East of England advancing practice stakeholder guidance

Answer: Advanced practice is delivered by experienced, registered health care practitioners. It is a level of practice characterised by a high degree of autonomy and complex decision making. This is underpinned by a post graduate master’s level award or equivalent that encompasses the four pillars of clinical practice, leadership and management, education, and research, with demonstration of area specific clinical competence. The Multi-professional framework for advanced clinical practice in England provides a clear definition and consistent approach to the development of advanced practice across England. All health and care professionals working at the level of advanced practice should ensure that their knowledge and skills meet the standards outlined within the framework.

‘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’.

Diagram 1– The four pillars of advanced practice

Answer: No, advanced practice is quite different from specialist practice. Specialists are experts in their chosen clinical area, for example in diabetes or asthma care and have a depth of competencies in that specific area. Advanced practitioners have a breadth of competencies and capabilities that extend across the four pillars of advanced practice (clinical practice, leadership & management, education, research – see Diagram 1). It should however be noted that advanced practitioners may work in either generalist or specialist areas of practice and the two roles are therefore not mutually exclusive. Services may need both specialist and advanced practitioners to provide optimum care to patients.

The table in Appendix 1 gives a high-level overview of enhanced and advanced levels of practice.

Answer: A trainee advanced practitioner is an experienced healthcare professional employed in a funded training post specifically to undertake the required training to work at the level of advanced practice. The recommended training comprises of a NHS England Centre for Advancing Practice accredited MSc Advanced Practice programme (Level 7 study) and work-based learning to develop capabilities across the four pillars of the Multi-professional framework for advanced clinical practice in England.

Answer: Trainees are required to attend education provider teaching days, practise clinical skills in their workplace and complete work-place based assessments of capabilities. They will also need time to meet with supervisors regularly to plan their individual educational needs and monitor their progress. The requirements of supervisors are explained in more detail in the Workplace Supervision for Advanced Clinical Practice document. It is expected that each trainee will dedicate a proportion of time to independent study to become successful in achieving the qualification. The notional number of hours of study and teaching expected is approximately 100 hours per 10 academic credits (which includes both taught hours, work based learning, and independent study hours). However, the actual time spent may be more, or less, dependent on individual learners. It is therefore important for advanced practice trainees to have sufficient work-based learning time to develop their advanced skills.

Answer: For trainees on an MSc Advanced Practice programme, employers are expected to support the trainee(s) to meet the requirements of the programme as per the education provider requirements. The employer will need to provide the trainee with sufficient study leave and protected time for work-based learning per week. The education provider advanced practice programme lead will be able to provide information on the total amount of study days required. The employer will also need to ensure that the trainee advanced practitioner has an appropriate co-ordinating education supervisor and associate workplace supervisors.

Answer: The timetables and study time required will vary according to the training route and the specific education provider, but all trainees will need periods of study leave to attend their educational programme and will be required to produce course work, undertake work-based assessments and produce a portfolio of evidence. Trainees may also benefit from rotations or placements in other areas within the organisation to gain the required breadth of experience. 

Answer: For trainees on the apprenticeship programme, the apprentice will have off the job learning of a minimum of 6 hours per week, irrespective of the number of hours worked per week. Apprentices must be employed for a minimum of 30 hours per week. The Gov.UK apprenticeship funding rules can be found in more detail here. For trainees on direct-entry MSc Advanced Practice programmes, employers are expected to provide the trainee with sufficient study leave and protected time for work-based learning per week. The advanced practice programme lead will be able to provide information on the total amount of study days required.

Answer: For trainees on the apprenticeship programme a minimum of 30 hours per week is required. For direct-entry MSc Advanced Practice programmes, this will vary for each education provider, however, the general requirements is still usually 30 hours. If the employer is recruiting a new person as a trainee advanced practitioner, then it is suggested they are recruited on a minimum contract of 30 hours. For existing employees, if they work less than 30 hours per week, it is advised that you contact the relevant advanced practice programme lead at the education provider to discuss their suitability for the programme. 

