Centre for Advancing Practice Conference 2022 abstracts

02 January 2023
Volume 1 · Issue 0

In November 2022, Health Education England held a conference for advancing practice. Below are a sample of the abstracts submitted.

ABSTRACT 20          1ST PLACE

Advanced clinical practitioners expectations of the benefits in pursuing this role, and whether these are being realised

Vikki-Jo Scott

Introduction: A systematic literature review revealed gaps in the evidence base regarding the benefits of pursuing a career as an advanced clinical practitioner (ACP), particularly evidence that draws from the ACPs own perspectives. The results from research conducted to address this gap will be presented.

Aims: To establish what expectations ACPs hold regarding their role and to evaluate whether these are being realised, noting any factors that may influence this. The aim of this study is to better inform ACPs, potential ACPs and those individuals who provide advice, support, training and education to ACPs.

Methods: This mixed-method research fits within the pragmatic research paradigm. It uses a sequential and exploratory design with statistical and reflexive thematic analysis. Following a recruitment questionnaire that was distributed via social media, focus groups were undertaken to explore the expectations of ACPs and trainees. Following this, a questionnaire is being designed to evaluate if ACPs expectations are being realised.

Results: At the point of submitting this abstract, over 200 responses to the recruitment questionnaire had been received from a diverse range of ACPs and trainees.

Conclusions: In the UK, the ACP community is diverse. Using maximum variation sampling, the selection of participants for the focus groups is underway and will ensure a mixture of participants influence the key themes used in the design of the follow-up questionnaire. The focus groups are planned to take place in the summer of 2022 with release of the follow-up questionnaire in the autumn.

ABSTRACT 7           2ND PLACE

An advanced clinical practitioner-led post-discharge clinic for patients with decompensated liver cirrhosis

Scott Oakes and Carole Farrell

Introduction: Following an episode of decompensation, patients with liver cirrhosis are particularly susceptible to emergency readmission – an outcome associated with significant cost, morbidity and mortality.

Aims: To deliver an advanced clinical practitioner (ACP)-led post-discharge clinic for patients with decompensated liver cirrhosis, with the aim to reduce emergency readmissions.

Methods: Retrospective data from a large south Manchester teaching hospital over 3 months identified that 48% of patients discharged following an admission with decompensated liver cirrhosis were readmitted within 30 days. Following a service evaluation and literature review, an ACP-led post-discharge follow-up clinic was established for this patient cohort. All patients from the gastroenterology ward with a diagnosis of decompensated liver cirrhosis were offered an appointment within 2 weeks of discharge.

Results: Of the patients reviewed in the ACP-led post-discharge clinic over a 3-month period, only 18% were readmitted within 30 days, which demonstrates a 30% improvement.

Conclusions: Admission avoidance initiatives have gained significant traction in recent years. However, efforts have tended to focus on the start of the patient journey, with investment in services aimed at reducing the volume of admissions from the emergency department. For patients at high risk of emergency readmission, such as those with liver cirrhosis, emphasis may need to shift towards the later stages of the patient journey. ACPs may be appropriately placed to manage complex post-discharge care, providing timely clinical input that may prevent emergency readmission.

ABSTRACT 64          3RD PLACE

Expanding advanced clinical practitioner roles in acute medicine to improve lumbar puncture practice at a district general hospital in north-west England

Mary Diaz-Santos, Alaoye Foy Yamah and Nilu Bhadra

Introduction: Lumbar punctures (LPs) are crucial in diagnosing and managing acute headaches in secondary care. An audit of 417 patients admitted to an acute medical unit (AMU) with acute headaches from November 2020 to January 2021 revealed that 12% had a LP. These patients waited an average of 57 hours after brain imaging for an urgent LP. Variation of LP practice from current guidelines were linked to poor patient outcomes. These were associated with operational pressures on senior doctors and training deficiencies within the AMU. Extending advanced clinical practitioner (ACP) roles to include LP was linked to better patient access and outcomes.

Aims: To improve standards of LP practice in an AMU through the introduction of a LP training programme to include ACPs.

Methods: A total of three plan, do, study, act (PDSA) cycles were performed to improve the programme, establish governance for ACPs and monitor waiting time and variation in LP practice. Guidelines in LP practice were addressed in the training and reinforced by introducing a LP trolley in the unit. The number of LP attempts and feedback from patients and trainees were monitored to evaluate the impact of training.

Results: Data were gathered every 4 months, which showed consistent improvement in aspects of LP practice. An initial decrease in the percentage of successful first attempts was noted and associated with ACPs developing their skills for LPs. By the third PDSA cycle, a marked increase from baseline in successful first attempts was observed. A reduction in LP waiting time to an average of 33 hours was noted by 8 months.

Conclusions: Extending LP training to ACPs ensured the availability of staff to support senior doctors, resulting in a reduction in waiting times. Establishing expectations in LP practice in training led to improved standards of care and patient safety. However, the benefits of training depended on opportunities for clinical supervision, which required early engagement and commitment from senior doctors. As ACPs become competent in LPs, supervision roles can be assumed so that benefits of training are sustained.


Comparing sonographic measurements of malignant unifocal tumours with penumbra features against histology

Samantha West

Introduction: The accurate pre-operative measurement and assessment of breast cancer is essential, as it is used to determine the surgical management of patients with breast cancer. Breast tumour size at presentation is used to assist in the clinical, mammographical, sonographical and magnetic resonance imaging correlation. A pictorial review was conducted to determine if the measurement of the echogenic penumbra is more accurate when compared to measuring the nidus of the tumour against the gold standard histology. This review was also used to provide accurate information for the pre-treatment staging (TNM) of breast cancers and to help decide if neo-adjuvant therapy could be offered if tumour size dictates and if the tumour is responsive.

Aims: To review and compare the accuracy of sonographic images of breast tumours with the nidus and echogenic penumbra against the gold standard histological tumour size. The results will be compared to the literature to determine if there are any significant differences in accuracy, and, where possible, look at ways to improve the accuracy. This study will also review local protocol versus modern literature of measurement specifics, and the impact on the surgical pathway with the potential to change practice.

Methods: This retrospective study collected data from 1 March 2021 to 30 September 2021. Images were independently evaluated by three professionals (an advanced practitioner, consultant radiographer and consultant radiologist with varying experience), with the aim of increasing the overall validity. The ultrasound measurements of unifocal tumours with obvious echogenic penumbra were compared against histology measurements. Images of multifocal tumours, ductal carcinomas in situ, B3-lesions and asymmetries were excluded.

Conclusions: Measurements can be subjective as each operator may perceive the measurement differently, especially when measuring the penumbra of a tumour as it can be difficult to determine where the penumbra starts and finishes. The acoustic shadowing from dense tumours can also make the measurement of tumour size difficult and, therefore, less accurate. The accuracy mean measurement calculated in this study was within 5 mm of the histological size, which is the same parameters as the current literature. When the size of the penumbra is included in the overall measurement, neither the nidus measurement nor the penumbra measurement appears to be nearer the histological measurement. Therefore, the penumbra measurement is not an accurate measurement parameter when comparing it to the histological tumour dimension.


Assessment of patients' perceptions of the level of hygiene practice in ultrasound laboratories in Alimosho, a Local Government Area of Lagos State, Nigeria

Jamiu Isiaq, Gregory Mbum and Ademiji Olufadeju

Introduction: Good hospital and laboratory hygiene practice is vital for the prevention of healthcare associated infections (HCAI) in hospitals and clinics. Interventions to improve hygiene practice are based on cleaning the general hospital environment and the ultrasound equipment, and staff training.

Aims: To assess the perceptions of patients regarding the level of hygiene practice in ultrasound laboratories.

Methods: This was a cross-sectional survey conducted in five reputable diagnostic centres in Alimosho, a Local Government Area of Lagos State. A total of 200 patients were selected via a simple random sampling technique to participate in a self-administered questionnaire, and data were collected on important socio-demographic variables and the perception of patients on hygiene practices in ultrasound laboratories. The data were analysed using Statistical Package for the Social Sciences (SPSS) version 20.0.

Results: Of the respondents, 62% perceived the scan room and sonographer hygiene practice as neat. There was no statistically significant association between age, gender and perception of hygiene practices, as well as no statistically significant association between education and employment status and perception of hygiene practices. However, participants with tertiary education (64%) and employed participants (73%) were more likely to perceive the hygiene practices as neat compared to other participants. Those who underwent transabdominal examinations (pelvic, abdominal and obstetrics scans) were 73% more likely to rate the hygiene practices as neat or very neat compared to those who underwent other examinations.

Conclusions: The present study noted a moderate perception of good hygiene practice among the ultrasound laboratories surveyed. However, the perceived sonographer hand hygiene and transducer hygiene was perceived as poor. There was no significant association between patients' perception and age, gender, employment status, ethnicity or educational status. These findings show a need for improved hygiene practice in the ultrasound laboratories in Alimosho to ensure an improvement in general patient experience and trust in the services they use.


An exploration enquiry to determine the effectiveness of advanced practice physiotherapist roles in assessing patients with frailty in the emergency department

Jasmine Morris

Introduction: Physiotherapists working in advanced practice roles is a developing field. With an increase in patient attendances, particularly older patients with frailty, this could drive the change in the use of staffing.

Aims: To review the impact on time taken for the formulation of plans in the emergency department (ED) when patients with frailty are assessed by an advanced practice physiotherapist (APP), to assess whether significant time savings are made.

Methods: An experimental, comparative study (retrospective data collected from April–August 2020) between a control group assessed by an ED practitioner followed by a therapist versus an intervention group assessed by an APP was conducted in an ED within a district general hospital. The length of time for the completion of assessments and the time taken for plans to be formulated were reviewed.

Results: A total of 25 patients were included in the intervention group data. When APP reviewed patients, plans were formulated within an average of 123 minutes, compared to 255 minutes for the control group. This equates to a time saving of 3300 minutes (57.5 hours). In the control group, there was an average wait time of 107 minutes between ED clinician and therapy assessment, meaning an additional time saving of 2675 minutes (44.5 hours) was made with the APP assessment.

Conclusions: Benefits in reductions of practitioner time (57.5 hours from 114 hours worked) and reductions in duplication of work were identified. Although significant time-savings were noted, the definitive impact and experiential outcomes for patients is still unknown. Therefore, further investigation is warranted.


Acute frailty assessment unit: a 6-month qualitative study of readmissions within 28 days of discharge and collective case analysis

Carol Hart, Lorna Shadbolt and Michail Kaklamanos

Introduction: Readmissions can have a negative impact on the care of frail individuals in regards to increased length of hospital stay, healthcare-related harm, reduced quality of life and mortality. Review of frailty readmissions should lead to improvements of frailty care and clinical effectiveness.

Methods: A retrospective, qualitative analysis of readmissions of frail individuals discharged from an acute frailty unit (AFU) was conducted over a 6-month period. This is a collective case study in which instrumental cases were used to highlight specific learning points. The Electronic Patient Records database was used to measure the total number of readmissions related to AFU discharges. The framework methodology was then used to further analyse and cluster cases. Common themes linked to readmissions and the time-to-readmission were studied, leading to structured (SMART) quality improvement interventions.

Results: A total of 430 individuals were discharged from an AFU, with 89 (21%) readmitted within 28 days of index hospital admission. Of the 89 individuals, 50 (58%) were readmitted to hospital (any ward) with a different presenting complaint compared to index admission, 22 (25%) were readmitted with the same initial complaint, and nine (10%) experienced problems because of ineffective discharge planning. In eight (7%) cases, readmission was linked to healthcare-associated complications. Of the 89 readmitted individuals, 40 (45%) stayed at home for <7 days after their index discharge, while the remaining 49 (55%) returned to hospital after 7–28 days. Only eight (9%) readmissions were from care home settings. A bundle of SMART interventions have been developed, including post-discharge support with acute frailty clinics, enhanced frailty dietetic support and improved communication with community partners.

Conclusions: This collective case study shares important learnings related to the readmission patterns of AFUs. Individual case studies are essential in understanding the ways in which patient-centred care should be tailored to become more effective.


There will be blood (and full frozen plasma, cryoprecipitate and platelets)

Stephen Murphy

Advanced clinical practitioners (ACPs) have been working on Nottingham University Hospital's (NUH) cardiac intensive care unit (CICU) since 2003. By 2010, the service had evolved to a point where the ACPs were providing out-of-hours first-line medical care for level 2 and 3 patients without an onsite medical presence. However, it was unclear what would happen in the event of post-operative bleeding. It has been highlighted that there are no barriers to non-medics authorising the use of blood and blood components. However, a lack of recognised education resources and a clear model for how this would work in practice meant that getting this change recognised at NUH was difficult. The two factors that eventually brought about change on CICU, and recognition of non-medical blood and blood component authorisation by ACPs, were the development of an educational programme by NHS Blood and Transplant (NHSBT) and, specifically in the case of CICU, the use of point-of-care thromboelastography devices to differentiate between surgical and coagulopathic bleeding. These two factors have meant that the CICU ACPs have developed fully ratified local guidelines that allow them to authorise the use of packed red cells, full frozen plasma, cryoprecipitate and platelets for patients post cardiac surgery. A large scale audit took place in 2018 when this practice was introduced (at this point PRC-only authorisation), and now a further large scale audit is taking place since the ratification of further guidelines in March 2022 that support the non-medical authorisation of blood components.


Developing a pre-course workbook for advanced practice students in the UK

Angela Banks, Colette Henderson, Anna Jones, Jonathon Thomas and Melanie Rodgers

Introduction: Demand for multi-professional advanced practitioners has intensified, as demonstrated through the increased number of applications to programmes and advertised jobs. The Association of Advanced Practice Educators (AAPE UK) were approached by the Advanced Practice faculty of the University of Huddersfield and asked to invite advanced practice educators to collaborate on the development of a pre-advanced practice course workbook.

Aims: Through the AAPE UK, a number of educators from higher education institutions across the UK collectively agreed a need for trainee advanced practitioner student support. Development of a pre-course workbook would support students undertaking programmes of education. It was felt this workbook should focus on areas of concern, such as contextual understanding of advanced practice, anatomy and physiology knowledge, and critical writing skills.

Methods: Faculty from the four countries of the UK collaborated virtually to agree content and assign roles to develop the agreed content. These meetings and associated email communications enabled the development of the workbook. To encourage knowledge of and engagement with AAPE UK, the workbook is hosted on the AAPE UK website and students are given access to the workbook for a year.

