Midwifery: Capability Framework published November 2022

Introduction

The NHS England (formally Health Education England) Maternity Workforce Strategy (2019) highlighted the complexity and number of services provided in maternity care. To support population health needs there is recognition of the requirement for new roles and possibly new levels of practice within midwifery to support ways of working within the transformation of maternity services. An Advanced Clinical Practice in Midwifery Capabilities Framework has been produced to enable the development of these role in midwifery.

What is Advanced Clinical Practice?

The definition of Advanced Clinical Practice is provided by NHS England.

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 masters 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.

This definition therefore requires that health and care professionals working at the level of advanced practice will exercise decision making in the context of complexity, uncertainty, and varying levels of risk, holding accountability for decisions made.

The Centre for Advancing Practice supports individuals and organisations using the Multi-professional framework for Advanced Clinical Practice in England (2017) It provides standardisation for programmes of education that support underpinning to advanced clinical practitioners. It also supports those already practising at higher levels to gain recognition through a portfolio route. The framework is based on four pillars that uphold this level of practice (Figure 1).

The framework describes requirements for those claiming Advanced Clinical Practice status as follows:

Although developed to demonstrate the level of practice across multiple professions there has been a movement in several disciplines to create further specific capabilities or clinical competencies. Before considering Advanced Clinical Practice in midwifery, it is important that there is clarity about the role of the midwife and how the proficiencies described at the point of registration can be developed through education and training from registered practitioner, through enhanced level to advanced level and then to consultant level practice to ensure career development.

Findings from the Deep Dive Report into Advanced Clinical Practice in Midwifery

A literature review conducted by the University of East Anglia demonstrated there is limited international consensus on Advanced Clinical Practice in Midwifery (Goemeas 2018) and international literature specific to midwifery is sparse (Casey 2017) because the number of midwives who hold advanced practice in the title of their posts is small. Whilst there appears to be a range of clinical specialist roles in the profession. In Australia there was recognition of advanced midwifery practice in 2009 but the Australian College of Midwives stated that advanced practice was an illustration of midwives working within their full scope of practice and not advanced skill level (Smith et al 2010). However, in 2009 the Royal College of Midwives recognised advanced capabilities when it described 4 areas of responsibility for consultant midwives i.e.: expert clinical practice; clinical and professional leadership; research and education; practice and service development. There is potential for confusion created by role titles including specialist midwife, advanced practice midwife or advanced midwife practitioner and consultant midwife and it is important to remember that advanced practice is a level of expertise rather than a role title. 

The Irish studies (Begley et al 2013; O’Connor et al, 2018; Casey et al 2019) described mainly roles held by clinical specialist midwives and these roles incorporated many elements of advanced practice including facilitating education for multi-disciplinary teams, co-ordinating research, leadership of care including complex care as well as publishing and dissemination of research and evaluative studies. These studies collectively formed a body of evidence which informed the development of the standards for advanced practice in Midwifery by National Board for Nursing and Midwifery, Ireland (NMBI 2018). Casey et al (2017) conducted a rapid review of 86 papers which mainly focused on Advanced Clinical Practice in nursing, with only limited evidence of midwifery advanced or specialist roles drawn from earlier work by Begley and colleagues in Dublin. Advanced Clinical Practice roles in midwifery in Ireland now span primary care, and acute settings.  The competencies described by the NMBI include the following broad areas: using advanced assessment and intervention strategies; using research when making clinical decisions; analysing complex interactions; guiding decision-making; and developing client focused care. There is recognition even within the standards document that governance, leadership and infrastructure are needed to implement and support the roles in organisations. The need for an educational pathway with support from higher education and employers is also highlighted to ensure sustainability.

The Deep Dive report into midwifery Advanced Clinical Practice in 2021  identified confusion about how the level of practice might be used in maternity organisations. The confusion limited the access to programmes of education for midwives to complete Advanced Clinical Practice education. The transformation agenda has however created an opportunity for service redesign, and we found that some services were providing opportunities for midwives to practise at this advanced level to provide services to meet local population need. Routes into Advanced Clinical Practice in Midwifery were unclear, however.