Answer: If a practitioner already has the prescribing qualification, or it is not a requirement of their scope of practice then the education provider is likely to provide a choice of module(s) that the trainee can undertake instead and agree this with their employer. An independent prescribing qualification is not an essential requirement for an advanced practitioner, but the advanced practitioner job description may dictate that prescribing is necessary in a particular role.

Answer: Supervision is an essential element of training to be an advanced practitioner. If you have been asked to supervise a trainee advanced practitioner it is important to ensure you have the experience, knowledge and expertise to provide good quality supervision. The Advanced Practice Supervisor Capabilities set out the learning and development principles for practitioners who are supervising colleagues as they progress to advanced level practice. These resources should be considered in conjunction with the Centre for Advancing Practice supervision guidance and minimum standard documents.

Answer: Good workplace-based supervision is a key factor for successful completion of advanced practice training. Trainees who are not well supervised can struggle and some have failed to complete the programme. Each trainee advanced practitioner requires a named workplace co-ordinating educational supervisor, (with possible associate workplace supervisors depending upon trainee needs) who can undertake multi-professional supervision and is familiar with the learning requirements of advanced practice. Supervisors must have protected time in their job plan to support the trainee. Trainees will need time to meet their supervisor regularly to plan their individual educational needs and monitor their progress. National guidelines on advanced practice supervision can be accessed here.

Answer: 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. The development of advanced practice roles should be inextricably linked to workforce development plans, which identify where advanced practice will have the greatest benefit and impact in a person’s journey through health and care pathways. This will also highlight advanced practice roles that already exist or need to be developed in a way which meets population needs, and therefore service demand.

Within your organisation there may be staff already working:

• at advanced level but using different job titles
• with advanced level job titles but who are not meeting the principles and capabilities set out in the Multi-professional framework for advanced clinical practice in England.

We advise you work with your operations/clinical managers and workforce information team to identify what, if any, advanced practice workforce you currently have, and how they are currently being deployed. For governance reasons, it is important to review whether existing advanced practice staff are working to the minimum capabilities set out in the Multi-professional framework for advanced clinical practice in England.

Answer: The advanced practice lead in your organisation should be aware of staff currently working in advanced practice roles and should be able to help managers understand the need for these roles and how they will 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 needs. Job descriptions should be mapped to the Multi-professional framework for advanced clinical practice in England and job plans should support the four pillars of advanced practice. A generic advanced practice job description and person specification is available here.

The South West Faculty for Advancing Practice have produced the Advancing Practice in Emerging Areas Workforce Transformation Resource. This resource is designed to be implemented locally by Integrated Care Systems or organisations and aims to support and standardise the approach to workforce transformation for advanced practice in emerging areas.

Answer: The NHS Long Term Workforce Plan (2023) clearly articulates the continued drive to develop the advancing practice workforce as part of the multi-disciplinary team, recognising the impact these roles can have not only on improving patient care, but also increasing the number of senior clinical decision makers within the NHS to improve productivity and increase capacity. It acknowledges the role advanced practitioners will have in supporting and driving service transformation and developing new and innovative ways of working.  As well as the importance of retaining our experienced senior staff and enabling effective career development where staff feel valued, entrusted and have the knowledge, skills and ability to provide high quality, safe, effective care for our patients and their families.

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:

• Retaining valued, experienced staff who wish to remain clinically facing and still be able to advance their career thereby maximising clinical career progression opportunities. Realise the full scope of practice within and across each profession.
• Increase the focus on person-centred care, self-care, population health approaches and rehabilitation, keeping people at home, in work or school and as independent as possible.
• Improve continuity of care, discharge processes, and access to services.
• Increase capacity to supervise and develop the multi-professional workforce, to maximise scope of practice, service productivity and innovation.
• Support service redesign and transformation.
• Support teams to develop increased decision-making capability and capacity, including that required to delivery 24/7 services, improve patient/service user and carer satisfaction and associated outcomes.
• Reducing spend on temporary staff with increased safety, productivity, and value of investing in an organisations own staff.

