The National Health Service (NHS) was established in 1948 to provide patients residing in the United Kingdom (UK) with effective healthcare based on their individual needs and not the ability to pay. The NHS is respected across the globe for the quality of care provided to all communities within the UK. This quality of care is reliant upon the commitment, compassion and expertise of the healthcare staff that work throughout the organisation. Within recent years, the capacity of the NHS to provide unparalleled patient care has been placed under pressure. Such pressure may be ascribed to tight financial constraints, issues surrounding workforce volume and demanding work patterns, for example.

Consequently, the Advanced Clinical Practice (ACP) role has been devised and developed in order to help mitigate workforce pressures and enhance patient safety and quality of care. The ACP role requires those healthcare practitioners involved to work to their full potential and to optimise the general response to the needs of the population served (i.e. by engaging across the multidisciplinary team and the family and friend network of the patient involved). This model has now been rolled out across all settings such as primary and community care, acute and mental health services plus those patients diagnosed with learning disabilities. Innovative models of care are critical for effective project execution and as a result healthcare professionals have developed themselves in conjunction with education providers (i.e. Higher Education) to meet increasing requirements of patients, families and communities as a whole.

As detailed by Health Education England (HEE), the ACP role involves those practitioners who come from a range of clinical backgrounds such as Nursing, Pharmacy, Paramedic Practice, Physiotherapy, Midwifery and plus other Allied Healthcare. ACPs are professionals that are educated to Master's level and have developed the skills, knowledge and attributes to enable the delivery of expanded roles and scope of practice. As such, ACPs are expertly trained and have a great deal of experience behind them to support clinical decision making and highly efficacious prescribing for their patients. The advanced level of training allows for the ACP to have a greater level of autonomy and clinical decision-making capability as compared to other healthcare professionals who have not undertaken such training.

All ACPs work towards the ‘Multi-professional Framework for Advanced Clinical Practice in England’ and this model includes the ‘Four Pillars’; namely, Clinical Practice, Leadership and Management, Education and Research; all are directly applicable to specialist competencies. These aspects must be clearly demonstrated during the assessment and evaluation process (e.g. at university) and vary dependent on the profession, role, population group, setting and sector of practice. In brief, the Clinical Practice element involves the delivery of healthcare that is compliant with the intended role whilst adhering to professional guidelines throughout (i.e. prescription dispensing). In terms of Leadership and Management, the individual must positively initiate and foster successful relationships, with clarity in roles central to support productive working and project delivery in the healthcare setting. Whilst the Education and Research components demand consideration of self plus team learning needs and engagement with research activity to augment clinical service delivery (i.e. quality, safety and value for money).

Taking the Pharmacist as an example, the Advanced Practice Pharmacist (APP) role signifies the next step in the evolution of Primary Care Clinical Pharmacy. Those APPs employed in a patient-facing, clinical role should be directly involved with the development and execution of new services (e.g. opiate deprescribing) in addition to undertaking audit (i.e. the use of GLP-1 agonists with reference to clinical guidelines). Approved APPs have the capacity to operate at a more developed level and undertake activities such as independent prescribing, clinical decision making plus leadership, management and research in their specialist clinical area. Community Pharmacists are well-placed to work as APPs within Primary Care as they have a sound understanding of patient care / self-care and can counsel patients is a readily understandable manner. The experience of managing common acute conditions can be developed by exposure to additional training (i.e. advanced diabetes or musculoskeletal training) thus enabling effective medicines use and related medicines optimisation.

A number of pathways exist to achieve ACP status for Pharmacists and Allied Healthcare Professionals:

Pathway 1

Undertake Health Education England (HEE) accredited Advanced Clinical Practice programme at university (e.g. Master's Degree at Level 7).

Pathway 2

Undertake and Advanced Pharmacy Practice programme from an accredited provider or Higher Education Institution.

Pathway 3

Undertake a commissioned Continuing Professional Development (CPD) unit (i.e. CPD modules from an approved provider or university).

There are several considerations that the individual (e.g. Community Pharmacists / Nurses) must bear in mind before embarking on ACP training:

Entry level ACP roles are NHS Agenda for Change, typically Band 7 or 8a.
The ACP role is one for those individuals who want to expand their scope of practice. That is to say, ACPs should ideally have prior exposure to community, hospital and primary care rotations.
The individual should be comfortable in dealing with change (i.e. moving from less experienced to expert) and with this enjoyment should be gained from learning new ideas / topics each day.
To work as an ACP, a Master’s degree is essential and with that there is an expectation that the healthcare professional will expand their scope of practice to prove competence in Clinical Practice, Leadership and Management plus Education and Research.

The ACP role clearly allows for the delivery of cutting-edge, autonomous working practices within the NHS and beyond (e.g. The Priory Group). Here, healthcare professionals holding the ACP qualification can support aspects such as prescribing medicine with related advice, conducting complex medicine reviews with patients and service delivery review (i.e. audit). Those skills acquired during training within Higher Education, for example, allow for the safe and effective clinical management of patients without the need to refer to other local practitioners thus saving consultation time and valuable resources.

The future certainly looks bright for ACPs with new opportunities developing rapidly as the timeline progresses. Naturally, this fresh approach to healthcare will ultimately be of great benefit to the patient population by ensuring the early and accurate diagnosis of disease with related therapeutic management.

How we can help here at www.pharmascholar.co.uk:

1. Clinical Practice – Bespoke clinical discussions and help with prescription writing.

2. Leadership & Management – Discussion around how best to manage self / teams.

3. Education – Consideration of study skills to enhance your personal development.

4. Research – Support with the quality improvement project (i.e. direction / writing).

Contact Dr Davies via mike@pharmascholar.co.uk today to book your slot.

The ACP can Support with Healthcare Provision within the NHS and Beyond