The report also included a mapping exercise in which NMC Standards of Proficiency for Midwives were mapped against the Multi-professional framework for Advanced Clinical Practice in England (2017), to test the theory that midwives practise at advanced level from point of registration. (Appendix 1)

The argument that midwives are already working at Advanced Clinical Practice level was captured in the data from HOM/DOMS and consultant midwives within the Deep Dive report. The specialist midwives and advanced clinical practitioners we spoke to were clear that the higher level of practice in their roles required further clinical skills development acquired through a combination of advanced level study and higher-level capabilities in leadership, management, education and research. We conducted an exercise mapping the NMC (2009, 2019) midwifery standards to the Multi-professional framework for Advanced Clinical Practice in England (2017) to identify where the NMC standards might enable practitioners to meet Advanced Clinical Practice levels of practice and where there were gaps. The level of practice and skills described in the proficiencies are designed as the point at which midwives enter the professional register.

The NMC 2009 standards for competence for midwives, states that midwives should be autonomous practitioners and lead care for women experiencing normal childbirth. The 2019 NMC Standards of proficiency for Midwives document provides a very detailed account of the expected role of the midwife based on the Lancet definition of midwifery and framework for quality maternal and newborn care as described earlier. We took account of the following passage from preamble in the 2019 standards, describing the scope of the midwife:

Critical thinking, problem solving, positive role modelling, and leadership development are fundamental components of safe and effective midwifery practice. Midwives play a leading role in enabling effective management and team working, promoting continuous improvement, and encouraging a learning culture. Midwives recognise their own strengths, as well as the strengths of others. They take responsibility for their own continuing professional development and know how they can contribute to others’ development and education, including students and colleagues.

They have the ability to develop in their careers in directions that can include practice, education, research, management, leadership, and policy settings. They continue to develop and refine their knowledge, skills, resourcefulness, flexibility and strength, self-care, critical and strategic thinking, emotional intelligence, and leadership skills throughout their career

This passage indicates clearly that within the scope of midwifery practice there is opportunity for midwives to develop their skills and knowledge in a range of directions. While the midwife is recognised as the ‘lead professional for care and support of women and newborn infants’, the standards suggest that there is room for development and growth across the career span of a midwife. So, the proficiencies therefore act as a baseline and do not, in any way, restrict development. It seems to indicate that development can take place across any or all of the four domains of advanced practice.

The list of proficiencies in the 2019 document is long and detailed, explicating skills and knowledge required at the point of registration. In the mapping exercise we explored in detail the language used to describe the proficiencies when mapping against the Multi-professional framework for Advanced Clinical Practice in England (2017). We have used a Red, Amber, Green approach to indicate where the proficiencies do not match, partially match or match (Table 4). We recognise that this mapping exercise is not an exact science and midwives working in different organisations will have opportunities to use different skills set. We drew on our experience as educators to consider the proficiencies at the point of registration.

Some proficiencies stated the midwife should demonstrate skills whilst others suggested that they need to have knowledge, rather than specific skills. For example, although the 2019 standards suggest that registrants will have knowledge to support prescribing, they will not have the skills to prescribe medicines until they have completed all the requirements in practice supported by evidence. Therefore, although they can give lifestyle advice, and supply some drugs under midwifery exemptions they do not meet the advanced practice level of assessing, diagnosing and prescribing i.e.

Initiate, evaluate and modify a range of interventions which may include prescribing medicines, therapies, lifestyle advice and care.

As a consequence, we rated this as amber in table 4. Indicating that the Advanced Clinical Practice attribute is partially fulfilled by the 2019 proficiencies. It was clear that many of the clinical attributes in the Multi-professional framework for Advanced Clinical Practice in England (2017) could be met by midwives, at least to some extent, particularly those who will in the future graduate with the proficiencies in the latest NMC standards.

Many of the management and leadership, research and education attributes in HEE’s (2017) Multi-professional framework for Advanced Clinical Practice in England will require exposure, experience and education to enable midwives to work at the required level. Following analysis, it seems clear that the Multi-professional framework for Advanced Clinical Practice in England (2017) is suitable for midwives to use in developing the skills and knowledge to reach the Advanced Clinical Practice level within the scope of midwifery.

