I’m doing a job that didn’t exist ten years ago. I think I’m doing a job that barely exists anywhere outside our little island, but its existence has parallels elsewhere around the world.
I’m talking about the non-medical advanced practitioners and in my case, with a paramedic background. Such advanced practitioners hail from a number of professional backgrounds, educated to masters level and working with a level of independence, accountability and depth only previously experienced by our medical colleagues. Typically, these clinicians are independent prescribers. They usually see patients unsupervised, diagnosing and devising treatment plans. Whilst, of course, with recourse for advice from medical and non medical colleagues, these encounters are typically autonomous.
In recent years, nearly all the non medical, “allied” professional backgrounds have become represented in this growing cohort of the healthcare workforce. Since 2017, the term we are encouraged to use to describe these clinicians is Advanced Clinical Practitioner (ACP). The national education body for the NHS in England (Health Education England) has described a framework for ACPs including 38 generic competencies. These competencies do not define clinical practice, but outline the behaviours across the four pillars of advanced clinical practice. These four pillars are:
education of self and others
leadership and management
An ACP would be expected to have elements of all four pillars of practice within their job role. It is widely accepted that most ACPs will have job plans that sit mostly in the clinical practice pillar, but this framework provides a mechanism for the cohort to grow to be increasingly self supporting. The numbers of advanced practitioners has been growing in the last decade and currently has significant momentum. A search for advanced practice roles on a the NHS’ own job website will reveal many new positions. This is mostly noted in certain services, with acute, urgent and emergency care services being most consistently amongst the early adopters of this role.
The Royal College of Emergency Medicine (RCEM) is a leader in this field. As well as requiring its ACPs to have a masters in a relevant subject, RCEM has introduced a credentialing of competence process. There are remarkable similarities between these competencies and those required of its medical trainees. Other medical colleges have also introduced some form of credentialing but many practitioners’ competencies and governance remains solely between them and their employers.
Aspirant ACPs will commonly be a number of years post registration and the most successful applicants for trainee posts will already have developed some enhanced or specialist scope of practice beyond that of initial registrants, and will be able to demonstrate the ability to succeed at masters level education. Such practitioners are described as “senior” or “specialist” level. For examples, as described here for UK nurses, and here for UK paramedics. Trainee ACPs will undergo a development process in parallel to completion of the relevant masters degree.
Inevitably, there has been mixed responses to the cohort of non medical advanced practitioners. It will be for those of us working in these roles to earn the trust of our colleagues and carve a niche for ourselves in the increasingly complex healthcare workforce.
This piece has intentionally shied away from the debates regarding the rights and wrongs of ACPs and the perceived drivers for this innovation. I neither accept nor reject the place of Physicians’ Associates in this cohort as their innovation occurs in parallel and their niche(s) in the healthcare workforce remain in equally early stages of development.
One thing is certain: any review of the healthcare workforce at the end of the next decade may be predicted to be radically different to one written in 2019, and on a personal level I have no idea what I will be doing. I feel a sense of optimism about the prospect to be able to assist in contributing to the definition of my job description and work plan.