Conclusions: This collaboration enabled faculty across the UK to work together and develop a UK wide resource. This method supports robust, proactive and aligned approaches to the development of advanced practice student resources. This virtual collaboration has supported the effective and efficient development of a UK wide resource and has led to agreement for future collaborations. An evaluation is in progress and the outcomes will be made available when finished.


Identifying areas of service improvement for same-day discharge patients attending acute oncology services

Michelle Gidlow, Clare Warnock and Tanya Urquhart-Kelly

Introduction: The management of acute oncology patients in a cancer setting can provide timely, safe and effective specialist care. However, little research has been undertaken relating to emergency day attenders who present acutely to a specialist oncology setting but do not require inpatient admission.

Aims: To evaluate current service needs for emergency day attenders to inform service development.

Methods: A service evaluation was undertaken in three assessment services within a regional cancer centre: an emergency assessment unit, rapid assessment clinic and an out of hours assessment service. A data collection tool was designed to capture data pertaining to length of stay, reasons for initial attendance and re-attendance, and acute oncology level of intervention. Data collection were completed between July and September 2020 with 229 patients identified for inclusion in the evaluation. Data were entered into SPSS and analysed using descriptive statistics.

Results: Data identified that urinary problems, pain and central venous access device (CVAD) issues each represented 8.8% of prevalent reasons of readmission. This corresponded with prevalent reasons for initial admission, with 20 patients attending with pain and CVAD issues, respectively. This provided insight into potential and proactive service interventions and advanced clinical practitioner lead initiatives.

Conclusions: The data collection tool proved an effective and structured means of identifying potential areas of service improvement. However, further research is required in a post-Covid-19 era to identify if patient needs have changed and to evaluate the impact of service improvements.


Acute frailty assessment unit in East Kent Hospitals University Foundation Trust: a 6-month qualitative study of readmissions within 28 days of discharge and collective case analysis

Lorna Shadbolt, Carol Hart, Michail Kaklamanos

Introduction: Readmissions can have a negative impact on the care of frail individuals in regards to increased length of stay, healthcare-related harm, reduced quality of life and mortality. Review of frailty readmissions should lead to improvements of frailty care and clinical effectiveness.

Methods: We conducted a retrospective, qualitative analysis of readmissions of frail individuals discharged from our Acute Frailty Unit (AFU) over a 6-month period. This is a collective case study in which we used instrumental cases to highlight specific learning points. We used the Electronic Patient Records database to measure the total number of readmissions related to AFU discharges. The Framework methodology was then utilised to further analyse and cluster cases. Common themes linked to readmissions and the time-to-readmission were studied, leading to structured (SMART) quality improvement interventions.

Results: Four hundred and thirty individuals were discharged from AFU. Eighty-nine (21%) were readmitted within 28 days of index hospital admission. Fifty-eight percent (50/89) of individuals were readmitted to hospital (any ward) with a different presenting complaint compared to index admission. Twenty-two (25%) cases were readmitted with the same initial complaint, while nine (10%) experienced problems due to ineffective discharge planning. In eight (7%) cases, readmission was linked to healthcare-associated complications. Forty (45%,40/89) individuals stayed at home for <7 days after their index discharge, whilst the remaining forty-nine (55%) returned to hospital after 7-28 days. Only eight (9%) readmissions were from care home settings. A bundle of SMART interventions has been developed, including post-discharge support with acute frailty clinics, enhanced frailty dietetic support and improved communication with community partners.

Conclusion: This collective case study shares important learnings related to the readmission patterns of acute frailty units. Individual case studies are essential in understanding the ways that patient-centred care should be tailored to become more effective.


What is the patients' preference on remote pre-assessment consultations, compared to face-to-face in the nurse-led immunotherapy clinic?

Alison Pass

Introduction: In March 2020, the worldwide pandemic changed the delivery of healthcare and in cancer care, patients were shielded from healthcare establishments to protect them from serious, if not life-threatening, illness. Consultations for the pre-treatment assessment moved from face-to-face consultations to remote and telephone consultations to prevent exposure to illness.

Aims: To establish if patients have a preference for remote monitoring as opposed to face-to-face monitoring.

Methods: A questionnaire was designed to ascertain the patients' preference towards remote pre-treatment assessment compared to face-to-face consultations in a nurse-led immunotherapy clinic. A sample of 20 patients who had been using the nurse-led service from January to August 2020, and, thus, had experienced the service before Covid-19, were invited to take part. In total, 18 of the invited 20 individuals agreed to take part in the study. Participants were telephoned by a clinician on a given date and time and asked the questions from the questionnaire. The participants responses were simultaneously recorded on an online system.

Results: The overall satisfaction of the patient group was between 64–88%, and, although the results evidenced areas of definite improvement, especially with convenience, the overarching feeling about whether patients preferred remote monitoring or face-to-face was inconclusive. However, the free-text box enabled a greater insight and highlighted that patients would like a mixture of face-to-face and remote monitoring. The use of technology was not completely rejected, as a few participants preferred the use of video. This service evaluation has enabled the researcher to have a better understanding of the patient group and how they have been affected by the consultation changes caused by the Covid-19 pandemic.

Conclusions: Patients' perceptions are valuable in healthcare as they allow clinicians a better understanding of how changes brought about impact their patients. This service evaluation highlighted that patients wanted a combination of modalities for their pre-assessment consultation. Although they were satisfied with the service delivery, they did not conclusively state that they were given a choice about how their pre-assessment consultation would happen and if they preferred to attend hospital or not. Therefore, additional research should further explore these choices.


Advanced clinical practitioner roles: a profile using job descriptions

Beverly Snaith, Claire Sutton, Liz Mosley and Sarah Partington

Introduction: The omni-professional advanced clinical practitioner (ACP) role is aligned to the medical speciality model and is designed to create clinical capacity, as well as new career paths beyond an individuals base registered profession. The limited evaluation of such roles has confirmed the variation in the implementation across specialities, geographical regions and settings.

Aims: To profile the ACP role using advertised roles and document sets. The objectives were to review ACP post opportunities, determine consistency in roles and establish whether roles are actually omni-professional.

Methods: ACP roles that were advertised on NHS Jobs (January–April 2021) were collated, and all relevant documents, including advert, job description (JD) and person specification (PS), were downloaded. Documentary analysis was undertaken using a coding framework that identified role title, employer (including location and type), speciality, pay, eligible professions (including required regulatory registration) and essential qualifications.

Results: In total, 143 unique posts were identified, including 44 trainee roles, across English acute, mental health, community, primary care, independent and charity sectors. Role titles varied, with some including alternative incorporating base profession options. Eligibility criteria were evident based on the background of potential applicants. Despite the generic titles and role descriptors, 11.2% were limited to nurse applicants. Pay variation was also noted, and, although the majority of posts were Band 8A, 19.2% of those using the agenda for change pay structure were advertised at Band 7.

Conclusions: Geographic and sector inclusion confirms the acceptance of these roles into mainstream healthcare. However, local implementation appears to be inconsistent with governance issues raised. The findings confirm that the omni-professional role is not as perceived by many individuals and may not be considered a career option to many.


The emerging role of the advanced clinical practitioner: the stakeholders vision shaping the clinical strategy

Sam Hancock and Sonia Grimashaw

Introduction: Many advanced clinical practitioners (ACPs) hold traditional medical roles. East Lancashire Hospitals Trust (ELHT) stroke therapy team and neurorehabilitation team have an occupational therapist and a physiotherapist undertaking a qualification in advanced clinical practice. The aim is for them to work together as ACPs to develop their roles within the teams and align their services. The role of the ACPs within the ELHT stroke and neurorehabilitation team will be unique and focus on rehabilitation within a community setting. It is crucial that the opinions of stakeholders help to shape how the ACP posts can incorporate aspects of the four pillars of clinical skills, leadership, research and education to enhance the care of the ELHT stroke and neurorehabilitation patients.

Method: Stakeholders of both services were asked for their ideas of how the ACP posts in stroke and neurorehabilitation can enhance the development of the teams and the clinical care of patients. Their thoughts and ideas were collected using an interactive ‘jamboard’.

Results: Stakeholders included the multi-disciplinary team, local and regional operational managers, consultants and consultant nurses, ward managers and university course leads. A total of 58 comments were received and were sorted into themes using an affinity diagram. The themes contributed to a vision of the ideas and expectations of the ACP role in stroke and neurorehabilitation and were aligned with the four pillars.

Conclusions: The aim is that a strategy is developed that represents the opinions of all stakeholders. The input from the stakeholders will help shape the clinical strategy and define the role of the ACP in stroke rehabilitation and neurorehabilitation.


Preventing hospital acquired pneumonia through quality improvement: introducing the COUGH care bundle

Jessica Murphy

Introduction: Hospital acquired pneumonia (HAP) has a significant burden on health and social care and is associated with increased morbidity, mortality, length of stay and healthcare costs. It is preventable through simple nursing interventions and encouragement of activities-of-daily-living. These high impact interventions are contained within the COUGH care bundle. An audit conducted over 1045 hospital bed days on the pilot ward, found an incidence of HAP 2.9 times greater than the national average. This equated to approximately £200 000 in additional costs and four avoidable deaths.

Aim: To introduce the COUGH care bundle, with a 70% adherence to the bundle within 3 months of implementation.

Methods: A quality improvement study using a model of change and evaluation was carried out on all patients admitted to a respiratory ward across 1045 hospital bed days. Patients admitted with a diagnosis of HAP were excluded. A total of 125 participants with an average age of 67 years (62.4% of whom were female) were included in this study.

Results: Throughout the pilot study there was an average compliance to the bundle of 87%, which resulted in an 85.6% reduction in incidence of HAP. This equated to an approximate cost avoidance of £170 000 and three lives saved.

Conclusions: HAP is preventable and should be escalated to the same level of concern as other healthcare-associated infections. However, the pilot ward used in this study became a Covid-19 positive ward. This meant a different cohort of patients between pre- and post-data were sampled, as well as the final sample size being small. Subsequently, causation could not be proven, only correlation.


Using a checklist improves team confidence in paediatric major trauma: an observational study

Marijke van Eerd

Introduction: Paediatric major trauma (MT) is often only a small section of mainstream trauma teaching, such as Advanced Trauma Life Support or European Trauma Course, with limited resources available. A bespoke checklist may improve the preparedness of trauma teams and reduce patient risk.

Aims: To develop and assess the impact of a dedicated paediatric MT checklist on clinician confidence in managing a paediatric trauma call.

Methods: An observational study between 4 April and 13 May 2022 was conducted in a UK major trauma centre. A dedicated checklist for a paediatric trauma call was developed. Medical and nursing trauma team members were invited to undertake simulation training and were surveyed on their degree of confidence in preparing for a paediatric trauma call before and after the introduction of the checklist. Scores were recorded on a Likert Scale (1–10) and compared using Mann-Whitney U tests. A P-value of <0.05 was considered statistically significant.

Results: There were 74 participants, including 19 (26%) registrars, 18 (24%) trainees, 11 (15%) advanced clinical practitioners and 26 (35%) nurses. There was a significant improvement in level of confidence after using the checklist, with median scores ranging from 7–9 in the second phase (P=<0.001).

Conclusion: Paediatric-specific guidance through the use of a dedicated checklist was associated with improvements in confidence among the study participants when managing a simulated paediatric MT. It is likely that this finding is translatable to clinical practice, and may enable clinicians to provide better care for paediatric patients and improve their outcomes.


Primary care indemnity themes promoting safety interventions

Ellen Nicholson, Anwar Khan and Alex Crowe

Introduction: Rising indemnity costs and the impact on general practice led to the introduction of a state-backed clinical negligence indemnity scheme for general practice (CNSGP) from April 2019. As secondary care was already a part of state indemnity, this could enable the investigation into pathways of care.

Aim: To classify and analyse the themes in order to understand the causes of claims occurring in general practice.

Methods: Claims data were collected from the NHS Resolution Claims Management System from 1 April 2019 to 31 March 2020.

Results: Clinical negligence claims associated with general practice accounted for 3.4% (401) of total new claims notified to NHS Resolution in the first year of the scheme. The audit evaluated open, closed and potential claims cases. The most frequent common case notifications were for diagnoses of cancer (9.3%), cardiac (7.3%) and sepsis (5.3%). Of these CNSGP cases, the most commonly reported causes were delay or failure to diagnose (43.5%), medication errors (18.5%) and delay or failure to refer (10%).

Conclusions: Many of these claims relate to systems, processes and communication issues that influence the delivery of effective care in primary care settings. The number of clinical negligence claims associated with general practice is expected to grow, as claims are often reported many years after the incident has taken place. This audit forms the basis of subsequent analyses that should identify trends to be addressed, with the aim of promoting patient safety by ensuring effective systems around healthcare are in place.


Implementing an advanced clinical practitioner training programme

Mark Dalton and Deborah Graham

Introduction: This project aimed to identify new ways of working to foster a more co-ordinated and unified approach to the existing advanced clinical practitioner (ACP) service within emergency medicine in an acute NHS Trust. All qualified and trainee ACPs, nurses and medical staff working within the emergency department were included in this study.

Aims: To explore, examine and evaluate the current ACP service within the emergency department of an NHS Trust.

Methods: Purposive sampling was used to recruit the study participants. One-on-one interviews, focus groups and clinical observations were then conducted. Thematic analyses was used to analyse the data.

Results: From the preliminary data, the main themes extracted from the one-on-one interviews were lack of leadership, lack of managerial supervision, lack of education and opportunities, and lack of role and personal development. The main themes extracted from the focus groups were a lack of educational investment, a lack of medical supervision and guidance, inclusivity in designing an on-going educational programme, and the identification of some core competencies.

Conclusions: The identified areas for improvement were the development of an on-going educational programme for all ACPs, trainees and physician associates, the development of a robust training model based on national guidelines surrounding ACP development and the development of a 3-year programme to compliment apprenticeship route. All ACP trainees are graded at agenda for change Band 7. Additional areas of improvement that were identified include an assessment and progress review, the target of yearly minimum standards, workplace based assessments, the outline of a supervision role and the responsibilities, an escalation plan, 19 core competencies, 24 clinical competencies and six procedural competencies. Since, this training model has been accepted by the Trust's executive team with the addition of in built supervision, rotational secondments and a full year of supernumerary practice for trainee ACPs. A total of 14 trainee ACPs are enrolled onto the programme and work across emergency and acute medicine, frailty, vascular, surgery and urology.


Professional identity and role transition of advanced practitioners: where do they fit in?