The mapping exercise (Appendix 1) showed gaps in the proficiency standards when mapped against the the Multi-professional framework for Advanced Clinical Practice in England (2017), demonstrating there was room for growth and development in midwifery careers to reach Advanced Clinical Practice level. The report clearly demonstrated that Advanced Clinical Practice is a level of practice that is beyond that of the qualified midwife at the point of registration. It is not a single definable job role as the roles undertaken by advanced clinical practitioners vary according to the service and population need.

We made recommendations for the development of a career and education pathway to support employers and midwives and this capability framework is the first step in that process. Subsequently University of East Anglia was commissioned to develop a two-stage project with the aim of firstly developing a capability framework for Advanced Clinical Practice in Midwifery and second to produce an education and career pathway framework document for HEIs and Employers. This report details the development and outcomes of the Midwifery Capability Framework for Advanced Clinical Practice in Midwifery.

Preparing the capability framework for Advanced Clinical Practice in Midwifery

The work on developing a capability framework for Advanced Clinical Practice in Midwifery began in January 2022. The team of academic midwives from University of East Anglia was commissioned to develop the capability framework for Advanced Clinical Practice in Midwifery and to follow up with a career and education pathway.  The process undertaken to produce the capability framework was as follows, with the key aim to agree a set of capabilities for a midwifery specific Advanced Clinical Practice framework to enable interpretation of the Multi-professional framework for Advanced Clinical Practice in England (2017) through a midwifery prism.

Initiation

• Desktop exercise examining NMC Standards of Proficiency for Midwives (2019), the Multi-professional framework for Advanced Clinical Practice in England (2017) discipline specific advance practice frameworks e.g. Primary Care, Mental health
• Use of the quality framework for maternal and newborn health (Renfrew, McFadden, Bastos, Campbell et al. 2014) to assist with incorporating midwifery specific language into capability statements

Stage 1:

Members of the national steering group for Advanced Clinical Practice in Midwifery and Health Education England (now NHS England) Task and Finish groups for Midwifery capabilities were invited to take part in workshops. They were able to invite others with relevant expertise such as employers and experienced Advanced Clinical Practitioners in Midwifery.

Two workshops were held

Workshop 1 identified, key attributes and values associated with the higher level of practice in midwifery. Mentimenter was used for values statements and attributes. This enabled creation of a word cloud.

The project team created a Padlet as an online tool for capturing thoughts and discussion using the four pillars of advanced practice and the quality framework for maternal and newborn health to act as guide. Participants inputted ideas during and after workshops.

Stage 2:

• Data analysis was conducted by UEA project team
• Capability statements were created and presented to Health Education England (now NHS England) task and finish group
• Further discussion in the task and finish group related to the NMC proficiencies and it became clear that we needed to enable users of the capability statements to understand if and how the statements related to or built upon the Standards of Proficiency for Midwives.
• A framework to explain the relationship to NMC proficiencies for midwives and the Multi-professional framework for Advanced Clinical Practice in England (2017) was created
• The final statement list was tested with the National steering group for Advanced Clinical Practice in Midwifery, refined and agreed.

Participants in workshop 1 included Advanced Clinical Practitioners, Consultant Midwives, Leaders in Midwifery practice, Nursing and Midwifery Council, Royal College of Midwives, Lead Midwives for Education from Higher education Policy, came together online to discuss the key attributes of Advanced Clinical Practice from a midwifery perspective and to explore the capabilities of a Midwifery Advanced Clinical Practitioner. Service user perspectives were provided by testimonies brought by those working in advanced practice roles.

Values and Attributes

To capture the values and attributes that are associated with an Advanced Clinical Practitioner in Midwifery a mentimeter was used and all participants provided 3 words or phrases. The data provided is shown within Figure 2.

It is clear from the values and attributes provided, that those working as an advanced clinical practitioner in midwifery will be required to work across all 4 framework pillars provided by the Multi-professional framework for Advanced Clinical Practice in England (2017), i.e. Clinical Practice, Leadership and Management, Education and Research (Figure 4). 