Answer:

• Hold a current statutory professional healthcare registration.
• Extensive experience post registration and in the relevant specialty area (recommend a minimum of 3 years clinical experience post registration with a further 2 years within the specialty area).
• 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 for advanced practitioner.
• Any practitioner with limited degree level study will require discussion with the education provider to assess suitability to study at master’s level. Apprenticeship requirements also state the need for level 2 (GCSE or equivalent) maths and English.

Answer:

• Shortlisting and interview panel should as a minimum include a senior clinician, organisational advanced practice lead or equivalent and managerial representation. It may also be helpful to include education provider advanced practice programme leads within the recruitment process
• Review NHSE – East of England No More Tick Boxes (2021) section 3 ‘Putting a different approach into practice’ to ensure fair recruitment processes are followed
• Following selection, candidates may ask for feedback relating to their profile and/or performance at the 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 where additional training is required along with appropriate banding level, (if applicable)

Answer: As of 1 April 2024, all NHSE – East of England funding for advanced practice training for new trainees is in the form of a training grant paid directly to the employer. The funding options detailed in the table below are available for new advanced practice training funding applications (continuing trainees will remain on previously agreed funding models). Regardless of funding option, £2,600 of the total training grant paid each year must be used to support clinical supervision.

Table 1 – NHSE – East of England advanced practice funding options 

Answer: Currently, the Faculty are responsible for funding surgical care practitioner training. This is subject to change in future finance years; the funding options and the team responsible for this within NHSE – East of England may alter. The current funding option for new surgical care practitioner trainees is detailed in table below (continuing trainees will remain on previously agreed funding models).

Table 2 – NHSE – East of England surgical care practitioner funding options 

Answer: Only advanced practice programmes that will result in an MSc (level 7) award and have either been accredited by the NHSE Centre for Advancing Practice or map to the Multi-professional framework for advanced clinical practice in England will be funded by the Faculty.

The Faculty will consider funding programmes outside of region if in England, however a valid reason for not choosing a local education provider must be provided when applying for funding.

Answer: There are certain requirements that an employer, the advanced practice trainee and the preferred training programme must meet before a successful funding application can be submitted to the Faculty. Please refer to table 3.

Table 3 – Funding requirements

Answer: Advanced practice job roles are not funded by NHSE – East of England. Job roles should be funded from an employing organisation’s existing workforce budgets. In primary care, some qualified advanced practice roles can be funded via the Additional Roles Reimbursement Scheme (ARRS). Visit https://www.england.nhs.uk/gp/expanding-our-workforce/ for more information about the ARRS.

Answer: There are four core stages involved in the process of NHSE funding advanced practice training:

1. Organisations apply for funding based on indicative need (see Applying for funding)


2. NHSE communicates funding intentions to organisations (see Confirming funding)


3. Organisations confirm to NHSE actual funding need (see answer to Q 3.5)


4. NHSE confirms and releases funding to organisations (see Payment of funding)

These stages are illustrated in diagram 2 on the right with approximated timelines.

Diagram 2 – Funding stages

*Please see answer to Q 4.14 for further information

** Please see Q 4.16 for further information

Answer: Applications for advanced practice training funding are submitted to the Faculty via a specific Excel template.

Answer: The window to submit funding applications opens in February and closes in March of the same year.  This will occur yearly.  

Answer: In secondary care, an organisational advanced practice lead should be the only person within the organisation making applications for NHSE advanced practice training funding. Within primary care, the local primary care training hub lead submits funding applications on behalf of primary care organisations within their catchment.

Direct applications from trainees, line managers, GP practice managers or department leads will not be accepted by the Faculty. You will need to contact your organisation’s/primary care training hub’s advanced practice lead to express an interest. If you do not know how to contact your organisational advanced practice lead or primary care training hub please contact england.eoeapfaculty@nhs.net.