Kimberly Treverton

Introduction: Historically, advanced practice evolved as a ‘gap-filler’ for the shortage of medical staff. Today, advanced practice includes autonomous professionals who come from a multitude of backgrounds and add significant value to the current healthcare system. Preconceived notions about advanced practitioners (APs), combined with a lack of standardisation in terms of education and qualifications, have served to shape professional identity.

Aims: To identify factors that may affect AP professional identity and consider how the findings may influence AP professional identity and role transition going forward.

Methods: Using a systematic review methodology and thematic analysis, existing literature was reviewed and qualitative primary research studies about identity and role transition were explored. A total of 10 qualitative studies from the UK and Ireland were included in this review. Sample sizes ranged from 2–86 participants.

Results: From descriptive themes yielded from the studies, a main theme of professional identity was identified, along with three analytic themes of role transition, others' perceptions and role standardisation.

Conclusions: This review highlights several factors that affect role transition and the professional identity of APs. Some of the information is not new, but draws attention to what has and has not been achieved so far in addressing these concerns. The literature also considers how language and titles are used and the importance of these when discussing advanced practice.


Evaluation of an advanced practice primary care musculoskeletal training pathway for first contact physiotherapy practitioners

Catherine Carus, Paul Millington, Lisa Edwards, Beverly Snaith and Maryann Hardy

Introduction: The ‘First Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal) A Roadmap to Practice’ was launched in October 2020. The document provided a roadmap of education for practice when moving into first contact practitioner (FCP) roles. After a period of national dissemination and implementation, it was appropriate to evaluate and ascertain the experiences of those attempting to accredit to this standard, as well as those supporting these clinicians via the portfolio route.

Aims: To evaluate the journey and experiences of supervisors and supervisees through the FCP Primary Care Musculoskeletal (MSK) Roadmap using a mixed methods approach.

Methods: Online surveys and focus groups of retrospective and prospective learners, as well as supervisors were undertaken. A thematic analysis was used to delineate the emerging themes and trends from the dataset. Triangulation of the survey and focus group data was conducted.

Results: Focus groups and survey data described a challenge from both a supervisors' and supervisees' perspective. The supervisors' course was deemed inadequate, as was the ongoing support from the training provider (in terms of role preparation and implementation). Supervisees reported inconsistencies in the supervision received, both within and between the different organisations. They also found the Roadmap to Practice complex, overwhelming and onerous to navigate and complete.

Conclusions: Although participants were generally supportive of the intentions of the Roadmap, the operationalisation remains a challenge. This will require significant revisions from multiple perspectives for the Roadmap to be a viable and sustainable route into FCP roles.


The impact of hostel life on personality attributes of young adults: case study of a public sector university

Samina Rafique and Mariyam Waseem

Introduction: During the transitional period from adolescence to adulthood, significant changes occur in the personality and behaviour of the individual. This is mainly determined by genetics. However, transactions with the social environment also plays a role. Hence, adolescents living away from their family in hostels of higher educational institutes may be influenced by their environment.

Aims: To investigate the perception of female students about the environment of hostels and its impact on personality development.

Methods: A cross sectional survey was carried out in a public sector university using a questionnaire. The responses about the various effects of hostel life were measured on a 5 point Likert scale, and two groups were then created according to age and results dichotomised for statistical analysis. The chi-square test was applied for comparison among the two groups.

Results: Management skills were the most agreed characteristic (92%) achieved by hostelites. Expense management, emotional stability and public dealing were agreed upon by 86%, 85% and 86%, respectively. A total of 199 out of 272 respondents confessed to gaining confidence and 230 realised that they became more groomed. The results were significant (P=<.0001) for all study variables between the two groups. A few undesirable aspects of hostel life were also identified, yet a majority of the girls were not hesitant in recommending hostel residence to others.

Conclusions: Hostel residence, besides providing opportunity for higher education to the students of distant towns, can have a positive impact on the behaviour and personality of those individuals living there.


The role of trainee advanced clinical practitioners in supporting same day discharge across the emergency department and optimising occupational performance at home

Metian Sharon Parsanka and Racquel Tejada

Introduction: The Covid-19 pandemic noted a demand in delivering care. This was clinically reflected by an increased length of stay and the inappropriate admission of patients into hospital from the emergency department (ED) as a result of reduced community capacity to support same day discharges.

Aims: To develop an intermediate pathway between ED and the community to support same day discharges and reduce delays.

Methods: A one off visit was completed by the trainee advanced clinical practitioner (tACP) and occupational therapist (OT) to support same day discharges for ED patients (male and female aged between 82 and 99 years) who would otherwise be admitted to hospital because of reduced community capacity.

Results: In total, two plan, do, study, act (PDSA) cycles were completed over a 2-month period. Data were collected via key performance indicators: the number of patients discharged from the ED after the visit from the tACP, the number of patients brought back after the tACP visit and admitted (and the reasons for this), the number of patients re-admitted within 7 days after the tACP visit (and the reasons for this), and the number of patients not seen by a tACP because of staffing capacity. Data collected during the project found that a further 24 patients were appropriate for the service, but were not seen. These patients were admitted while medically fit, discharged with therapy input and had an average length of stay of 45 days.

Conclusions: The project demonstrated positive outcomes resulting to timely discharges, reducing length of stay and reducing unnecessary admissions. However, the outcome was limited by staffing capacity, which highlighted the need for additional PDSA cycles.


Impact of interprofessional learning on professional dynamics among healthcare professionals

Chukwuemeka Henry Elugwu

Introduction: Assessment of the impact of interprofessional learning (IPL) on professional dynamics among radiographers and other health professionals is very important for quality patient care management.

Methods: A prospective cross-sectional descriptive study was conducted in various healthcare departments at Federal Medical Centres and Federal Teaching Hospitals in southeast Nigeria, providing a sample size of 386 healthcare professionals. The new validated questionnaire ‘Interprofessional Learning Dynamic Scale (IPLDS)’ was used for this study. It contained 63 items with two sections: A and B. ‘A’ for socio-demographic data and ‘B’ for professionals' relationship, knowledge, readiness, perception and attitude towards IPL. Data were collected through simple random sampling and analysed descriptively using frequency tables, Spearman rank correlation, one-way ANOVA on rank and Tukey-Kramer honestly significant difference comparison.

Results: Of the respondents, 57.3% were female. Gender showed a significant positive relationship with teamwork, conflict resolution and prejudice (rank correlation coefficient (rs)=0.122; P=0.016). Discipline showed a significant negative relationship with teamwork, conflict resolution, prejudice (rs=-0.133; P=0.009), and communication (rs=-0.132; P=0.010). Previous experience of IPL showed a significant positive relationship with radiographers' ability to accommodate, collaborate, form teamwork, resolve conflict and communicate effectively with other healthcare professionals. Level of education had a negative significance with knowledge (rs=-0.192; P=0.0), readiness, perception and attitude towards IPL (rs=-0.299; P=0.0). This study also showed statistically significant differences among health professionals on their relationships (P=0.0), knowledge of (P=0.043), readiness for (P=0.0), and perception and attitude towards IPL (P=0.001).

Conclusions: Gender, discipline and level of education were of great influence on radiographers' relationship with other health professionals. This study demonstrates that IPL experience can positively strengthen team dynamics and prevent the transfer of negative stereotypes of disciplines into the workforce.


Is there a place for simulation in enhancing leadership skills in the clinical area? Views of trainee advanced nurse practitioners

Maura Sale

Introduction: The NHS has had to adapt and evolve to meet challenges in service provision. The changing face of the NHS is partly because of a growing and aging population, the existence of more long-term conditions and a reduction in junior doctor working hours. Supported by Health Education England, an advanced level of nursing practice was implemented to support these shortfalls in healthcare delivery. It is pivotal that workplace curricula are established to support the education and development of this level of practice. To date, there is paucity of evidence to suggest simulation as a pedagogical approach that supports the education and development of leadership skills at this level of nursing practice, and whether these skills are transferable to clinical practice.

Aims: To explore the benefits of simulation in enhancing trainee advanced nurse practitioner leadership skills and the transferability of these skills to clinical practice.

Methods: A qualitative research design informed by phenomenological methodology was used in this study. Over a 5-month period, trainee advanced nurse practitioners (ANPs) attended mandatory workplace simulation sessions that focused on leadership skills. Participants were recruited through purposive sampling from this group and invited to attend a virtual focus group 2 weeks after the final simulated session.

Results: A total of four themes were identified from the data: safety, motivation, acquisition of knowledge and confidence, and the transferability of skills to clinical practice.

Conclusions: Trainee ANPs believed simulated practice provided a safe space for learning, gave them the knowledge and confidence they required to lead on patient care and facilitated the transferability of these skills to clinical practice. It is recommended simulation should be used as a pedagogical approach to support the education and development of trainee ANPs. Further research is needed using different methodological approaches to objectively quantify the benefits of simulated learning in trainee ANP workplace curricula.


Prehabilitation in the non-surgical cancer pathway: a scoping review

Kelly Wade-Mcbane, Alex King, Catherine Urch and Julian Jeyasingh-Jacob

Introduction: Prehabilitation is used in surgical cancer pathways to optimise outcomes. However, 50–60% of patients within the UK are treated with chemotherapy and/or radiotherapy. Prehabilitation has the potential to increase the resilience to withstand anticipated treatment deconditioning. However, few prehabilitation pathways exist in the non-surgical field. Is there a role for prehabilitation in chemotherapy or radiotherapy?

Methods: A scoping review of empirical primary research was conducted. Online databases (n=3) from 2016–current were used. Prehabilitation was defined as either a uni-modal or multi-modal intervention including exercise, nutrition and/or psychosocial support within a home, community or hospital based setting. A synthesis matrix was used to extract the details for analysis.

Results: A total of 631 studies were identified. Of these, 109 full papers were retrieved and a total of 34 articles were included in this review. Positive outcomes in physical and psychological wellbeing for patients who followed a prehabilitation programme were identified in the 34 articles. Research gaps were identified in mixed methods and qualitative research.

Conclusions: Prehabilitation does have the potential to increase the resilience of a patients receiving chemotherapy or radiotherapy treatment to withstand anticipated treatment deconditioning. Future research should consider using a conceptual framework to conceptualise the living with and beyond cancer experience to help shape and inform personalised prehabilitation services.


Using advanced practice to develop a radiographer and nurse led on treatment review service

Rachel Rigby

Introduction: The advanced clinical practitioner (ACP) in radiotherapy on treatment review (OTR) contributed to service development and redesign with involvement in the recruitment and training of a review team, consisting of radiographers and a nurse. The review team has significantly increased the number of non-medical reviews offered and is contributing to modernising the radiotherapy service. With a newly established team and changes to traditional working practices, an evaluation was implemented to assess patient satisfaction with communication and interactions during OTR consultations with the review team.

Aims: To evaluate patient satisfaction with communication with the aim of improving the communication between patients and healthcare professionals. To improve the patient experience by encouraging patient participation to shape radiotherapy services, ensuring patients feel involved in their care, listened to and well informed.

Methods: Patients having OTR with the review team outside of the clinicians' sessions were the chosen cohort. The European Organization for Research and Treatment of Cancer Quality of Life (EORTC QOL) communication questionnaire (EORTC QLQ-COMU26) was used for data collection. The questionnaire was given to all patients during a specified time, and all questionnaire responses were anonymous. Data collection and analysis were undertaken by the ACP.

Results: The EORTC questionnaire uses six multi-item scales to assess responses based on behaviours and relationships. Scores are calculated from 0–100, with a high score indicating good communication. The results showed that all sections scored over 90, reflecting high levels of patient satisfaction across all multi-item scales.

Conclusions: A theme was identified from the lowest scoring results that related to checking the patients' understanding before and after delivering the information. These results were shared and used to formulate an action plan for further training and development within the review team to enhance communication.


Examining the impact of prescribing medication on the role identity of physiotherapists

Colin Waldock, Trudy Thomas, Julie Macinnes and Bijayendra Singh

Introduction: Physiotherapists have been able to undertake the role of prescribing since 2006 as supplementary prescribers and 2013 as independent prescribers. However, the number of prescribers among physiotherapists remains low. Research on the role identity of physiotherapists is limited, with no literature exploring the impact of being able to prescribe medication on the physiotherapist role. It is hoped that understanding what happens to physiotherapists when they become prescribers will help to determine how well prescribing fits with the profession.

Aims: To investigate the perceptions of three principle stakeholder groups (physiotherapists, members of the public and thought leaders) of the role identity of physiotherapists and the subsequent change to the role once able to prescribe medication. This study also aims to develop a theory of role identity change and evaluate the theory via a questionnaire distributed to the wider physiotherapy profession.

Methods: This study used a mixed methods approach incorporating a qualitative project (phase one), which was based on a constructive grounded theory and involved interviewing the three stakeholder groups, the development of the questionnaire (phase two), which was validated by expert groups and cognitive interviews, and the distribution of the questionnaire among physiotherapists (phase three).

Results: The interpretive analysis led to the development of a conceptual framework, suggesting that when physiotherapists undertake prescribing training there is a dynamic interplay between forces acting on the categories of evolving identity and imaging of physiotherapy. Phae three of this study is still in progress.

Conclusions: The outcomes of this study may be relevant to other professional groups undertaking or planning to undertake the role of prescribing medication.


Developing a therapeutic radiographer workforce strategy for career progression and succession planning for advanced practice roles

Claire Reynolds

Introduction: Within radiotherapy, role development has moved into advanced and consultant level practice. However, within these roles, and for those who wish to remain in a patient-facing treatment planning or delivery role, there has been a lack of defined career progression.

Aims: To work with radiographers to develop specialisms, which can be used to progress individual's careers as well as looking at succession planning for existing advanced clinical practice (ACP) and consultant roles.

Methods: Phase one of the project involved focus groups, in small numbers to facilitate discussion and ensure service delivery, with different staff groups. Data collection and analysis used the 4D model of appreciative inquiry, as well as ensuring alignment with organisational values and objectives. The current provision of specialist roles within regional and national radiotherapy departments was also investigated.

Results: The results from the focus groups developed ideas for specialisms for radiographers based on identifying a career with unlimited potential. Phase two of the study will involve scoping the provision of training for these specialisms and understanding how pathways and job descriptions could change based on the findings.

Conclusions: Frustration over a lack of clear career progression identified the need for this project. The outcomes of this project could be used to build cases for specialist practice, as well as look to build elements of the four domains of advanced practice into job descriptions for staff at all stages of their career. Therefore, this will allow for robust mechanisms of career progression and succession planning for advanced and consultant roles.


