow. However, all practitioners must make considered use of research evidence to inform decision-making. Beyond that, the emphasis might be on supporting, delivering or leading research. All contribute to the collective effort required to transform services, and the experiences and outcomes of individuals and communities. In so doing, all contribute to making the most effective use of a limited public purse. They also participate in the recruitment, retention, engagement and development of staff through more varied, exciting and rewarding career opportunities.

Purpose and intended use of the Multi-professional Practice-based Research Capabilities Framework

The purpose of the Multi-professional Practice-based Research Capabilities Framework is to:

1. facilitate transformation of health and care service delivery.
2. enhance outcomes and experiences of individuals and communities.
3.  support health and care professionals to engage in, and with, research.

The Framework elaborates incremental research capability development as one of the pillars across four levels of practice. The focus is specifically on practice-based health and care professionals. The intended audience does not extend to colleagues in medicine and dentistry, for whom well-established guidance and structures already exist.

The Framework aims to highlight and promote active involvement in, and with, research as an integral component of practice for all health and care professionals. This is the case regardless of the setting in which they work – whether primary, secondary or tertiary care, in the community, social care or elsewhere. The Framework outlines a common set of core capabilities for the diverse disciplines outside medicine and dentistry.

The expectation is that all practice-based health and care professionals develop these fundamental capabilities, relevant to their level of practice. It is, however, recognised that individuals or groups of practitioners may possess or choose to develop capabilities beyond those outlined at a particular level of practice. This might relate to different entry level qualifications. It could apply to those in research delivery leadership roles or actively pursuing a clinical or practitioner academic development pathway.

The intention of the Framework is to facilitate and accelerate the development of practice-based research capabilities, capacity and career pathways across the health and care professions.

Developing research alongside the other three pillars of practice will strengthen practitioners’ contributions to transforming services, outcomes and experiences.

The structure of the Framework is based on four levels of practice (entry, enhanced, advanced and consultant levels of practice, as set out in a later section). It will be a valuable tool for:

Strategic alignment of the Multi-professional Practice-based Research Capabilities Framework

The design of the Multi-professional Practice-based Research Capabilities Framework aims to ensure alignment with existing national regulatory requirements, strategies and frameworks, (as outlined in Appendix 1). The anticipation is that it will also align with any other forthcoming national research strategies in England.

The Framework is focused on health and care professionals working in England. It may be a useful reference for those in the other three nations and other health and care disciplines.

Founding and guiding principles

The following principles further underpin the development and application of the Multi-professional Practice-based Research Capabilities Framework: 

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Figure 1: Situating the Multi-professional Practice-based Research Capabilities Framework within the context of the four pillars of practice

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Defining and describing the Multi-professional Practice-based Research Capabilities Framework’s four levels of practice

Entry level practice

The Standards of Practice or Proficiency published by regulatory bodies represent their threshold requirements for professional registration. These standards provide recognised and established threshold expectations of all registrants in particular professions. Always applicable while an individual remains on the register, they are a logical reference point for research-related capabilities at the start of practitioners’ careers. The following have informed framework contents at the entry level:

• the Nursing and Midwifery Council’s Standards of Proficiency for Registered Nurses.
• the Nursing and Midwifery Council’s Standards of Proficiency for Midwives.
• the General Osteopathic Council’s Practice Standards.
• the General Pharmaceutical Council’s Standards for Pharmacy Professionals.
• the Health and Care Professions Council Standards of Proficiency.

The definition of the academic level underpinning entry to each profession is frequently noted within the Standards of Practice / Proficiency as published by the relevant regulatory body.

Enhanced level practice

Enhanced Practice is a level of practice that already exists within the health and care workforce. It is delivered by established clinicians, who are autonomous professionals, making a significant impact on patient care and clinical services.

Through use of profession-specific knowledge, skills, and behaviours, they make autonomous decisions within a defined area of practice, mitigating and managing risk to the patient, themselves, others, and the service. There are no ‘generic’ Enhanced Practitioner roles; practitioners are post qualification/registration and have experience and a recognised body of profession-specific knowledge. Recognising and formalising Enhanced Level Practice will drive cultural change and provide a positive impact on services.

Practitioners working at enhanced practice level do so across different sectors and settings. They hold and apply a focused depth of professional knowledge, skills, and behaviours within their individual scope of practice and sphere of influence to meet population health, patient care, service delivery, and workforce needs. Fundamental to practice at enhanced level (and all levels of practice) is practitioners having and exercising a developed understanding of their personal scope of practice at any one point in time and the limits of their scope and competence, and therefore knowing when they need to seek advice and guidance to ensure that patient safety is upheld.

The Enhanced Clinical Practitioner Apprenticeship Standard, and Health Education England (now NHS England) expectations shaped capabilities at this level.