Answer: The organisation or primary care training hub will receive an email from england.eoeapfaculty@nhs.net which will contain:

• An electronic letter outlining the conditions of funding
• An Excel workbook which contains data on the funding has been indicatively agreed

Answer: Indicative funding for new advanced practice funding requests is usually confirmed in May each year.

Answer: No. When the Faculty agree indicative funding for new advanced practice trainees, the funding stated is conditional.  Organisations or primary care training hub must provide assurance to the Faculty that a trainee has successfully been recruited and will be starting their course on the date indicated in the application. To obtain this assurance, the Faculty require organisations and primary care training hubs to complete a funding utilisation return (see answer to Q 4.13) before funding will start to be paid to organisations and/or education providers.

Answer: Organisations and training hubs are required to complete a funding utilisation return before NHSE – East of England will start payments of funding. The return is made using the same Excel workbook sent from the Faculty to confirm funding (see answer to Q 4.10).

The Faculty requires assurance that a trainee has successfully been recruited and is ready to start their course on the date indicated on the funding application before prior to commencement of funding to organisations and/or education provider

Answer: This is dependent upon the agreed funding start date. This is outlined in the table below.

Table 4 – Funding utilisation return deadlines

Answer: NHSE – East of England pay advanced practice training funding through invoicing. Organisations and institutions who the Faculty have agreed to provide funding with will receive instructions on how much to invoice for and when to submit invoices in a document called the Education Funding Agreement (see NHSE East of England advanced practice training funding FAQ document here for further information).

Answer: Advanced practice funding is usually paid out in monthly instalments and NHSE – East of England will instruct organisations and institutions via the Education Funding Agreement to invoice in this pattern ((see NHSE East of England advanced practice training funding FAQ document here for further information). Once NHSE – East of England receives and approves an invoice for advanced practice training, the payment is made to the organisation or education provider within 3 business days.

Answer: It is imperative that the Faculty are informed of any changes that might impact payments for advanced practice training it has agreed to fund. If a change of circumstance happens before a trainee commences training, it is the responsibility of the employing organisation or primary care training hub to inform the Faculty – see answer to Q 4.13 for further instructions. Changes that happen after a trainee has already commenced training must be reported to the Faculty – see Trainee changes and funding for further instructions.

Answer: The trainee is required to complete and submit a notification of change form to the Faculty as soon as they know they will be withdrawing from the programme. The form must be countersigned by the trainee’s employer. The form can be downloaded from this webpage.

Where a trainee withdraws from a programme, funding that was being paid by NHSE – East of England to the employer or education provider will stop the month after their leave date. Funding will not be reinstated following a withdrawal.

Answer: The trainee is required to complete and submit a notification of change form to the Faculty as soon as they know when they will be pausing their programme. The Faculty need to know about any pauses to programme, including pauses related to sickness, paternity/maternity leave, career breaks, etc. The form will need to be countersigned by the trainee’s employer. The form can be downloaded from this webpage.

Where a trainee pauses programme, funding that was being paid by NHSE – East of England to the employer or education provider will stop the month after their pause date. Funding will be reinstated the month after their return date and the payment end date will be extended to account for the number of months payments missed due to the pause. For this reason, it is very important that the Faculty are informed of the trainee’s planned return date as soon as it is known, and if this cannot be provided on the original form an updated form should be submitted once the return date is known.

Answer: The trainee is required to complete and submit a notification of change form to the Faculty as soon as they know when they will be moving to their new employer. The form will need to be countersigned by the trainee’s current and new employer. The form can be downloaded from this webpage.

It is not guaranteed that NHSE funding will move with the trainee. Each notification of change form will be reviewed on a case-by-case basis.