A pilot of advanced clinical practitioners' telephone triage to improve team efficiency, morale and service provision

Victoria Redfern

Introduction: Increased volume of emergency surgical activity placed immense pressure on the registrars, highlighting a need for change. A consultation exercise took place to discuss solutions, and the disruptive effect of the telephone was a consistent theme. This resulted in the trial of advanced clinical practitioners (ACPs) carrying the referral phone.

Aims: A pilot study exploring whether ACP triage of emergency surgical referrals improves team efficiency and morale compared to current practices.

Methods: This study was a prospective mixed-methodology design that used a structured questionnaire of nine open and closed questions. A Likert scale was used to obtain registrar opinions on workload and ability to complete tasks in a timely manner before and after ACPs phone triage. The sample size was relatively small, with a maximum of 16 registrar to canvas, aiming to obtain a minimum 50% return. All referrals taken during this pilot study were also evaluated using a structured referral form created before the start of the study.

Results: Before this study, 93% of registrars deemed their workload difficult to manage, over 50% stated it was very difficult to formulate and action patient treatment plans in a timely manner, and 86% felt it very difficult to break bad news. After this pilot study, there was a 100% improvement in all evaluated domains. During the study, there were a total of 544 referrals with 429 accepted to the surgical assessment unit. The number of referrals given advice or declined increased, while the number of referrals discussed with the registrars decreased as the confidence of the ACPs grew.

Conclusions: This pilot study demonstrated how ACPs can positively effect service provision, sustainability and contemporise workforce planning. Ultimately, empowering people and transforming care.


Improving the fast track discharge process for palliative patients

Charmaine Butcher and Nicki Morgan

Introduction: The University Hospitals of North Midlands (UHNM) palliative care team undertook an 8-week audit to assess the discharge of patients known to their team. Following the analysis and sharing of data, the fast track discharge process for palliative patients was changed, and a new care bundle created.

Aims: To identify issues within the Trust and to process map the current discharge process, with the aim to support the introduction of a new care plan and simplify the process to reduce risks.

Methods: A total of 68 patients were contacted within 48–72 hours after discharge. The call was designed to assess if the patient had any concerns and if the discharge process steps had been followed. The patient's electronic records were checked, including the discharge letter and, if applicable, the ReSPECT documents. Discharges were categorised by ward and division, and then good, poor or adequate.

Results: The results showed that 22% of discharges were considered good, 20% poor and 58% adequate. This highlighted that the current process was complex and needed the involvement of multiple teams and documentation. Additionally, wards had limited information, understanding or training on how to complete the necessary documentation and the possible outcome for the patient if discharged inadequately.

Conclusions: The outcome resulted in the collaborative working of community and hospital teams. A new process and care bundle, alongside a training package and guidance, was created and implemented. Since, an audit of discharges to evaluate the effectiveness of the change has been conducted, with the results expected in December 2022.


Does providing a virtual supervision support group for emerging advanced clinical practitioners increase resilience in practice?

Julie Belton and Carol Sears

Introduction: The NHS and Health Education England's priority to build a competent advanced practice workforce. A GP practice successful obtained funding to support new and emerging advanced clinical practitioners (ACPs) to review up to date research. The main challenges to developing ACP roles in primary care can be working in small organisations where the student ACP is known to colleagues in another role, making the transition complicated and isolating. Students are often experienced clinicians but the transition to ACP can call their confidence into question, leading to uncertainty.

Aims: To assess if offering support and supervision helps to reduce the uncertainty and helps to create robust and resilient practitioners.

Methods: Online support and a supervision programme for emerging North West London ACPs was created. A list of students was obtained, and they were offered a monthly lunch time session via Microsoft Teams. During the first meeting, ground rules were set and the years sessions planned. Clinical red flag presentations were assessed using a case study approach, as this is a common area of concern for new ACPs. A WhatsApp group for easy communication was developed, which proved to be a useful platform for information sharing and created a collaborative cohesive group.

Results: Members fed back at the end of the year that the use of case studies was really helpful. Other feedback included finding the group approach informative and supportive, aiding their development and helping to build their confidence. The use of case studies allowed for critical thinking and evaluation, with learning promoted in a non-judgemental environment and supported by experienced and knowledgeable tutors. The use of examples for clinical red flag presentations was found to be very helpful.

Conclusions: Supervision is vital in creating robust, confident and resilient practitioners. Whether using online platforms is the best method is still unclear. However, in this study the online approach was more convenient and cut down on travel time.


A retrospective cohort study of pre-hospital agitation by advanced paramedic practitioners in critical care

Nick Brown, Timothy Edwards, Ian McIntyre and Mark Faulkner

Introduction: Pre-hospital clinicians can expect to encounter patients with agitation, including acute behavioural disturbance (ABD). These situations carry significant risk for patients and emergency medical services. Advanced paramedics within the London Ambulance Service (LAS) are frequently tasked to these incidents. At present, little evidence exists regarding the clinical decision making and management of this patient group.

Aims: To explore the demographics of patients presenting with potential ABD and quantify the degree of agitation, physical restraint, effectiveness of chemical sedation and any associated complications.

Methods: A retrospective analysis of pre-hospital clinical records for patients coded with ABD and attended to by LAS advanced paramedics.

Results: A total of 237 patient records were identified. Of which, 147 (62%) patients were physically restrained and 104 (44%) patients were chemically sedated. Sedation was more commonly administered where patients were exposed to physical restraint. High Sedation Assessment Tool (SAT) scores were associated with the administration of sedative agents and at higher doses. A total of 89 (85%) patients undergoing sedation had a SAT score reduction of 2 points or a final score ≤0. The mean SAT score reduction was 2.72 (standard deviation=1.29). Following physical restraint, three cases of minor injury were reported.

Conclusions: Advanced paramedics undertook sedation in less than half the cohort, suggesting other strategies, such as communication and positioning, were used. Most patients were managed into a state between being restless and rousable, largely negating the need for ongoing physical restraint during hospital transfer. In selected cases, appropriately trained advanced paramedics can use sedation safely and effectively.


Developing advanced practice within a mental health trust

Jodie Ley

Introduction: Advanced clinical practitioner (ACP) roles are relatively new in mental health, with none present in Cornwall. In March 2022, Health Education England (HEE) South West funded an Educational and Supervisory lead for Cornwall, to lead a system wide programme of implementing regional and national advanced practice workforce priorities and working with the Southwest Regional Faculty for Advancing Practice.

Aims: To explore all current advanced practice roles and understand where there may be benefit from developing the role of ACPs to meet all areas of the HEE readiness checklist.

Methods: Roles with an advanced title at Band 7 or higher were appraised. Roles starting at Band 8a and higher were reviewed to establish where the advanced practitioner qualification may be required within job descriptions. Roadshows involving associate directors, team managers and individuals introducing the advanced practitioner role were held to explore the development of this role. Areas within the system viewed as a priority were focused on first, with the view to the ACP role bridging a gap in a service line. The information gathered was used to understand how the role of advanced practitioner can be of benefit and how it is delivered in other mental health trusts.

Results: At the start of this project, there were no ACPs based in Cornwall. However, there were clinical practitioners at Band 8 and higher without AP qualifications, who required a review of their job description, consideration for eportfolio route and individual circumstances.

Conclusions: Using the information that was gathered through networking with national colleagues, a medical lead for ACP was developed. A total of eight trainee ACP posts have been advertised, and a 5-year plan of developing future roles created.


GPimhs pharmacy service evaluation: a specialist mental health pharmacist medicines optimisation service for people under primary care

Karen Shuker

Introduction: Surrey and Borders Partnership NHS Foundation Trust, an early implementer site for GP integrated mental health services, studied the contribution to care made by a specialist mental health pharmacist in one pilot site. The service provides biopsychosocial interventions to support people in primary care.

Aims: To evaluate pharmacist driven interventions and provide recommendations following their respective outcomes.

Methods: A retrospective review of the medical records for people using the specialist pharmacist service between September 2021 and March 2022 was undertaken. A spreadsheet was devised to collate the data, which was undertaken for one primary care network with five GP practices.

Results: A total of 57 appointments were delivered for 40 people using the services. Of these 57 appointments, 20 were Level 2 medication reviews (notes review), 20 were Level 3 medication reviews (notes review and consultations) and 17 were follow up consultations. With regards to the nature of advice or recommendations given, two were no change, 17 were told to either commence, switch or stop their medication (when antidepressants were involved all were recommended to switch), eight were optimising medications, 10 were physical health monitoring, 12 had multiple recommendations made, five had follow-up appointments booked and three were referred to secondary care for off-label medicines. Of the recommendations given, 89% were accepted, hypertension was diagnosed when there was antidepressant treatment, and other physical health monitoring issues that were picked up included raised cholesterol and wrong blood pressure medication.

Conclusions: A specialist mental health pharmacist medication optimisation service significantly impacted the care of people in primary care for both mental and physical health concerns.


Lincolnshire rotational advanced clinical practitioner pilot proposal

Helen Chilvers, Heidi Green and Ros Kane

Introduction: Lincolnshire is a rural community with high health inequality and known challenges relating to both access to services and retention of suitably qualified healthcare provision. This is particularly evident in primary care and community services where advanced practitioners are deployed at significantly higher rates than in other localities. The proposal introduces a novel approach to mitigating silo working and improving post-master's development by establishing a system wide rotational fellowship supported by Health Education England Midlands advanced clinical practitioner (ACP) faculty funding.

Aims: To provide a service evaluation proposal of the delivery of a post-masters rotational fellowship. The aim is to understand what are the barriers and enablers to establishing an effective ACP rotation, and, when implemented, what are the benefits and drawbacks to the rotation?

Methods: A qualitative service evaluation using semi-structured interviews with thematic analysis was used.

Results: A poster introducing the proposal and outlining the initial observations regarding the barriers and enablers encountered during the planning process was created. A formal service evaluation is to be submitted at this conference. A further follow-up poster will be submitted on completion of service evaluation.

Conclusions: The poster will outline key considerations in the planning process for the operational implementation of the fellowship programme, up to the recruitment of fellows. A further poster will be submitted presenting data from the completed service evaluation of the pilot project.


Staff experiences of using telephone interview for cognitive status-modified to diagnose dementia in memory assessment service during Covid-19

Mark Kitchingham

Introduction: During the initial phases of Covid-19, all face-to-face appointments in the memory assessment service (MAS) were suspended. On resumption of the MAS pathway, alternatives to traditional face-to-face assessment methods were required. The measure chosen by the trust to enable remote cognitive assessment was telephone interview for cognitive status-modified (TICS-M), which staff had limited or no experience of using.

Aims: To explore staff attitudes of using TICS-M to diagnose dementia in the MAS and to understand the confidence of staff in using TICS-M as part of a multidisciplinary team (MDT) diagnosis of dementia. The study aimed to assess whether TICS-M was a viable alternative to face-face assessments and understand factors affecting the uptake of TICS-M in practice.

Methods: Purposive sampling was used to identify participants from MAS teams within the trust. Online focus groups were used to collect data based on professional group. Thematic analysis, underpinned by an interpretive phenomenological approach, was used to analyse the data and identify the themes.

Results: The two key themes identified from data collection were the impact of Covid-19 on how the MAS operates and how the MDT has adapted to using TICS-M to diagnose dementia in MAS.

Conclusions: This study found there may be a future role for TICS-M in the MDT diagnosis of dementia in MASs. Despite staff concerns about validity and reliability, TICS-M could enhance staff and patient experience. It was key to clarify the use of TICS-M for certain patient groups, with staff preferring face-to-face assessments and finding it difficult to achieve a balance between efficiency and maintaining quality.


Oxygen prescribing in district hospital: a qualitative improvement project

Kirsty Laing, Fiona Hargreaves and Rachel Turner

Introduction: British Thoracic Society (BTS) guidelines state every patient should have a target oxygen range prescription to guide administration. Oxygen is a drug and, therefore, should have a prescription to ensure patient safety.

Aims: To improve oxygen prescribing within Harrogate District Foundation Trust (HDFT), with an ultimate aim of achieving 100% of oxygen prescriptions.

Methods: Intervention plan, do, study, act cycles were used, and key stakeholders were integrated into the qualitative improvement project group. A baseline survey was undertaken to determine why oxygen prescribing was not completed. Multiple interventions, including changing electronic prescribing, implementing oxygen prescribing guidance and various forms of educational training, was undertaken to improve trust-wide prescribing from 30–79%.

Results: The project is now entering the sustainability phase with the rotation of a large workforce. Therefore, the team are continuing to gather data to assess the long-term impact. Data collection has included weekly run charts of oxygen prescribing on the admission ward and a monthly data collection for all the patients in the trust.


Drug assisted endotracheal intubation skills in an advanced critical care practitioner team

Gavin Denton

Introduction: Airway management, including endotracheal intubation, is one of the cornerstones of care for critically ill patients. Internationally, health care practitioners from varying professional backgrounds deliver endotracheal intubation as part of their critical care role.

Aims: To consider the safety profile of advanced critical care practitioners in performing this aspect of critical care in a single centre.

Methods: Airway and endotracheal intubation skills were acquired during and after the advanced critical care practitioner training pathway. A combination of theoretical teaching, theatre experience, simulation and work based practice was used. All intubations were supervised by either an intensive care unit (ICU) registrar or consultant, the usual practice being that they would deliver the induction agents and act as second intubator if one was required. Case series data of all critical care intubations carried out by advanced critical care practitioners were collected. As a routine audit of clinical practice, within the context of organisation-approved scope of practice, consent was not required for data collection. Institutional approval for the audit was provided (reference 4461). The author(s) declared no conflicts of interest with respect to the data collection, authorship and/or publication of this article.

Results: Data collection identified that 675 intubations were carried out by advanced critical care practitioners. Of which, 589 were supervised, non-cardiac arrest intubations requiring drugs. First pass success (FPS) was achieved in 89.6% of cases. The overall success rate was 99.8%, with a second intubator required in 4.3% of cases. Some form of complication was experienced by 42.3% of patients. However, the threshold for complications was set at a low level. A meta-analysis regarding intubation success rates in emergency departments considered a FPS rate of 84% as a minimum standard. An international study identified a FPS rate of 79.8% in critically ill patients. This advanced critical care practitioners (ACCP) case series achieved an 89.6% FPS rate. Review of intubation log books of ICU trainees in the UK found a FPS rate of 91.8% in critically ill patients.