Throughout the workshops we used the Multi-professional framework for Advanced Clinical Practice in England (2017) and the NMC standards of Proficiency for Midwives as a guide to aid discussions. It was important to keep in mind the proficiencies expected of all midwives and consider how these might develop with education, experience, skills training and leadership mentoring. The workshops took place as online discussion forums in which debate and discourse was encouraged to reach a point of consensus through repeated meetings. However not all meetings included the same attendees therefore there were points of discussion which were revisited on a number of occasions.

The UEA project team devised a Padlet to record the workshop participant’s comments, thoughts and opinions by linking the Multi-professional framework for Advanced Clinical Practice in England (2017) capabilities to the framework for maternal and newborn care (Renfrew et al 2014), thus allowing midwifery language, values and priorities to be incorporated into the developing midwifery Advanced Clinical Practice capabilities. During these discussions attention was regularly brought back to the Standards of Proficiency for Midwives NMC (2019). It was recognised that the Advanced Clinical Practice capabilities would originate from the NMC proficiencies building upon them to ensure midwives working at advanced level are demonstrating capabilities complementing the multi-professional framework with a clear focus on the population they serve.

[Midwives] have the ability to develop in their careers in directions that can include practice, education, research, management, leadership, and policy settings. They continue to develop and refine their knowledge, skills, resourcefulness, flexibility and strength, self-care, critical and strategic thinking, emotional intelligence, and leadership skills throughout their career (NMC 2019 p4).

The three requisites for Advanced Clinical Practice in Midwifery are shown in Figure 3:

1. Registration as a midwife on the NMC Register
2. The generic capabilities identified across the four pillars of Advanced Clinical Practice, as defined in the Multi-professional framework for Advanced Clinical Practice in England (2017) namely Clinical, leadership and management, education, research.
3. The Advanced Clinical Practice in Midwifery core capabilities

The following capability statements show, where applicable, the origins of the skills and knowledge within the NMC standards of Proficiency for Midwives. The Advanced Clinical Practice in Midwifery Core Capabilities will be reached through formal education and training in the clinical environment supported by a structured programme and mentorship building on this baseline proficiency standard. New levels of skill and competence in decision making will be demonstrated and assessed as part of a programme of development ensuring that all four pillars of advanced practice form part of the performance of the Advanced Clinical Practitioner in Midwifery.

Advanced Clinical Practice in Midwifery  Core Capabilities

Having developed expanded levels of knowledge and skills that enable midwives to perform at a higher level of practice. Advanced Clinical Practitioners in Midwifery will demonstrate the following midwifery specific capabilities within their scope of practice and professional registration.

These core capabilities for Advanced Clinical Practice in Midwifery, with The Multi-professional framework for Advanced Clinical Practice in England (2017) are recommended as the outcomes for education and portfolio assessments of midwifery advanced practice. They should be used to develop education programmes and to plan assessments. through their integration within the ‘generic’ requirements of advanced practice

Considerations for employers

The Multi-professional framework for Advanced Clinical Practice in England (2017) provides guidance for employers on governance of advanced practice roles including the following key aspects.

Managers and clinicians should work together to identify where Advanced Clinical Practice can support pathways of care, having maximum impact. Development of roles which require Advanced Clinical Practice capability must be in response to local population need with a view to improving quality and outcomes of care pathways. Examples of roles that have been developed are contained in the scoping review report. These were created in response to identified need to provide particular care pathways. The need for particular care pathways and roles will vary across organisations and populations.

Roles requiring Advanced Clinical Practice capabilities should have a clear purpose and objective and defined sphere with adequate planned support for the role. In planning workforce managers and clinicians should work together to ensure the supply and succession planning of appropriately skilled individuals.  Where some individual practitioners are working to a higher level, other practitioners may require support to increase their levels of skills and knowledge. Discussions with local HEIs should support the workforce planning and ensure education is accessible to enable individuals to progress to advanced practice through clear pathways  Advice on education and career planning should also be available to practitioners who have a desire to develop. Development of this kind may support retention of staff in organisations. 

Where new roles are implemented, evaluation that includes impact on service user experience and care outcomes will provide valuable evidence of the benefits or otherwise of the roles in care pathways.

Four key principles are outlined in the multi-professional framework that are important considerations for all maternity organisations planning for advanced practice roles in new service development.