Where a trainee moves to another employer within the East of England (and where the new employer is eligible to receive funding for advanced practice training, see answer to Q 4.4), their funding will stop being paid to the former employer and start being paid to the new employer the month after their contract end date. If funding was being paid to the education provider instead of the employer, the funding will continue to be paid to the education provider. See answer to Q 4.21 for advice on trainees moving to employers outside of the east of England.

Answer: The trainee is required to complete and submit a notification of change form to the Faculty as soon as they know when they will be moving to their new employer. The form will need to be countersigned by the trainee’s current and new employer. The form can be downloaded from this webpage.  The Faculty will share the completed form with the NHSE Regional Faculty for Advancing Practice responsible for trainee’s new region.

Where a trainee moves to another employer outside theEast of England, funding from NHSE – East of England will stop the month after the contract end date at their current employer. There is no guarantee that NHSE funding will continue after this date; currently each NHSE region’s funding rules differ for advanced practice training and the NHSE Regional Faculty for Advancing Practice within the trainee’s new region will decide whether the trainee and their new employer are eligible for continued funding.

Answer: If a trainee needs to delay the start of their training programme the trainee is required to inform their employer as soon as possible. The employer will then need to inform the Faculty of this change by completing the utilisation return (see answer to Q 4.13 for further instructions). A notification of change form is not needed in cases where a trainee delays the start of their programme.

Answer: The trainee is required to complete and submit a notification of change form to the Faculty as soon as they know when they will be moving to their new education provider. The form will need to be countersigned by the trainee’s current and new employer. The form can be downloaded from this webpage. 

It is not guaranteed that NHSE funding will move to the new education provider. Each notification of change form will be reviewed on a case-by-case basis. If a trainee moves to a new advanced practice programme that is ineligible for NHSE – East of England’s funding (see answer to Q 4.4), funding will stop the month after the trainee moves to the new programme and funding will not be reinstated.

If the trainee moves to an eligible programme, funding will continue after the move date but who is being paid may change depending on the specific scenario. See diagram below for further information. If a new education provider does not recognise the module credits completed at the previous university and requires the trainee to repeat or complete additional modules, NHSE will not provide additional funding above what has already been agreed.

Funding payment changes when a trainee moves university

Answer: This is an online survey that the Faculty sends directly to all trainees on advanced practice programmes that it is providing funding for. The purpose of the survey is to monitor the progression of trainees to ensure that funding payments reflect actual trainee activity. The survey also collects demographic data about trainees so that NHSE can monitor the level of equality, diversity and inclusivity of the advanced practice trainees it is funding.

Answer: The exact date the survey is sent changes annually, but the month remains the same. The survey is first sent when a trainee starts their programme, and sent subsequently each year whilst they are active students. See diagram for further information.

Timeline of when trainee monitoring survey

Answer: Each time the survey is sent (see answer to Q 4.25) trainees will be given 6 weeks to complete the survey. The survey takes on average no longer than 10 minutes to complete. If the survey is not completed by the trainee within the outlined timeframe NHS England funding will cease.

Answer: This is a government tax paid by employers who have an annual pay bill of more than £3 million. Payment of the levy creates a funding pot that can be accessed by the organisation to pay apprenticeship training costs for their staff. The funding pot created is held in a digital account that an organisation uses to manage payments to universities. For secondary care organisations that pay the apprenticeship levy your organisation will have an apprenticeship lead who you can contact about using the levy to fund an advanced practice apprenticeship programme.

Organisations that do not pay the apprenticeship levy (e.g., primary care organisations), you can organise a transfer from a willing levy-paying organisation.

Transfers can be supported by your local Integrated Care Board’s apprenticeship lead – please contact england.primarycare.eoe@nhs.net to obtain their contact details. Alternatively, organisations who are unable to arrange a levy transfer can have their apprenticeship training costs subsidised (95%) by the government. See here for more information.

Answer: Yes. NHSE – East of England will fund trainees on advanced practice apprenticeship programmes who meet the funding eligibility criteria (see answer to Q 4.5). 

Answer: A list of education providers offering MSc Advanced Practice programmes that NHSE-East of England will provide funding for can be found in Appendix 3.