Conclusions: Using a multi-modal approach, this ACCP service has developed a process to acquire advanced airway management skills, including endotracheal intubation. Under medical supervision, ACCPs delivered advanced airway management achieving a FPS rate of 89.6%, which contrasts favourably with both international and national success rates. Although complications were experienced in 48.3% of patients, when similar complication cut-offs are compared to published data, ACCPs also compare favourably with published data.


Can the use of ambulatory care reduce the re-admission rate of general surgical emergencies? A systematic review and meta-analysis

Samantha Resuggan

Introduction: With the influx of emergency surgical admissions and the subsequent increased demand on emergency departments (ED) and surgical assessment units, same day emergency surgery is becoming commonplace. Studies have shown that ambulatory management can reduce the admissions, pressure on hospitals and, therefore, impact on their costs.

Aims: By encapsulating two common general surgical emergencies (cholecystectomies and appendectomies), this review aims to explore whether the management of ambulatory care impacted on the re-admission rates.

Methods: A database search using CINAHL, MEDLINE, Cochrane library, TRIP, google scholar, science direct and grey literature was conducted. A population, intervention, comparison and outcomes (PICO), strict inclusion and exclusion criteria and Joanna Briggs Institute analysis identified a total of eight articles.

Results: A separate meta-analysis was carried out for both groups. The data obtained clearly shows no statistical significance in the reduction of re-admissions for laparoscopic cholecystectomies (P=0.83). However, a significant statistical difference in the rate of re-admissions is shown in the meta-analysis for laparoscopic appendectomies (P=0.02).

Conclusion: Despite ambulatory care being a worldwide process that is continually evolving, there are no studies that can be found that cover its impact on re-admission rates. This review recognises the use of ambulatory care having a positive impact on the re-admissions of appendicectomy patients. However, it has not established a connection between the ambulatory pathway and the reduction in re-admissions for laparoscopic cholecystectomies. Therefore, further research is required.


The impact of advanced clinical practitioner led idiopathic normal pressure hydrocephalus diagnostic pathway to reduce elective waiting list times

Elizabeth Cray and Samuel Jeffery

Introduction: Covid-19 has impacted on patient services and capacity within the NHS. A challenge within neurosurgery has been tackling the backlog of patients waiting for an elective extended lumbar drain test (ELD). The neurosurgical advanced clinical practitioner (ACP) has played a pivotal role in improving service efficiency.

Aims: To offer an interim diagnostic assessment of a high-volume lumbar puncture (LP) for patients with suspected idiopathic normal pressure hydrocephalus (iNPH) to reduce the waiting list for elective ELD. The aims were to identify a diagnosis of iNPH, reduce the elective waiting list for ELD and prevent a 3-day admission into hospital.

Methods: Patients identified with probable iNPH from initial consultation through a dedicated multidisciplinary clinic were then referred to the neurosurgical ACP for a high-volume LP.

Results: Over 7 months (October 2021–May 2022), a total of 21 patients (12 female, nine male with a mean age of 77 years) consented to a high-volume LP. On introduction of this pathway, 52% of patients had been on the waiting list for an ELD for a minimum of 6 months. Patients considered to be ‘responsive’ were offered a ventriculoperitoneal shunt. This avoided 21 patient admissions to hospital and 163 bed days.

Conclusions: This interim pathway was introduced by the neurosurgical ACP to improve the delivery of the diagnostic iNPH pathway and reduce the elective waiting list for ELD. This study demonstrated real and measurable improvements in quality of care and service provision by avoiding 21 patient admissions to hospital and 163 bed occupancy days.


To evaluate the effectiveness of delivering cognitive behavioural therapy ten as a treatment pathway for non-underweight eating disorder patients with a full range of eating disorders within a primary care setting

Amanda Russell

Introduction: Evidence based existing forms of cognitive behavioural therapy (CBT) for eating disorders (CBT-E) have been used and proven to be effective for non-underweight patients for many years. CBT-E is a lengthy treatment that has cost and time implications for patients and the NHS. It is delivered by psychologists working within specialist eating disorder services (SEDs). Current pressures and waiting times for these services have resulted in patients being managed and treated within primary care settings. In 2018, a shorter more concise version of CBT-E was developed that can be delivered by novice therapists - CBT-ten (CBT-T). This form of CBT for eating disorder (ED) patients has started to be delivered within a primary care setting and has delivered good outcomes in terms of recovery for ED patients.

Aims: To evaluate the effectiveness of CBT-T for non-underweight ED patients within a primary care setting.

Methods: A retrospective cohort study of 34 patients, with 16 patients meeting the inclusion criteria and considered eligible for CBT-T. A course of CBT-T with a 1-month follow-up was delivered by the ED nursing team. Measures assessed eating attitudes, behaviours using the eating disorder examination questionnaire (EDE-Q), and anxiety and depression via the patient health questionnaire-9 and generalised anxiety disorder-7 scoring tools.

Results: CBT-T delivered a good uptake from patients in terms of acceptability, and retention was encouraging. Outcomes at the end of the treatment and 1-month follow-up were positive in terms of global EDE-Q scores, which demonstrated a reduction and remission of ED symptoms and psychopathology.

Conclusions: Results supported CBT-T as an effective treatment pathway in the management of non-underweight ED patients. It compares favourably with the longer version of CBT-E but has advantages of shorter delivery time and being facilitated by non-specialist therapists. This has significant implications for the future management of ED patients in primary care.


The role of an advanced clinical practitioner in improving the diagnosis and treatment of osteoporosis in a community falls service

John Frosdick, Dan Forster, Lauren Webb and Erisa Ito

Introduction: The fracture liaison service database suggests that nationally, over 90 000 individuals should be on anti-osteoporosis medication but are not, resulting in thousands of avoidable fracture related admissions. Prior to the advanced clinical practitioner (ACP) role across three integrated community teams, a weekly multi-disciplinary meeting discussed patients with recent falls. When a fracture risk assessment tool (FRAX) indicated measuring bone mineral density (BMD), it was highlighted to the GP for further action. Baseline data highlighted that over a 6-month period, 22 patients required a bone density (DEXA) scan. Of which, nine scans were requested by a GP, with only five patients attending the scan. Overall, osteoporosis was diagnosed in two patients.

Methods: With the ACP in post, all DEXA scans were requested internally. Results are communicated by letter to the patient and GP, including recommendations for bone protection where indicated.

Results: After 9 months (September 2021–May 2022) of using the new pathway, 182 DEXA scans were requested. Results were reported for 166 patients, with a new diagnosis of osteoporosis in 57 patients (34%), osteopenia requiring treatment in 10 patients (6%), and osteopenia requiring lifestyle advice in a further 41 patients (25%). Non-attendance rates were initially high but improved with a second plan, do, study, act cycle, which introduced sending a letter to the patient highlighting the purpose of attending.

Conclusions: Increased capacity from the ACP role has enabled a more proactive service, with increased requests of DEXA scans from 41% to 100% and an improved patient attendance rate from 44% to 77%. Ultimately, this has resulted in the better diagnoses of both osteoporosis and osteopenia. A repeat study assessing the number of patients taking bone protection medication and rates of future fragility fracture is planned.


Establishing a baseline of learning and development of pharmacy professionals in general practice within Bristol, north Somerset and south Gloucestershire

Joanne Clarke

Introduction: The number of pharmacists working within general practice has increased with the introduction of the ‘additional roles reimbursement scheme’ (ARRS). While there is an approved learning pathway for those employed under ARRS, it was not clear what the whole local pharmacy workforce required for the development.

Aims: To establish the existing learning methods, understand the use of competency frameworks to support learning and understand what communities of practice were in place. To also establish current and future learning needs, including what support was required.

Methods: An anonymous questionnaire was distributed to all pharmacists working in general practice across Bristol, north Somerset and south Gloucestershire (BNSSG) (n=119). The tool used a mixture of qualitative and quantitative questions.

Results: There was a 24% response rate (n=29). Of the respondents, 21% (n=6) were using a framework to evidence competencies. Career aspirations included becoming ACPs, consultant pharmacists or partners in their practice, but it was recognised that further development was required. In total, 45% (n=13) of pharmacists reported no protected development time and 72% (n=21) were part of at least one network group. However, the same number (72%) supported the development of more communities of practice.

Conclusions: A limitation was the small numbers of respondents. However, it gave a broad overview of the current need for learning and development in the local area. It was clear that the pharmacy workforce in general practice in BNSSG required more support for career development, especially into advanced practice. Implementation of these results has shaped the role of the pharmacy lead within the training hub, who supports the pharmacy workforce within general practice.


Barriers to advanced practice in emerging areas: unique or common?

Luke Cunningham and Jennifer Lloyd

Introduction: The South-West (SW) Advancing Practice Faculty analysed the 2021–22 scoping returns and the subsequently funded places onto advanced practice (AP) courses by profession. It showed that representation across the breadth of registered health professions was limited, with 81% of advanced practice training places offered to practitioners from two professions.

Aims: To describe the barriers and opportunities for progression into advanced practice roles for allied health professionals (AHPs) and pharmacists.

Methods: Published literature, including previous Health Education England projects, on AHPs and/or pharmacists and advanced practice was reviewed. The result was an updated overview of the identified barriers that face the emerging areas of the AHP and pharmacist workforce wishing to progress into advanced practice. Findings were shared with colleagues within the SW and nationally for feedback, which was then integrated to create the SW AHPs and Pharmacists in Advanced Practice Scoping report (pending publication).

Results: Barriers were categorised into a fishbone diagram. Themes were colour coded to indicate whether they are unique to AHPs and/or pharmacists, or if they had the potential to be common across all professions within advanced practice.

Conclusions: Around 1/3 of barriers were common to AHPs and pharmacists. However, 2/3 of the identified barriers had the potential to apply across all workforces considering advanced practice in emerging areas. The barriers facing AHPs and pharmacists in advanced practice roles are multifactorial. However, there are commonalities that are best approached strategically and multi-professionally. A driver diagram has been produced to guide future workforce transformation in these areas.


Meeting National Institute for Health and Care Excellence inpatient foot guidance with no additional funding

Paula Yates and Khadijah Salim

Introduction: Both the National Institute for Health and Care Excellence (NICE) in 2011 and Diabetes UK in 2012 recommended that patients with diabetes, on admission to hospital, have a foot check. The aim being to screen for pre-existing diabetes related foot pathology and ensure those with diabetic foot ulceration (DFU) are referred to an appropriate foot multidisciplinary team (MDT) in a timely manner. Additionally, it aimed to identify and reduce hospital acquired harm because of the increased risk of developing a hospital acquired pressure ulceration associated with an insensate foot.

Methods: In 2012, a foot pathway was introduced and in 2017, National Diabetes inpatient Audit and Advancing Quality Alliance conducted an ongoing audit of a percentage of inpatients with diabetes who were selected randomly against agreed parameters.

Results: The audit found that 25% of DFU patients were not seen at all during their stay, and the average number of foot assessments performed was 32%.

Conclusions: The percentage of inpatients having diabetes at any one time was estimated to be 17%. Alongside the expected number of daily admissions from local data, there would be approximately 50 new patients with diabetes every day spread out across all wards on all sites. Therefore, screening by the podiatry department would not be feasible.


Does the role of an integrated diabetic foot coordinator help improve outcomes?

Kimberley Martin, Alexandra Harrington and Matthew Cichero

Introduction: Ensuring patients with complex diabetic foot complications have access to the right care at the right time is key to improving clinical outcomes. A non-surgical coordinator was appointed to aid admission avoidance and improve discharge within the diabetic referral pathway.

Methods: Data from an established data base were used to review the time to assessment, length of stay, surgical oversight and healing rates.

Results: During a 15-month period, a total of 459 patients were reviewed. Of which, 271 were inpatients, 108 were in ambulatory care and 80 were virtual. An average of 98% of referrals were triaged within 24 hours, improving to 100% by December 2021. The average length of stay reduced from 12.78 days to 8.06 days and those needing surgical oversight changed from 100% to 42%, with the National Diabetes Footcare Audit reporting 68.9% cases had healed at 12 weeks (UK average 48.7%).

Conclusions: The introduction of the integrated diabetes foot coordinator has supported patient care, ensuring the right care at the right time, and subsequently shortening the inpatient length of stay. The use of robust local data collection is helping to evidence the clinical effectiveness.


Is there a difference between EM clinicians regarding completeness of documenting red flags for cauda equina according to National Institute for Health and Care Excellence (NG59) standard?

Clare O'Carroll and Garry swann

Introduction: Back pain is a common presentation to the emergency department (ED), accounting for almost 5% of all ED presentations annually. Patients may present with a spectrum of symptoms; from minor musculoskeletal pain to more serious pathology, including cauda equina syndrome (CES). Despite the introduction of national guidelines outlining important red flag symptoms, the accuracy of note taking remains incomplete.

Aims: To measure the completeness of note taking between advanced clinical practitioners (ACPs) and medical clinicians against the National Institute for Health and Care Excellence (NICE) (NG59) standard in patients presenting with lumbar back pain when requesting magnetic resonance imaging (MRI) scans. To determine the completeness of note taking related to red flag symptoms between ACPs and medical clinicians against the NICE (NG59) in patients who present with back pain when requesting MRI scans. To undertake a retrospective audit of clinical notes over 4 months across two busy EDs. To compare practice between ACPs and medical clinicians against the NICE (NG59) standard.

Method: Data were collected retrospectively and chronologically from 31 October 2019 to 10 March 2020 from electronic patient records from two hospitals within one large Hospital Trust. A total of 200 patients who were referred for an MRI of the lumbosacral and whole spine and aged older than 16 years were reviewed. Pertinent details were extracted for the audit in line with the NG59 standard.

Results: Of the participants, 58% (n=116) were female and 42% (n=84) male. Overall, 13% (n=26) received care from ACPs, 75% (n=150) from doctors and 12% (n=24) from Orthopaedic clinicians. NICE (NG59) red flag symptoms of saddle paraesthesia, anal laxity, faecal incontinence, urine incontinence/micturition and bilateral neurology were documented more frequently by ACPs, whereas urinary retention and bilateral sciatica symptoms were documented more in the medical clinician groups. Urine retention was the least documented red flag symptom and urine incontinence the most documented in all clinician groups.