Routes to Advanced Clinical Practice in Midwifery

An important element of any workforce planning needs to be education and career development. There was evidence in the Deep Dive report (HEE 2021) that newly qualified midwives aspired to develop their clinical knowledge and skills, along with research, education and leadership and management capabilities, to work at the level of advanced practice.

Some midwives in specialist clinical roles had developed high levels of capability and knowledge in one medical condition, its support and management, and had clearly gained higher level capability in the clinical pillar but had not accessed education and training to develop the other pillars i.e., Management and Leadership, Research and Education. This level of practice could fit the criteria for enhanced practice^[1].

Those already practising at higher level and who hold education at Master’s level as outlined in The Multi-professional framework for Advanced Clinical Practice in England (2017)may be able to gain recognition through the HEE Centre’s ePortfolio (supported) route.

To support employers, educators and individual midwives a framework is being created to support midwifery career development from newly qualified midwife to consultant midwife. The framework will aim to signpost routes and education required for each stage of the journey.

References

Begley, C; Elliott, N; Lalor, J; Coyne, I; Higgins, A; Comiskey, C.M (2013) Differences between clinical specialist and advanced practitioner clinical practice, leadership, and research roles, responsibilities, and perceived outcomes (the SCAPE study) Journal of Advanced Nursing Vol. 69 Issue 6, pp. 1323–1337, 2013.

Casey , O’Connor L, Cashin A, Smith R, O’Brien D,  Nicholson E, O’Leary D, Fealy G, McNamara M,   Glasgow M E, Stokes D,  Egan C  (2017) Review the outcomes and impact of specialist and advanced practice nursing practice on quality of care cost and access to services. Nurse Education Today 56,  35-40

Casey M, O’Connor L, Cashin A, Fealy G, Smith R, O’Brien D, Stokes D, McNamara M, O’Leary D, Glasgow M E. (2019) Enablers and challenges to advanced nursing and midwifery practice roles J Nurs Manag  2019. 27, 271 – 277

Cumberledge J ( 2016) National Maternity Review. Better Births: Improving outcomes of maternity services in England. NHS England

Gaskell L, Beaton S. (2015) Developing clinical competency: experiences and perceptions of advanced midwifery practitioners in training. Nurse Education in Practice 15 266 – 270

Goemaes R, Shaw J, Beeckham D, Decoene E, Verhaeghe S, Van Hecke A (2018) Factors influencing the implementation of advanced midwife practitioners in healthcare settings: a qualitative study. Midwifery 66 88 – 96

Health Education England (2019) Maternity Workforce Strategy – Transforming the Maternity Workforce. https://www.hee.nhs.uk/our-work/maternity/maternity-workforcetransformation-strategy

The Multi-professional framework for Advanced Clinical Practice in England (2017) https://advanced-practice.hee.nhs.uk/

O’Connor L, Casey M, Smith R,  Fealy G,  O’Brien D,  O’Leary D, Stokes D, McNamara M, Glasgow M E,  Cashin A (2018) The universal and collaborative and dynamic model of specialist and advanced nursing practice: a way forward? J Clin Nurs  27 e882-894

Smith R, Leap N, Homer C (2010) Advanced Midwifery Practice or advancing midwifery practice Women and Birth 23 117 – 120

Renfrew, McFadden, Bastos, Campbell et al. (2014). Framework for quality maternal and newborn health. The Lancet 384, 1129-1145

Van Hecke A. Goemaes R, Verhaeghe S, Beyer W, , Decoene E,  Beeckham D (2019) Leadership in Nursing and midwifery: activities and associated competencies of advanced practice nurses and midwives. J Nurs management 2019 27 1261 – 1274

Appendix 1: Mapping of NMC proficiencies against the Multi-professional framework for Advanced Clinical Practice in England (2017)

Red (R)	NMC proficiency statements do not meet criteria for  Advanced Clinical Practice
Amber (A)	NMC Proficiency statements partially meet criteria for  Advanced Clinical Practice
Green (G)	NMC statements meet criteria for Advanced Clinical Practice

The Multi-professional framework for Advanced Clinical Practice in England (2017)

