AHP Advanced Practice in Scotland

Chris RowleyAHP Workforce and Education LeadScottish Government

AHPs have been brilliant!

Rapid local development of new roles to benefit patients

• Consistency

• Confusion

• Portability

AHP Directors Scotland Group

Lack of an underpinning national infrastructure for AHP Advanced Practitioners means that at present there is a ceiling effect to the potential impact these roles have nationally.

Background to Transforming NMAHP Roles

•Advanced Practitioners have been identified as essential in supporting increased capacity and capability within the health and care workforce in Scotland

•A national approach to Advanced Practice (AP) is a key strand of Transforming Roles

Transforming NMAHP Roles

CNO

Transforming

NMaHP Roles

PG Education & Development

Group

Physicians Associates

Children, Young People and

Families

Leadership Team

• Short Life Working Groups

General Practice Nursing

Specialist Nursing

Advanced Practice

AP AHP

AP MW

AHP ADV Practice Group

Oct 18, Dec 18, Feb 19, Apr 19, Aug 19, Sep 19, Dec 19

Ensure Nationally Consistent

Sustainable and Progressive Roles

Education and Career Pathways

Work at pace

• Good understanding of Advanced Practice

• Need to cover all professions

• Build on what we have, Don’t reinvent the wheel

• Capture existing roles

• Enable role development

• Sustainable

• Future proof

Practitioner Advanced PracticeSenior/Specialist

Practitioner

Graduation

Consultant

Consolidation of practice

2 years

Fast-Track to Advanced Practice

AP Development

Consultant pathway

Clinical Academic & Research Pathway

Senior Practitioner

Practitioner Senior Practitioner

Advanced Practitioner

• Definition (Level of practice)

• Competence (Knowledge Skills and Behaviours KSBs)

• Job description and pay

• National data

• Education & CPD

• Authority and Accountability

• Evaluation

Methodology

Definitions

ANP, NES group, UK - Sub group-developed own.

• Senior Practice

• Advanced Practice

• Consultant Practice

And recognised that practice at any level can be Generalist or Specialist

Consultant AHP Practice

• Consultant level AHP practice builds directly on the attributes of advanced AHP practice.

• It is underpinned by doctoral-level learning (not necessarily a doctoral-level qualification) and spans the four pillars of practice. It involves exercising a wide sphere of influence at local/regional, national and international levels, within and beyond the practitioner’s profession, and that is founded on the practitioner’s clinical expertise. It involves demonstrating and leading clinical excellence; exercising strategic leadership and initiating quality improvements and systems developments; facilitating others’ learning and development; and contributing to knowledge creation, dissemination and implementation.

• It is characterised by the capacity to manage high levels of complexity, uncertainty, unpredictability and risk through critical thinking and problem-solving, and to initiate and lead innovative approaches at service and system levels to optimise people’s experiences and outcomes of care.

Advanced AHP Practice

• Advanced level AHP practice is delivered by experienced, registered practitioners who have progressed their knowledge, skills and behaviours beyond those required for senior AHP practice.

• It is underpinned by a Master’s level award, or equivalent evidence of learning, that encompasses the four pillars of clinical practice, leadership and management, education and research, and leads to the demonstration of core and area-specific capabilities relevant to scope of practice and role.

• It is characterised by a high degree of autonomy in practice and the ability to make decisions independently. It is manifested in the ability to analyse complex problems in a range of contexts and settings; the synthesis and interpretation of information (including that which is incomplete or ambiguous, and relating to the evidence base); the management of risk; and the formulation and progression of new approaches to service delivery to enhance people’s experiences and outcomes of care.

Senior AHP Practice• Senior level AHP practice involves the critical application of professional

knowledge and skills. • It is underpinned and informed by experience and learning gained through

activity and professional development as a registered practitioner. Its focus is on contributing to developing and delivering services within a particular sphere of practice; e.g. relating to a particular population/patient group, individuals presenting with a particular health condition(s), patient pathway, healthcare environment, or broad intervention approach. It involves the deepening of professional knowledge and skills in a particular, specialist area, or the deepening of professional knowledge and skills to meet needs across a wide service area.