Conclusions: The audit demonstrates the completeness of more red flag symptoms by ACPs compared to medical clinicians in suspected CES cases. The evidence base has found poor sensitivity and specificity with regards to ‘red flag’ signs and symptoms, providing low diagnostic accuracy when identifying potential cases. This has important implications in practice because all MRI scans are vetted by senior radiologists and any issues relating to completeness of notes may result in harm, as patients may receive inappropriate and/or unnecessary imaging, or indeed, no imaging at all.


The changing landscape of radiology performed nasogastric and nasojejunal insertions and exchanges: the move to an advanced clinical practitioner led service

Claire Elwood and Dave Merrett

Historically, radiologically guided nasogastric (NG) and nasojejunal (NJ) tubes have been inserted by medically trained practitioners, such as a radiologists. With the increased demands on the radiology service and the importance of ensuring patients receive adequate nutrition, either as an inpatient or an outpatient, it was decided within this Trust to train two advanced clinical practitioner (ACP) radiographers to perform this role. By interrogating data from the last 3 years on NG and NJ tubes performed within radiology in this Trust, the radiographers have assumed a greater proportion of the work as the service has grown, year on year following their in-house training. The data shows the ACP role has successfully evolved and has assisted in matching the increased demands with the increased capacity. This non-medical model has shown to have a positive impact on the patient journey.


Virtual diabetes group consultations and education in primary care

Aysha Badat

Aims: To measure the effectiveness of a primary-care virtual-group-consultation and diabetes-self-management-education-programme [VGC-DSME] to improve glycaemia, metabolic control and patients self-efficacy in the management of diabetes.

Methods: A quantitative study was conducted on a small group of patients with uncontrolled diabetes as part of a quality improvement (QI) project. Individuals older than 18 years with Type-1 or Type-2 diabetes were eligible for this study. For 2 hours a week, four patients completed a 4-week VGC-DSME programme via Microsoft Teams. Data measuring heamoglobin A1C (HbA1c), lipids, blood pressure (BP) and body mass index (BMI) were obtained before the workshops and at a 3-month follow-up. Patient's self-efficacy was evaluated by means of a mixed-methods-strategy using a semi-structured survey.

Results: HbA1c significantly reduced by 21 mmol/mol (16%), with an average systolic-BP reduction of 8 mmHg (10%). Average diastolic-BP increased by 5 mmHg (4%), as did the lipid-profile by 0.7 mmol/L (0.03%) because of an adverse-health-event with one participant. There was a rise of 22.5% in motivation level, 25% in confidence levels and 31% in self-management skills, rating VGC-DSME at 96% with a likelihood of recommending to others. The change-impact of the QI-project revealed that patients are 7-times less likely to see the GP, and the patient activation level increasing by 1.8 (scale of 1-5) correlates to primary and secondary care demand savings of £1002 per patient per year.

Conclusions: The results confirm the significant benefits of VGC-DSME in improving glycaemia, metabolic-control and patients self-efficacy, as well as the notable impact on saving GP-appointments and monetary gains. Results were considered valid and reliable. However, evidence needs to be further assessed in a larger cohort of patients for generalisability.


Implementation of a prehabilitation pathway: empowering patients to get ready for surgery

Olivia Chapman, James Pidding, Jessica Lipman, John Whittle, Lorna Starsmore and Nicholas Tetlow

Introduction: Prehabilitation is the process of enhancing patients' functional capacity before surgery. The literature supporting prehabilitation suggests potential improvements in post-operative recovery and a reduction in complications. It also signals a shift to a more proactive approach, empowering patients to be active participants in their care. The Prehabilitation pathway at University College London Hospital (UCLH) launched in November 2021 and has had 97 patients referred into the pathway.

Method: This was a multi-modal service with a multidisciplinary team triage followed by an initial appointment, check ins, and pre- and post-operative re-assessments, as well as zoom exercise classes. This was a 1:1 input with options of a dietician and coaching as required.

Results: Initial data suggests that patients actively engaging in the prehabilitation service report better patient reported outcomes with a reduction in fatigue by 64.9% and a reduction in the EQ-5D cumulative score by 38.2%. This could indicate more independence and improved function compared to the initial referral. The 30 second sit to stand score shifted from 12 to 19, above average for the cohorts mean age, suggesting an improvement in fitness. Alongside the data, patient feedback also demonstrates how prehabilitation has transformed the experience of waiting for surgery: “Prehabilitation enabled me to, for the first time since my cancer diagnosis, build up confidence to walk outside for the first time and go on a weeklong family holiday”.

Conclusions: The initial findings are an encouraging indication that engaging in prehabilitation can transform the wait for surgery, empowering patients to improve fitness levels and their quality of life.


Improving headache assessment on the ambulatory care unit

Graham Robinson and Mark Holland

Introduction: Headaches are common, painful and cost the NHS £400 M per year. Discriminating primary headaches (such as tension, migraine and cluster) from life-threatening pathologies is a challenge in ambulatory emergency care (AEC). Investigations carry risks and costs, and guidelines exist but are not always followed.

Aims: To audit and improve practice in AEC by piloting a guideline summary and training intervention for advanced clinical practitioners (ACPs).

Methods: Over 65 days, two clinical audits were undertaken over (before and after intervention). From 1352 presentations there were 100 (7.4%) headaches. Current practice and guideline adherence by all clerking professionals and the impact of the intervention on ACPs who clerk around half of the patients was analysed.

Results: Baseline adherence to standards on neurological examination and red flag assessment was 90% and 91%, respectively. Fundoscopy was only attempted on 26% of patients. Of the 100 patients, 63% were red flag positive, 94% of whom underwent neuroimaging with significant findings in 14% (including stroke, subdural haematoma, cerebrospinal fluid leak, arterial dissection and glioma). Of the 37% of patients who were red flag negative, 30% underwent neuroimaging because of clinical suspicion but with no significant findings. The intervention aimed at ACPs improved their confidence and knowledge of headache assessment, leading to clearer management plans and a 26% reduction in length of stay.

Conclusions: This real-world study provides a valid snapshot of current practice, prevalence of serious underlying headache pathologies and identifies opportunities for exploring further improvement, such as using fundoscopy and guideline adherence to support a reduction in unnecessary neuroimaging.


Caring for Homeless - Jubilee House. An advanced clinical practitioner outreach homeless care project: integrated working across boundaries in Crewe to tackle extreme health inequalities

Zoe Ahearne and Beverly Price

Introduction: Crewe is situated in affluent Cheshire, yet has a migrant, multi-cultural population within an area rated as 2 on the indices of deprivation (NIMD). With increasing numbers of established homeless, the number of the hidden homeless are also rising. People without addresses are less likely to present with health issues, meaning access and health management is limited, which results in the worsening of untreated conditions. Following the Covid-19 pandemic, five surgeries recognised a need to bring healthcare to marginalised patients, and, therefore, collaborated with podiatry, optometry and local organisations, including ‘Chance Changing Lives’ and ‘Motherwell’. The Local Centre provides a safe environment where clients access cooked meals and support, both practically and socially.

Aims: To offer acute care, health support, health education and signposting without appointments in familiar environments, with the aim of encouraging patients to access longer-term healthcare and services at a registered practice. It targets health needs and aims to improve the health outcomes specifically related to dental care, foot health, cancer, influenza, sexually transmitted disease, diabetes, hypertension and nutrition, as evidenced within the Queens' Nursing Institute 2017 report.

Methods: To date, 12 bi-weekly sessions (2 hours per session) have treated 27 patients. Conditions varied from skin lesions to mental health. Other ailments included pain, acid reflux and incontinence. Patients were treated and prescribed for onsite, with on-referrals to appropriate professionals.

Conclusions: This study created integrated outreach services that improved quality of life, addressed health inequalities as a local community, improved professional relationships and best practice, provided advice to rough sleepers attending Jubilee House, established a trusted service and broke down barriers. Positive feedback was gathered from the organisations and patients.


Developing an advanced practice led medical ambulatory emergency care service

Jemma Baker

Introduction: Advanced practice is an emerging role within ambulatory emergency care (AEC) and is proving to be effective, with figures suggesting that an advanced practitioner (AP) can autonomously manage approximately 30% of AEC clinical scenarios.

Aims: There is a paucity of research regarding the productivity of APs. This work sought to measure the productivity of the AP team with an AP led service in an acute medical AEC.

Methods: Data from the 1 April 2021 to 31 May 2022 were retrospectively collected from an admission book in an AEC that changed to an AP led service in June 2021, documenting the patients who attended daily, who the clerking clinician was and if the patient was discharged.

Results: The average number of patients presenting daily through this service increased from 12 to 20 per day (a 67% increase), with the average number of patients seen per hour by the AP team increasing from 0.5 to 0.7. The AP team are now seeing up to 70% of patients with a 35% follow-up rate and 3% admission rate.

Conclusions: This demonstrates that the current AP team have developed in clinical confidence and productivity over the last year, with proactive support from senior medical colleagues. It is believed that this team can continue to evolve with a wealth of opportunity for healthcare provision. These findings may be helpful in future workforce planning for AP led AECs.


Overcoming the challenges of developing integrated advanced clinical practitioner roles in community children's services

Clare Smith

Introduction: Community Children's Health Services (CCHS) support a variety of needs through a multiprofessional workforce. With the challenges of providing more care at or close to home, keeping children out of hospital wherever possible to meet the changing needs of the community and healthcare systems, the case for integrated advanced clinical practitioner (ACP) roles is justified. Owing to the diverse nature of clinical needs in children's health, the capabilities for each role need to be defined. Additionally, there are few examples of established integrated roles across the UK.

Aims: To develop integrated ACP roles within CCHS to facilitate system wide pathways of care for children and young people.

Methods: Proposed roles were based on priority need. Health Education England's Multiprofessional Framework and Supervision guidance informed the governance framework for scope of practice, learning and supervision needs. Individual capabilities frameworks were informed by existing area specific frameworks. Additional supervision was sought through partner organisations.

Results: Across a range of professions, four roles were identified, including ACP (physiotherapy); neurodisability, ACP (learning disability nurse); learning disability, ACP; children who are looked after and ACP (children's community nurse). Three of the four roles have been successfully implemented and are in training. However, securing integrated supervision with partner organisations remains a challenge.

Conclusions: Integrated ACP roles can facilitate system wide working. A clear process for developing scope, capabilities and supervision of these new roles enables their implementation. Challenges exist, however, the necessity of referring to multiple collegiate frameworks and system level support for supervision should be emphasised.


The impact of advanced practice on a frailty support team (virtual ward)

Esther Clift, Karen Parker, Charlene Martin, Nicole Edwards and Lucy Lewis

Introduction: There is significant investment in developing virtual wards to meet the needs of older people living with frailty during an acute decompensation, at home, to avoid deconditioning and hospital acquired infections. This requires advanced clinical practice (ACP) clinicians with the knowledge, skills and experience to assess, diagnose and make complex clinical decisions, and implement treatment interventions to keep people safely at home. This way of working is innovative and challenging.

Aims: To highlight the skills and behaviours required to meet the needs of patients living with frailty, who receive acute assessments and interventions at home. The number of people seen and outcomes for patients supported in the team are described. It is hypothesised that this is a safe and acceptable alternative to hospital care.

Method: The service is community based, with two ACPs and eight trainee ACPs supporting nine primary care networks (PCNs). Data were gathered on the experience of trainee advanced practitioners in the team, the impact of the team numerical and outcomes, the population of the patients, and feedback from the patients and ACPs.

Results: All of the trainees have undertaken further masters level training. Patients and families greatly value the opportunity to receive the care they need at home.

Conclusions: Frailty virtual wards are a safe and effective way to support older people through an acute illness and deterioration. Further development of advanced and consultant practice in community settings is important to extend the reach of these services.


Advanced practitioner led fracture clinics: is this an effective environment for advanced practitioner learning and development?

Sarah Butler, Katy Clay, Paula Houghton, Daniel Scarffe, Kerry McLean and Claire Wright

Introduction: Advanced practitioners (AP) taking a role of clinical leadership within a fracture clinic setting is becoming more commonplace. Using this clinical environment for educational purposes has not been formally explored, but can potentially offer opportunity for the learning and development of less experienced/novice APs.

Aims: To explore whether AP led fracture clinics can provide an effective learning environment for less experienced APs and other clinicians under the mentorship of more experienced, expert colleagues.

Methods: A semi structured questionnaire was used for APs working within an AP led fracture clinic to reflect on the learning undertaken in an AP led clinic over a 6-month period. The data were analysed thematically.

Results: The main themes emerging from six clinicians were opportunities to develop clinical expertise, communication skills, leadership skills, and exposure to new underpinning research evidence supporting practice through case-based learning. APs with differing learning needs found value in this learning environment.

Conclusion: An AP led fracture clinic can be an effective learning environment for less experienced APs and other clinicians with formal and informal learning, and can provoke deeper reflection. APs are best placed to support the development of other APs as they have a full understanding of all the facets of the role. Identifying clear learning objectives can further ensure that these educational opportunities are optimised.


The impact of introducing an advanced clinical practitioner to orthogeriatrics to transform the care of the frail, older patient

Joanne Prescott

Introduction: Orthogeriatrics are embedded within trauma and orthopaedics to address the holistic needs of older people with hip fractures. More recently, the British Orthopaedic Association have published guidelines for the care of frail, older people who have sustained other injuries and are at risk of suboptimal care. Locally, a lack of orthogeriatricians to provide this care was addressed by employing an advanced clinical practitioner (ACP) to ensure they received comprehensive geriatric assessments (CGA).

Aims: To conduct a snapshot audit to convey the impact of the ACP role on the care of the frail, older patient with severe, non-hip injuries.

Methods: A retrospective notes audit was conducted to identify how many patients, over 75 years, were admitted to the orthopaedic wards in September 2021 with non-hip fragility fractures, and how many received a CGA since the employment of the ACP.

Results: In September 2021, 44 patients over 75 years were admitted. Of which, 57% were non-hip fractures and 44% were seen by the ACP. This meant that 62% of non-hip fragility fractures were reviewed and included a bone health review (54%), a DNACPR discussion (46%) and a delirium assessment (46%).

Conclusions: Areas of improvement were identified. Over 75 years was used as a surrogate marker for frailty and more work is needed to reach all patients regardless of their age. However, the results highlight the extensive improvements made, as these standards of care would not have been achieved prior to the employment of the ACP.


Exploring the value added of an advanced practice physiotherapist within acute medicine

Nikki Walker

Introduction: An ageing population brings with it increased demand on healthcare, with individuals living with multiple comorbidities and emerging frailty syndromes. Traditional, linear, multiple-stepped pathways feed system-wide congestion, making it harder for patients to access the right care at the right time. This compounds risk of deconditioning, contributing to protracted admissions. The NHS Long Term plan highlights the opportunity for advanced practice to transform service delivery, alongside the role allied health professionals have within this.