1 Clinical Practice. Health and care professionals working at the level of Advanced Clinical Practice should be able to:	NMC 2019
1.1 Practise in compliance with their respective code of professional conduct and within their scope of practice, being responsible and accountable for their decisions, actions and omissions at this level of practice.	G
1.2 Demonstrate a critical understanding of their broadened level of responsibility and autonomy and the limits of own competence and professional scope of practice, including when working with complexity, risk, uncertainty and incomplete information.	G
1.3 Act on professional judgement about when to seek help, demonstrating critical reflection on own practice, self-awareness, emotional intelligence, and openness to change.	G
1.4 Work in partnership with individuals, families and carers, using a range of assessment methods as appropriate (e.g., of history-taking; holistic assessment; identifying risk factors; mental health assessments; requesting, undertaking and/or interpreting diagnostic tests; and conducting health needs assessments).	G
1.5 Demonstrate effective communication skills, supporting people in making decisions, planning care or seeking to make positive changes, using Health Education England’s framework to promote personcentred approaches in health and care.	A
1.6 Use expertise and decision-making skills to inform clinical reasoning approaches when dealing with differentiated and undifferentiated individual presentations and complex situations, synthesising information from multiple sources to make appropriate, evidence-based judgements and/or diagnoses.	A

1 Clinical Practice. Health and care professionals working at the level of Advanced Clinical Practice should be able to:	NMC 2019
1.7 Initiate, evaluate and modify a range of interventions which may include prescribing medicines, therapies, lifestyle advice and care.	A
1.8 Exercise professional judgement to manage risk appropriately, especially where there may be complex and unpredictable events and supporting teams to do likewise to ensure safety of individuals, families and carers.	G
1.9 Work collaboratively with an appropriate range of multi-agency and inter-professional resources, developing, maintaining and evaluating links to manage risk and issues across organisations and settings.	G
1.10 Act as a clinical role model/advocate for developing and delivering care that is responsive to changing requirements, informed by an understanding of local population health needs, agencies and networks.	G
1.11 Evidence the underpinning subject-specific competencies i.e., knowledge, skills and behaviours relevant to the role setting and scope, and demonstrate application of the capabilities to these, in an approach that is appropriate to the individual role, setting and scope.	G
2. Leadership and Management. Health and care professionals working at the level of Advanced Clinical Practice should be able to:	NMC 2019
2.1 Pro-actively initiate and develop effective relationships, fostering clarity of roles within teams, to encourage productive working.	A
2.2 Role model the values of their organisation/place of work, demonstrating a person-centred approach to service delivery and development.	A
2.3 Evaluate own practice, and participate in multi-disciplinary service and team evaluation, demonstrating the impact of Advanced Clinical Practice on service function and effectiveness, and quality (i.e., outcomes of care, experience and safety).	R
2.4 Actively engage in peer review to inform own and other’s practice, formulating and implementing strategies to act on learning and make improvements.	R
2.5 Lead new practice and service redesign solutions in response to feedback, evaluation and need, working across boundaries and broadening sphere of influence.	R
2.6 Actively seek feedback and involvement from individuals, families, carers, communities and colleagues in the co-production of service improvements.	R

2. Leadership and Management. Health and care professionals working at the level of Advanced Clinical Practice should be able to:	NMC 2019
2.7 Critically apply advanced clinical expertise in appropriate faciliatory ways to provide consultancy across professional and service boundaries, influencing clinical practice to enhance quality, reduce unwarranted variation and promote the sharing and adoption of best practice.	R
2.8 Demonstrate team leadership, resilience and determination, managing situations that are unfamiliar, complex or unpredictable and seeking to build confidence in others.	R
2.9 Continually develop practice in response to changing population health need, engaging in horizon scanning for future developments (e.g., impacts of genomics, new treatments and changing social challenges).	R
2.10 Demonstrate receptiveness to challenge and preparedness to constructively challenge others, escalating concerns that affect individuals’, families’, carers’, communities’ and colleagues’ safety and well-being when necessary.	A
2.11 Negotiate an individual scope of practice within legal, ethical, professional and organisational policies, governance and procedures, with a focus on managing risk and upholding safety.	A
3. Education. Health and care professionals working at the level of Advanced Clinical Practice should be able to:	NMC 2019
3.1 Critically assess and address own learning needs, negotiating a personal development plan that reflects the breadth of ongoing professional development across the four pillars of Advanced Clinical Practice.	A
3.2 Engage in self-directed learning, critically reflecting to maximise clinical skills and knowledge, as well as own potential to lead and develop both care and services.	G
3.3 Engage with, appraise and respond to individuals’ motivation, development stage and capacity, working collaboratively to support health literacy and empower individuals to participate in decisions about their care and to maximise their health and well-being.	G
3.4 Advocate for and contribute to a culture of organisational learning to inspire future and existing staff.	R
3.5 Facilitate collaboration of the wider team and support peer review processes to identify individual and team learning.	R