Answer: Please see answer to Q 4.3.

Answer: This is an MSc programme certified by NHSE Centre for Advancing Practice that fully integrates all 38 capabilities from the Multi-professional framework for advanced clinical practice in England and meets NHSE’s Standards for Education and Training (2021).

The accreditation process was initiated by NHSE in 2020 to ensure that education providers in England offerconsistent and high–quality level of education for advanced practice trainees.

Completing an NHSE accredited advanced practice programme is one route for practitioners to gain recognition from NHSE. To find out which programmes have been accredited please visit https://advanced-practice.hee.nhs.uk/our-work/programme-accreditation/. An alternative route for experienced advanced practitioners to gain recognition is to undertake the NHSE e-Portfolio (supported) Route.

Answer: A direct-entry (non-apprenticeship) advanced practice MSc requires a trainee to apply directly to the education provider to register for the course. The trainee should have confirmation from their organisational/primary care training hub advanced practice lead that funding has been approved by NHSE. A trainee is required to complete 180 credits to be awarded an MSc.

An advanced practice degree apprenticeship requires the employing organisation to apply to the education provider. Unlike direct-entry programmes, employing organisations can use their apprenticeship levy (see Apprenticeship funding) to fund the trainee’s tuition costs. Apprenticeships require the employer, trainee and university to sign a commitment statement before the programme starts. A trainee is required to complete 180 credits to be awarded an MSc; this will include a mandatory end-point assessment (EPA).

Answer: Entry requirements for programmes can be found on each education provider website. The links to the webpages for local education providers in East of England can be found in Appendix 3.

Any questions about programme entry requirements, programme content, application process or individual modules should be referred directly to the education provider.

Answer: If funding is indicatively agreed by NHSE, the organisational or primary care training hub advanced practice lead should inform the trainee promptly. For direct-entry MSc programmes, the trainee is responsible for successfully applying to an education provider.  Apprenticeship programmes will require the employing organisation/training hub to initiate the application.  

Each education provider will have different application deadlines. Application deadlines for apprenticeship programmes tend to be shorter than direct-entry programmes. It is therefore important for trainees / employers to apply for a programme promptly after NHSE funding has been agreed.

Answer: Advanced practice MSc programmes are taught by lecturers and expert clinical practitioners who offer dedicated academic support and guidance. Trainees are allocated a named personal tutor. The education provider also offers comprehensive student support services as well as a dedicated librarian.

A guide for trainee support can be found in Appendix 4.

Answer: Please see answer to Q 4.18.

Answer: Please see answers to Q 4.20 and Q 4.21.

General principles

Trainees requiring support with education provider

There is an expectation for all advanced practice trainees to be proactive in managing their learning journey. This includes acting to manage and resolve problems that may occur during their training programme, with the support of their manager, supervisor, organisational/training hub advanced practice lead, MSc programme lead, and the NHS England – East of England Faculty for Advancing Practice.

The trainee must report to their line manager and organisation or training hub advanced practice lead immediately if they:

• intend to the leave the programme
• defer on assignments or need to resubmit assignments. These may be education provider assignments or practice placement assignments, portfolios, skills, etc.
• have difficulties in attending required study days, and or are unable to attend
• are considering requesting a deferment, to intermit or pause on their programme

The line manager and advanced practice lead must report any of the above to the NHS England – East of England Faculty for Advancing Practice via england.eoeapfaculty@nhs.net within 7 days of being informed.

Trainees in receipt of NHS England funding who are planning a complete or temporary withdrawal from programme must report this immediately to NHS England via a notification of change form.

Trainees requiring support in placement areas

There is an expectation for all advanced practice trainees to be proactive in managing their learning journey. This includes acting to manage and resolve problems that may occur during training, with the support of their line manager, supervisor, organisational advanced practice lead, MSc programme lead, and the NHS England – East of England Faculty for Advancing Practice.