Aims: To develop an advanced practice physiotherapist (APP) within acute medicine, and explore the impact on length of stay and patient experience, alongside capacity and capability within the multi-professional team.

Methods: A physiotherapist carried out a 6-month pilot within the acute medical unit of a teaching hospital, undertaking the initial assessments for adults presenting with a primary complaint that impacted movement and function. The role integrated advanced practice skills with early mobilisation and proactive reablement, embedding a culture of ‘home first’ and ‘discharge to assess’.

Results: It was demonstrated that improved access to physiotherapy assessment, alongside reduction in length of stay by 1.08 days compared to the existing service. There was also a 50% reduction in 30-day readmission rate. Patient and staff feedback was overwhelmingly positive, reflecting value added across the four pillars of advanced practice.

Conclusions: Physiotherapists are a valuable tool to support the medical profession in managing the growing demand on acute care. APPs offer opportunity to build on the more widespread model of advanced care practitioners while leveraging the unique selling points of a physiotherapist.


Experiences of allied health professionals working as advanced clinical practitioners: a scoping review of quantitative and qualitative evidence

Kay Murphy, Gerri Mortimore, David Nelson, Samuel Cooke and Despina Laparidou

Introduction: Advanced clinical practitioners (ACPs) are a diverse workforce consisting of nursing and allied health professionals (AHPs) who have demonstrated enhancing service provision to the growing service user demands. However, there is a significantly higher proportion of AHPs that leave in comparison to nurses with no explanation of why, resulting in a loss of financial, supervisory and academic investment, and unpredictable challenges in workforce planning and development.

Aims: To explore the experiences of AHPs working as ACPs, identifying current and emergent literature and evidence.

Methods: The following databases were searched: Academic Search Complete, AMED, CINAHL, MEDLINE, PsychINFO, PROSPERO and Google Scholar. Restricted parameters were used to capture evidence of the experiences of AHPs working as ACPs in the NHS. Narrative and thematic analysis was undertaken to identify themes.

Results: No articles were identified specifically focusing on the AHPs experiences as ACPs, identifying a gap in the current literature. A total of four articles were identified.

Conclusions: Confusion towards the ACP role still exists and is worsened by the variety of role titles. Furthermore, a lack of understanding of the capacbilities of AHPs results in AHPs clinical abilities and skills being ‘under-used’. It is acknowledged that challenges differ between AHPs and nurses in advance practice. Literature on the representation of smaller AHP professions in advanced practice roles remains absent. Further investment in research within this area is encouraged.


Transition experience, post-Health Education England framework, of senior healthcare professionals becoming advanced clinical practice degree apprentices: a qualitative study

Alexandra Picts

Introduction: Transition to advanced practice roles has been shown to involve a process and phases. Since this finding, the Health Education England (HEE) framework and the advanced clinical practitioner (ACP) integrated degree standard have been introduced. Post this framework, transition of trainee ACPs, particularly degree apprentices (DAs), in their first year of training has not been examined.

Aims: To explore the experience of role transition for ACP DAs, identifying similarities and differences in these experiences across professions and settings, and establishing whether there are any cross-cutting themes.

Methods: Qualitative semi-structured interviews were conducted via the Zoom platform of healthcare professionals (HCPs) working in primary, secondary and tertiary settings, enrolled on the same 3-year apprenticeship programme at a single university. With purposive sampling of first year students, five (of 28) ACP DA students self-selected, representing common ACP professions of paramedics, nursing and radiography.

Results: Thematic analysis of recorded transcripts identified five themes of the ACP DA transition experience: what they themselves brought, reflections on how they see themselves and were seen by others, and the effects of organisational support and learning at Master's level.

Conclusions: In this study, ACP DAs from a post-HEE framework viewpoint, have a similar transition experience to previous advanced practice trainees. This may be associated with factors common to all, rather than background profession or workplace setting. The transition moment remains unclear, and workplace uncertainty may resolve with better engagement with available information. The themes could be used to perhaps ease transition and direct further research.


Telehealth versus in-person musculoskeletal physiotherapy assessment: a comparison of specific outcomes

Darren Hallinan

Introduction: The Covid-19 pandemic has caused a remarkable expansion of telehealth within musculoskeletal (MSK) services across the world.

Aims: To test the hypothesis that physiotherapy MSK assessment through telehealth results in different outcomes relative to in-person assessment, specifically reviewing diagnosis, treatment and management outcomes.

Methods: A retrospective evaluation was performed of two sample groups of patients assessed within an NHS MSK service by senior and advanced practitioner physiotherapists (APPs). The first sample performed assessments in-person (n=4008) and the second sample via telehealth (n=2966).

Results: The telehealth group demonstrated a 3.3% drop in the provision of rehabilitation programmes, a 6.2% increase in the provision of advice and education, a 3.5% higher rate for magnetic resonance imaging scans requested, and a 600% higher rate for urgent reports stemming from APP investigations. There was a <1.1% difference in the rates for all other investigations requested between the two groups. The number of patients booked in to see either an APP or a medical doctor on their first follow-up was 14.8% greater in the telehealth group. There was a 92.3% collective decrease in soft-tissue structures booked in for corticosteroid injection follow-up in the telehealth group.

Conclusions: Most results exhibited statistically significant differences between the two sample populations. However, some are likely to be a by-product of the impact of the Covid-19 pandemic on the telehealth sample, rather than inherent differences between the telehealth and in-person groups. In all cases, the results should be validated with well-controlled post-pandemic in-person versus telehealth data.


Breaking down barriers of vulnerability with research to inform and evidence impact of a rapid response service in secondary care

Andrea Roberts

Introduction: Attendances to the emergency department (ED) have risen by 40% in 15 years, while the number of inpatient beds has fallen by nearly 50%. Lack of hospital bed capacity has a direct impact on the day-to-day running of EDs, resulting in dangerous overcrowding, leaving patients vulnerable to poor care and indirect harm. Admission avoidance is a national driver for the NHS and part of the Long-Term Plan. By moving care into the community, quality of life, dignity and mortality can be improved/maintained. Therefore, a research proposal that informed a pilot study was developed. The pilot study empowers patients, carers and relatives with community alternatives of how and where their treatment can be delivered (where clinically reasonable), facilitated by a rapid response service (RRS) in the ED.

Aims: To analyse the introduction of a hospital emergency department-based rapid response service (RRS), by exploring the impact of the RRS on outcomes relevant to patients and providers, including facilitated ED discharges and the re-admissions of those referred and discharged early.

Methods: A quantitative evaluation of rapid response-initiated discharges to community services over a 16-week period was conducted.

Results: Over a 16-week period, 70% of the patients reviewed by the RRS were discharged to community services, an increase of 450%. Equating to 1.5 discharges per day based on a 5-day service Monday–Friday, compared to 0.3 discharges before the pilot study.

Conclusions: With an average bed/day cost of around £400, the RRS generates savings to the trust by reducing bed capacity, overcrowding and indirect harm.


Using a free learning management system (Moodle) as an advanced clinical practitioner e-portfolio platform: an alternative to current subscription systems

Juan Pedro Carrasco Alvarez and Ann O'Sullvian

Introduction: Completing a portfolio is an effective way for clinicians to evidence clinical competence and for organisations to demonstrate governance on advanced practice. These portfolios are normally recorded as e-portfolios contracted to third parties, requiring a subscription fee and the use of existing portfolio templates or bespoke formats that normally increases the cost. This poster evaluates the use of an open source (free) as alternative to a subscription-based software.

Aims: To evaluate the validity of an open source software (Moodle) as an effective e-portfolio platform and compare its features to existing software.

Methods: Using a minimum set of essential and desirable variables, including portfolio creation, evidence submission, cost, link online courses, online file creation, file download, feedback, panel communication and completion tracker. Different available portfolios to the open source Moodle e-portfolio tool were compared.

Results: Moodle meet most of the essential characteristics to build a robust ACP e-portfolio and allows fluid communication between trainees and their assessors. However, it does lack some of the most common features of an e-portfolio, such as 360 feedback that must be supplemented with other common third-party software.

Conclusions: Moodle could be considered as an e-portfolio for those Trusts willing to use a subscription free tool that meets most of the essential requirements of an e-portfolio.


A service evaluation of a paediatric musculoskeletal triage clinic delivered by an advanced practice physiotherapist in an integrated care organisation

Ciara McClarey and Vicky MacBean

Introduction: A paediatric musculoskeletal triage clinic (PMTC) was developed in response to increased waiting times and an increased volume of complex referrals. The clinic was led by an advanced practice physiotherapist (APP) with advanced clinical practice (ACP) training and licensing to refer for Musculoskeletal imaging.

Aims: To evaluate a PMTC delivered by an APP in an integrated acute and community organisation, in relation to appointment outcomes, satisfaction and time from referral to clinic appointment.

Methods: A prospective service evaluation was completed and included all patients aged up to 17 years requiring musculoskeletal triage, who were accepted into the PMTC from February–July 2021. Diagnosis, initial PMTC appointment outcome and waiting times were gathered from electronic records. Satisfaction feedback was gained from children and young people (CYP) aged 12 to 17 years and parent/carers using the Modified Visit Specific Satisfaction Questionnaire (MVSQ, scored 0–100) and the Friends and Family Test (FFT). Feedback was gather from CYP aged 5 to 11 years using the CYP FFT.

Results: A total of 85 referrals were accepted into the PMTC and 82 CYP attended the clinic. Of the participants, 79.2% were managed autonomously by the APP after the initial PMTC appointment without referral to secondary care consultants. Mean(SD) MVSQ score was 92 (10.8), equivalent to excellent. Of the respondents, 99% rated the PMTC service as ‘Good’ or ‘Very Good’ on the FFT. There was a statistically significant (P=0.005) difference in mean waiting time, from 46 days in the paediatricians clinics to 6 days in the PMTC.

Conclusions: An APP-run PMTC allowed autonomous management of CYP, had high satisfaction ratings and lower waiting times. PMTC long-term outcomes remain to be evaluated.


Developing advanced practice in primary care: an innovate collaboration to develop 16 advanced practitioners to meet the needs of housebound patients within North Tyneside

Judith Lawrence and Jayne Theasby

Introduction: The development of the community nurse practitioner (CNP) role in North Tyneside was commissioned by North Tyneside clinical commissioning group (CCG) and commenced January 2021. The project was an innovative partnership between Northumbria Healthcare NHS Trust, Northumbria University and the CCG.

Aims: To improve patient access to appropriately skilled and qualified community nurses. The focus was to support the delivery of care by existing community, frailty and intermediate care services in North Tyneside and to work collaboratively with GP practices.

Methods: Over the last 18 months the practitioners have undergone a period of academic preparation completing a post graduate certificate in community care, which includes history taking, clinical skills and non-medical prescribing. During the 18 months they have had a number of clinical placements in primary, community and secondary care settings, working in collaboration with 10 GP practices across North Tyneside. This role will undertake a holistic clinical assessment of patients who initially present with unplanned/urgent (non-emergency) health needs.

Results: At the time of assessment, the CNP will identify any other non-urgent health and social care problems that need attention and implement a programme of care, which may include arranging appropriate investigations and onward referrals as deemed necessary. The CNPs will be part of the Care Point multidisciplinary team (MDT). The initiation of a clinical management plan will be discussed and shared with the registered GP and other MDT members involved in the patients care.

Conclusions: This was a challenging project that commenced during Covid-19. Imaginative and innovative practice and professional development allowed this project to succeed in a time of immense pressure within the NHS.


Is the triage review radiographer service effective so that only the clinically necessary are redirected to the oncology emergency service?

Rachel Russell

Introduction: According to the Clinical Advice to Cancer Alliances for the Commissioning of Acute Oncology Services document, out-patients should have a pathway for rapid review and access to appropriate services or advice.

Aims: To establish if the service successfully resolves patient adhoc treatment issues, to ascertain the impact the triage service has the workload of the on-call doctor, and to identify any trends that require higher level of interventions.

Methods: Narrative syntheses of quantitative methods model with retrospective data collection was conducted in a radiotherapy department within a general hospital. This study included all patients during a defined period.

Results: Radiographers were able to manage 74% (n=117) of the interventions required without input from the external medics after the service implementation, with 26% requiring management by the on-call doctor, the emergency assessment bay, accident and emergency, or a GP. The radiotherapy-led triage service reduced the radiotherapy workload of the on-call doctor by 58%. Increased likelihood of requiring an intervention or triage associated with patient sex (χ2(1)=12.344, P=<0.001) and diagnosis (χ2(20)=50.044, P=<0.001). It was also suggested that there was a statistically significant association between intervention category and diagnosis (χ2(80)=102.995, P=0.043).

Conclusions: The project found that the service is managing patients effectively, reducing the workload on the junior doctor team and has identified three factors that may be areas for further research.


Are you still an advanced clinical practitioner if you do not practice clinically? A Personal journey through the four pillars

Tamsin Mauri

Introduction: Moving away from clinical practice after working as an advanced clinical practitioner (ACP) for 10 years, is it possible to leave the clinical practice pillar behind and still keep the title ‘ACP’?

Aims: To demonstrate the journey to becoming a non-clinical ACP and the benefits of a non-clinical role.

Methods: Mapping the author's personal career journey using the four pillars of advanced practice to demonstrate the variation.

Results: Advanced clinical practice is a defined level of practice, by using their experience, knowledge and skills, ACPs can positively impact on patients, staff, patient care, education and clinical practice. The author's non-clinical ACP role encompasses multi-professional and multi-sector working, including primary, social, community and secondary care, ambulance service, mental health services, clinical commissioning group, healthier together and the health and care charity sector.

Conclusions: ACPs have a set of unique skills and experiences that can make them excellent managers, help them to transform and modernise pathways of care, and enable the safe and effective sharing of skills across multi professional and multi sector services. As a non-clinical ACP, the author demonstrates and uses their clinical knowledge while maintaining their professional registration. The author set up new services to meet the objectives in the NHS People Plan, and the People Promise and the Health and Wellbeing Framework. Their clinical background, knowledge and skills puts them in the unique position to understand the clinical needs of patients to influence senior management teams, make a positive impact and still be an ACP.