3. Education. Health and care professionals working at the level of Advanced Clinical Practice should be able to:	NMC 2019
3.6 Identify further developmental needs for the individual and the wider team and supporting them to address these.	R
3.7 Supporting the wider team to build capacity and capability through work-based and interprofessional learning, and the application of learning to practice	R
3.8 Act as a role model, educator, supervisor, coach and mentor, seeking to instill and develop the confidence of others.	A
4. Research. Health and care professionals working at the level of Advanced Clinical Practice should be able to:	NMC 2019
4.1 Critically engage in research activity, adhering to good research practice guidance, so that evidence-based strategies are developed and applied to enhance quality, safety, productivity and value for money.	R
4.2 Evaluate and audit own and others’ clinical practice, selecting and applying valid, reliable methods, then acting on the findings.	R
4.3 Critically appraise and synthesise the outcome of relevant research, evaluation and audit, using the results to underpin own practice and to inform that of others.	A
4.4 Take a critical approach to identify gaps in the evidence base and its application to practice, alerting appropriate individuals and organisations to these and how they might be addressed in a safe and pragmatic way.	R
4.5 Actively identify potential need for further research to strengthen evidence for best practice. This may involve acting as an educator, leader, innovator and contributor to research activity and/or seeking out and applying for research funding.	R
4.6 Develop and implement robust governance systems and systematic documentation processes, keeping the need for modifications under critical review.	R
4.7 Disseminate best practice research findings and quality improvement projects through appropriate media and fora (e.g., presentations and peer review research publications).	A
4.8 Facilitate collaborative links between clinical practice and research through proactive engagement, networking with academic, clinical and other active researchers	R

Appendix 2: Glossary of Terms

Advanced clinical 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. (NHS HEE 2017)

Capability: Extent to which individuals can adapt to change, generate new knowledge and continue to improve their performance

Competency: Specific knowledge, skills and behaviour related to the clinical speciality of their advanced practice

Enhanced Clinical Practitioner: Enhanced Clinical Practitioners are qualified health and social care professionals who are working at an enhanced level of practice with specific knowledge and skills in a field of expertise. They manage a discrete aspect of a patient’s care within their current level of practice, which will be particular to a specific context, be it a client group, a skill set or an organisational context. This is in contrast to Advanced Clinical Practitioners who have developed their knowledge and skills to an advanced level of practice and would manage the whole episode of a patient’s clinical care, from the time they first present, through to the end of the episode. HASO Skills for health.org

Consultant- level practice: comprises four pillars: expert practice in the consultants own profession; strategic and enabling leadership; learning developing and improving across the system; research and innovation. The four pillars are underpinned by consultancy: the foundations for putting expertise in place across systems of health and social care. HEE (2020)

Midwifery definition:  Midwifery is defined in the series as: “Skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum throughout pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life. Core characteristics include optimising normal biological, psychological, social and cultural processes of reproduction and early life, timely prevention and management of complications, consultation with and referral to other services, respecting women’s individual circumstances and views, and working in partnership with women to strengthen women’s own capabilities to care for themselves and their families”. Lancet framework for maternal and neonatal.

Preceptor Midwife: Registrant midwife on a rotation to complete a development pathway of preceptorship which may be a minimum of 12 months full time or pro-rata. The midwife is expected to complete a set of competencies to meet the gateway for relevant banding. 

Registered Midwife: Person registered with the UK Nursing and Midwifery Council on midwifery part of the register. All midwives must meet the standards for midwifery proficiency (NMC 2019). To remain on the register, midwives must undertake revalidation every three years.

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