• It is characterised by the capability and confidence to practise independently and as part of a multi-professional team; active engagement in service evaluation and improvement; and contributing to team leadership and others’ learning.

Competency

Competency?, NES, UK, Post Registration Career Development Framework (PRCDF) much copied,

Use NES KSBs and seek an update.

http://www.careerframework.nes.scot.nhs.uk/

That the generic PRCDF KSBs and Role Specific KSBs be used to underpin the definitions.

Role Specific KSBs need to be set by an appropriate role specific national group.

Advanced practitioners will be expected to demonstrate:

• All of the Role Specific Clinical KSBs

• All of the Generic Clinical KSBs

• At least 1 of the Generic Facilitation of Learning KSBs *

• At least 1 of the Generic Leadership KSBs *

• At least 1 of the Generic Evidence Research and Development KSBs

• *Although 1 is the minimum on these three pillars Advanced practitioners must be able to demonstrate at least 8 KSBs spread across these three pillars.

Variation

Pilots

• Advanced MSK Focussed Practitioner in Primary Care

• Advanced Practitioner Unscheduled Care

• Advanced Practitioner Reporting Radiography

• National Groups of Clinical Experts

• Primary / Secondary care / Multi -Professional

Pilots outcome

• Got KSBs at speed

• Variance

• Style

• Level of practice

• Detail

• No method for assessing people against them

Pilots learning

• Role Specific Representative National Groups (RSRNG)

• Develop KSBs and sign off criteria

• Clinical Experts

• HEIs guidance about Level of practice and assessment

• Professional Bodies Guidance about Scope of practice

• Written Guidance on KSB development

• Buddy to set Direction and make links to others

• Validation or independent check on level of practice

Pay and Job Descriptions

• KSBs for Senior Practice min of level 6 on career framework

• KSBs for Advanced Practice min of level 7 on career framework

• KSBs for Consultant Practice min level 8 on the career Framework

• Generic core job description based on the KSBs

• Boards may choose to tailor the JD

• Additional KSBs may attract more pay

• Lack of routine data. Who does what where?

• Staff to be recorded on SWISS /eESS. level, area, role

• Current and potential Future needs?

• Service Needs Analysis, (SNAs)

• Learning Gap?

• Learning Needs Analysis (LNAs)

Data

MSK USC RR

• SNAs 14 boards 10 4 8

• How many 84.06 16.62 25.6

• Year 1 46.27 4 16

• Year 2 44.7 6 10

• Year 3 32 8 7

• Year 4 15 6 6

Pilot SNA Data

LNAs sent to all staff included in the SNAs

Detailed Overview of services provided.

Rich data on Impact on service some formal studies

Clear statements on the support required

Other comments, limit on RR sessions delivered due to lack of backfill

MSK USC RR

• How many 84.06 16.62 25.6

• Returns 42 8 20

• Response rate 50% 48% 80%

Pilot Data

• KSB document will include potential descriptors of the service.

• Consistent language eg part time wte

• Use input masks to ensure consistent data entry eg wte

• National cipher number to be allocated and recorded on completion of sign off.

Data learning

Education & CPD

SNA data = Scenario planning

LNA data = NES map to resources

Identified National Gaps may mean National commissioning

More multi-professional learning

Next steps

Formally take forward the pilot roles in 2019/20 to RSRNG

AHP Transforming Roles Publication

NES mapping educational resources for the Pilots

Electronic Publication for each Advanced role developed

Nationally agreed Role Specific Knowledge Skills Behaviours

Where to access training and support

Evidence to support role impact

Next stepsSupport Validation and Sign-off National, Regionally, Board

A single validation route for AHP KSBs

Single set of sign off documentation for AHPs

Enable recording on HR systems

Develop processes for Consultant and Senior Practice

What will the difference be to AHPs

• Visible, consistent national roles

• Access to training

• Ability to spread valuable roles quickly

• Easier for any board to pick a role off a shelf

• Easier to transition between employers

• Proper career pathways

• Succession planning

chris.rowley@gov.scot

Questions