Thematic analysis of challenges within an advanced practice workforce

Diana Comerford

Introduction: There is an increasing demand for the advanced practitioners (AP) role. APs face multiple barriers, including role clarity, role use and additional factors impeding autonomy, both nationally and internationally.

Aims: To develop the Trust's strategy to mitigate barriers and improving recruitment and retention of APs, challenges need to be understood.

Methods: Data were collected from those who had ‘advanced’ and ‘practitioner’ within their job titles and those perceived to be in an advanced role, based on previous scoping. Informal discussions occurred to understand their role within the organisation and challenges. Qualitative data were collected and recorded in Excel for 15 practitioners. Of which, nine had advanced and/or practitioner in thier job title, one was a specialist physiotherapist, two were a nurse consultant or midwife, and two were lead nurses. Thematic analysis was performed to understand common challenges.

Results: Themes developed showed the following were required: career progression pathways beyond Band 8a; structures and resources for governance, supervision and support; role clarity and congruent job descriptions; and opportunities to develop the four pillars of advanced clinical practice (clinical, leadership, education and research).

Conclusions: The results are valuable baseline views of APs to challenges faced. Some were not in AP roles but felt they were practising at advanced level. The results support the importance of role definition to provide clarity and expectations. These conversations contributed to developing an AP forum, policy and engagement from leaders to understand AP roles. Additionally, this study created the opportunity to review the Trust's overall supervision and governance provision for the future, with improved stakeholder engagement as a central element.


Improving the management of tobacco dependence

Emma Toplis, Lucy Boast, Judith Hampson, Robert Smithers, Hayley Gleeson and Gillian Lowrey

Introduction: The NHS Long Term Plan states that all inpatient smokers should be offered treatment for their tobacco addiction by 2023/24. At University Hospitals of Derby and Burton (UHDB) NHS Foundation Trust, a multi-professional, multi-service group including community partners was formed in October 2020 to optimise the management of tobacco dependency.

Aims: Over a 12 month period to train 50% of respiratory ward staff in very brief advice (VBA), simplify prescribing of nicotine replacement therapy (NRT) and to increase the number of referrals to community tobacco dependency services.

Methods: Three key areas were addressed: training and education, prescribing and access to NRT and referrals to community tobacco dependency teams. VBA training was delivered to respiratory staff. An electronic NRT order set was created on the Trust's prescribing software based on CURE methodology and respiratory ward stock lists updated to include NRT. A secure email for outpatient referrals and a direct referral via the trust electronic system for inpatients was implemented.

Results: In total, 50% of respiratory ward staff were trained in VBA, successfully implemented a NRT order set and increased the prescribing of NRT. Referrals to community tobacco dependency services significantly increased from 2 pre-intervention (Q4 2020), to 103, 181, 134 and 147 (Q1–4 2021). Of the treated patients, 59% accepted support and 36% were smoke free at 1 month.

Conclusions: The success of the project is because of the collaboration with the community partners in order to provide a comprehensive, patient centred approach to tobacco dependency management. The successful respiratory department pilot has now been expanded Trust-wide.


Embedding equality, diversity and inclusivity within a multi-disciplinary non-medical prescribing education programme: shared experience of curriculum modifications in response to student feedback

Wendy Churchouse, Beth Griffiths and Peter Sewell

Introduction: Swansea University delivers a multi-disciplinary non-medical prescribing (NMP) programme. The programme reflects the pillars of advanced/enhanced practice and the Royal Pharmaceutical Society competency framework for prescribers. The programme empowers students to critique and develop their practice from both a clinical and governance perspective. All NMP students are qualified and experienced practitioners. Therefore, knowledge of unconscious bias, equality, diversity and inclusivity (EDI) should be integral to their practice. However, adhoc informal NMP student feedback prompted a critique of the curriculum in regards to unconscious bias and EDI.

Aims: To collaborate with students to critically review the NMP curriculum in regards to unconscious bias and EDI.

Methods: Likert scales were used to quantify NMP student knowledge and confidence about integrating EDI and avoiding unconscious bias into contemporary practice. Thematic exploration of individual/adhoc student feedback was then completed.

Results: The NMP curriculum has been modified to provide 2 study days dedicated to unconscious bias and EDI. These include interactive sessions with experts in transgender, mental health, substance misuse, older persons and learning disabilities.

Conclusions: Empowering NMP students to explore and question their individual practice and that of others in regards to unconscious bias and EDI is an essential part of advanced practice. Advanced practice education should be exemplars of best practice, innovating and inspiring transformative health care.


Allied health professional led soft tissue returns clinic within an urgent care setting

Alex Buckley and Mike Bryant

Introduction: Patients referred out of traditional accident and emergency/urgent care centres (UCCs) into fracture clinics or outpatient physiotherapy clinics, have a high failure to attend rate. This leads to patient anxiety and delays to appropriate care.

Aims: To screen patients who were deemed ‘significant soft tissue injuries’ and required either specialist musculoskeletal (MSK) follow up or orthopaedic opinion within the fracture clinic.

Methods: A pilot period of 6 weeks, from which four clinics holding nine patients each was set up within the urgent care centre at Burnley General Hospital. Patients were screened using previous UCC notes, alongside an inclusion criteria and a formal clinical assessment. Point of care ultrasound was used if it was deemed clinically appropriate by the consultant physiotherapist.

Results: A total of 34 patients were seen within the clinic. Only 9% of patients went on to have more formal investigations organised (two magnetic resonance imaging scans and one X-ray). The patients who did have more investigations all went on to a surgical opinion or procedure. A total of 11 patients (38%) had point of care ultrasound (POCUS) to aid in the diagnosis and treatment planning. More significantly, 13 patients (45%) needed no further follow up or investigations after the clinic session. In total, five patients (14%) failed to attend the clinic.

Conclusions: The pilot study showed that patients normally referred to fracture clinic or MSK services can be managed more effectively and timely in a specialist run soft tissue returns clinic. This improves patient outcomes, reduces anxiety and focuses on the patient journey.


Three-to-one spine advanced practitioner clinic: a service development project

Andrew Kemp, Stephanie Hemmings, Andrew Coombs, Laura Finucane and Johan Holte

Introduction: Post-pandemic, musculoskeletal (MSK) outpatient waiting lists increased, notably within the MSK advanced practice pathways, requiring a strategy to reduce wait times. An initiative service development project involving a MSK clinic led by a spine advanced practitioner (AP) overseeing three experienced Band 7 clinicians was proposed.

Aims: To reduce the spine MSK pathway wait times using three Band 7 clinicians to cover an AP role and to bridge a training gap between the respective roles.

Methods: In total, three Band 7 clinicians were given initial training followed by clinics of three one-hour appointments for new routine patients on the spine MSK pathway. The supervising AP did not carry a clinic list, allowing for discussion upon patient management and clinical reasoning. One year after the clinic had started, the number of patients seen and clinic outcomes were compared against established AP outcomes. Clinicians were also asked about their experiences of being involved in the three-to-one clinic.

Results: Over the year, 54% more new patients were seen in the three-to-one clinic compared to a single spinal AP clinic (214 and 141, respectively). Clinicians described a safe, enjoyable and supportive learning environment, gaining experience of working in an advanced practise role building upon their knowledge and skills within this pathway

Conclusions: This service initiative allowed a greater number of routinely referred patients to be seen in the spine MSK pathway. Overall, clinicians felt their current roles had benefitted and described a safe and supportive environment.


Does an advanced practitioner led fracture clinic add value to a trauma outpatient service?

Daniel Scarffe, Fiona Cowell, Sarah Butler, Rebekah Edwards, Claire Wright and Kerry Mclean

Introduction: Fracture clinics are traditionally led by orthopaedic surgeons. As advanced practitioners (APs) with a physiotherapy base profession, the authors have expertise in the orthopaedic management of acute musculoskeletal injuries and rehabilitation. In keeping with the NHS Long Term Plan and new ways of working, AP led fracture clinics have the potential to add value by enhancing patient experience, integrating orthopaedic management with rehabilitation, streamlining care pathways and improve efficiency.

Aims: To evaluate the outcomes of an AP led fracture clinic over 6 months in 2022, identifying conditions that can be successfully managed in this environment, efficiencies in care pathways and capture patient satisfaction.

Methods: Empirical data were collected and analysed on diagnosis, referral source, follow-ups, onwards referrals to physiotherapy and consultant led clinics. A simple questionnaire was used to evaluate patient experience.

Results: Out of a total of 364 patients, 71% of patients required only one visit and 28% required onward referral for further rehabilitation. Of the patients, 8% required follow up in a consultant led fracture clinic. Patients reported a high level of satisfaction.

Conclusions: AP led fracture clinics are a safe and effective way to manage patients with musculoskeletal injuries not suitable for surgery, with high levels of patient satisfaction. This study provides a template for other services and can be compared to consultant led fracture clinics and facilitate future cost analysis.


Improving and standardising discharge summaries in a regional oesophagectomy unit: implementing a template tool

Rosie Forbes

Introduction: Discharge from hospital following Ivor Lewis Gastrooesophagectomy (ILGO) occurs as early as 7 days following this major two-phase surgery. Consequently, a comprehensive discharge document is fundamental in maintaining effective communication with community care providers, and upholding patient care and safety beyond the acute hospital setting. A retrospective audit revealed the inclusion of quality information varies greatly across discharge documents.

Aims: To improve the quality of the discharge document for patients who have undergone ILGO. By standardising the information provided, patients' safety and experience of care and recovery beyond the acute setting will be improved.

Methods: The project design employed a plan, do, study, act (PDSA) method to implement a discharge template tool within a regional oesophagectomy unit. Engagement with the wider health professional team generated key components for inclusion in an exemplary template. The key components were used to benchmark the standard of ILGO discharge summaries retrospectively prior to template implementation. Following implementation, an audit was conducted to measure the templates' use in practice.

Results: Following implementation, ILGO discharge summaries were audited for use of the template tool in practice. The template was used in 19 of the 23 summaries examined.

Conclusion: The implementation of a high quality template, formulated using a multi-disciplinary approach, offers a foundation in enhancing patient safety and continuity of care, as well as strengthening the knowledge of care providers for patients undergoing ILGO, and increasing the efficiency of the discharge document completion.


Four-to-one hip and knee advanced practitioner clinic: a service development project

Steph Hemmings, Andrew Kemp, Mary McAllister, Laura Finucane and Samantha Dawes

Introduction: Owing to the Covid-19 pandemic, musculoskeletal (MSK) advanced practice pathways increased markedly, requiring a strategy to reduce wait times when services resumed. An initiative involving a MSK clinic led by a hip and knee advanced practitioner (AP) overseeing four experienced Band 7 clinicians was proposed.

Aims: The aim of the project was to reduce the hip and knee MSK pathway wait times using four Band 7 clinicians to cover an AP role and to bridge a training gap between Band 7 and AP roles.

Methods: Four Band 7 clinicians were given initial training sessions on notes systems, letter templates and relevant guidelines. Four staggered one-hour appointments for new routine patients on the hip and knee MSK pathway were allocated per clinician with the AP not carrying a clinic list. This allowed for discussion around clinical reasoning. A joint debrief session followed at the end of the clinic. After 1 year, a focus group was held to capture clinicians' experiences of being involved.

Results: Over 14 months, 65% more new patients were seen in the four-to-one clinic compared to one AP (446 and 270, respectively). Clinicians reported the benefits of bridging the gap in knowledge and experience with their roles outside of the clinic and working in advanced practice in a supported and safe way.

Conclusions: This service initiative helped reduce waiting times for those routine patients on a hip and knee MSK pathway following the pandemic. Overall, clinicians felt their current roles had benefitted through AP training done in a supported manner.


The respiratory advanced clinical practice network is born: supporting the growth and development of respiratory advanced practice for the future

Rebecca Stacey, Andy Lee, Emma Toplis, Kathryn Thomas, Rebecca Kurylec and Padmavathi Parthasar

Introduction: In response to a lack of standardised approach to the development of a UK advanced practice (AP) workforce, the respiratory advanced clinical practice (ACP) network was formed in 2021.

Aims: To embed the ACP role into respiratory medicine. The vision is to create a validated and structured educational platform linking to continuous professional development and provide support to shape a sustainable ACP workforce.

Methods: ACP focus groups led by founding members were held, with twitter and word of mouth used to generate interest. ACP case studies were published on the British Thoracic Society (BTS) website, which launched during National AP Week. Conference stands promoting the network were held at Birmingham, Sheffield and the BTS summer meeting. This facilitated the Enquire-Connect-Inspire (ECI) networking platform and a free educational webinar. Chair interviewed by Respiratory Futures and Health Education England.

Results: A total of 90 UK-based network members signed-up between November 2021 and June 2022. Of these members, 77 (86%) were trainees or trained ACPs and 13 (14%) were other health professionals. In total, 97 participants signed-up to the ECI and 24 attended the educational webinar. An unquantified number of twitter and face-to-face contacts and 10 emails have enquired about trainee and trained ACP competencies. The number of trained respiratory ACPs in the UK is currently unknown.

Conclusions: Within 10 months the network has gained 90 members, and with a growing sphere of influence, has the potential to increase its membership further. There is a clear appetite for APs to access professional and clinical support provided by an ACP-lead network.


Perceptions of advanced practice in oncology amongst the multi-professional workforce

Leanne Osgood, Joanne Harris, Elizabeth West, Delia Sworm, Sarah Loizou and Daniel Jennings

Introduction: In response to the NHS Long Term Plan and national shortages within the medical oncologist workforce (17% shortfall), an oncology division adopted a workforce model to embed a multi-professional advanced practice (AP) team to help transform service delivery and better meet local health needs. Anecdotally, there still appears to be mis-conceptions around role definition and scope of practice, which in turn can lead to a myriad of titles for such roles emerging in practice.

Aims: To evaluate the perceptions of staff of the multi-professional AP role in the oncology division and to identify if more support is required to embed AP roles within oncology.

Methods: A self-completed questionnaire was distributed electronically, aimed at clinical staff and senior managers within the oncology division to check assumptions. The questionnaire was open for 4 weeks and contained a mix of qualitative and quantitative questions.

Results: The following categories emerged across the professions: variance in titles of AP in oncology, understanding of the role (trainee versus qualified), national and local policy, and areas for improvement to support embedding roles.

Conclusions: There is acknowledgment of the positive impact of APs within oncology. However, to ensure that AP roles are fully understood by the multi-professional team, there needs to be improved communication that includes clear role definition, clarity on job titles and a more visible presence within the multi-professional team by APs showcasing their work and impact on services.