Advanced level practice

In 2017 Health Education England published the Multi-professional Framework for Advanced Practice in England. Advanced level practice is delivered by experienced, registered health and care practitioners. It involves a high degree of autonomy and complex decision making and is based on a master’s degree or equivalent.

Advanced practice requires the demonstration of core capabilities across all four pillars of practice. It includes:

• the analysis and synthesis of complex problems across a range of settings,
• enabling innovative solutions to enhance the experiences and improve the outcomes of people accessing services and wider communities.

Advanced level practitioners exercise autonomy and decision making in complex situations. They manage uncertainty and variable levels of risks and are accountable for their decisions.

The research pillar of the Multi-professional Framework for Advanced Practice shaped capabilities at this level.

Consultant level practice

In 2020, Health Education England published the Multi-professional Consultant Level Practice Capability and Impact Framework. Consultant level requires practitioners to demonstrate capabilities outlined for all four integrated domains of practice and to offer consultancy as a foundation for sharing expertise across systems of health and social care. Those working at this level deliver values-based professional practice. They work with individuals, families, carers, communities and others in complex and changing situations. They also provide leadership across pathways, services, organisations, and systems. Consultant practitioners support others to learn, develop, and improve in and from practice. In doing so, they support workforce transformation and promote excellence.

Consultant level practice involves continuous evaluation and improvement. It creates knowledge-rich and inquiring cultures across services and the system. It encompasses supervising research, contributing to and leading interdisciplinary research and innovation programmes that contribute to the knowledge base. Consultant level practice positively impacts on:

• development,
• quality (person centred, safe and effective care with continuity),
• innovation in practice,
• expanding capacity and capability in research
• evaluation across the system and beyond to improve effectiveness.

The Framework for Higher Education Qualifications level 8 (doctoral level) equivalence characterises consultant level practice. An academic award at doctoral level is not mandatory for enabling effective consultant-level practice. However, consultant practitioners aspiring to work in clinical academic roles normally need to attain a doctorate as part of that role development.

The expectations set out in the research pillar of the Health Education England (2020) Multi-professional Consultant Level Practice Capability and Impact Framework shaped framework capabilities at consultant level.

Development of the Framework

Initial desk-based research scoped and collated a ‘library’ of multi- and uni-professional research capability frameworks (and similar) in England. Mapping these frameworks against the research pillars / elements of the capabilities established for entry, enhanced, advanced and consultant levels of practice. The initial draft of the Multi-professional Practice-based Research Capabilities Framework presented the reviewed, analysed and synthesised contents of 26 frameworks (see Appendix 3).  

A phased approach was taken to engagement to help refine the draft Framework.

Phase 1 (spring 2023) involved national leaders of the relevant professions in NHS England, Health Education England and the National Institute for Health and Care Research. Phase 2 (summer 2023) involved a broader group of stakeholders including:

• national professional leaders and representatives within NHS England
• the National Institute for Health and Care Research
• the Council of Deans of Health
• the Council of Allied Health Professions Research
•  the professional bodies for in-scope professional groups
• practitioners.

The first edition of the Multi-professional Practice-based Research Capabilities Framework considered all feedback received. Every effort was made to ensure the Framework is inclusive of as many professions as possible. A glossary of key terms is provided at Appendix 5.

Overview of structure and domains

Figure 2 shows the Framework capabilities organised into eight non-hierarchical, inter-related domains. The domains align with the evidence, research and development pillar of practice. They are to be interpreted in relation to individual roles, employment contexts and relevant professional and regulatory standards. Within each domain are a range of capabilities spanning the four levels of practice (see Figure 3). The number of capabilities within a domain has no bearing on its relative ‘importance’.  The capabilities identified within each level of practice build on, and incorporate, those that precede it.

Figure 2: Eight capability domains

Figure 3: Four levels of practice

Outlining the eight capability domains

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Footnotes

[1] Support workers, senior support workers, technicians, assistants, assistant practitioners and associate practitioners work with and alongside the health and care professionals and in those disciplinary areas, playing an important and growing role in delivering of safe and effective care for people accessing health and care services and wider communities.

[2] Fraser S. & Greenhalgh T. (2001) Coping with complexity: educating for capability. British Medical Journal 323, 799–803.

[3] McGee P, Inman C Eds (2019) Advanced practice in healthcare: dynamic developments in nursing and allied health professions. 4th ed. Chichester: John Wiley & Sons.

[4] Brunner et al (2018) An eHealth capabilities framework for graduates and health professionals: Mixed-methods study. Journal of Medical Internet Research 20(5), DOI: 10.2196/10229

[5] Leary (2022) The Principles of Enhanced Level Practice

[6] Support workers, senior support workers, technicians, assistants, assistant practitioners and associate practitioners work with and alongside the health and care professionals and in those disciplinary areas, playing an important and growing role in delivering of safe and effective care for people accessing health and care services and wider communities.

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