During early March 2023, Health Education England (HEE) had the privilege of working with multi-professional health education leaders from Australia. We collaborated with Universities Australia's Health Professions Education Standing Group (HPESG) to host senior academic, health policy and regulatory body colleagues for a week-long study tour in England to share learning on how the two countries are implementing innovative solutions to address healthcare workforce development challenges.
The study week was spent in animated discussion with multiple partners comparing, contrasting and learning from each other across several topics, including advancing practice. This study tour offered the opportunity to comparatively consider the recent progress of the advancing practice agenda and discuss its next steps. An interesting debate ensued about advanced practice regulation, credentials in speciality areas of practice, and ensuring that advanced practice is based upon levels of decision making, and not reduced to either tasks or creating a homgenous workforce.
The Centre for Advancing Practice team discussed the journey since the publication of HEE's Multi-Professional Framework for advanced clinical practice in England (2017), which highlighted the four pillars of advancing practice: clinical practice, leadership and management, education, and research. Also highlighted was the subsequent establishment of the Centre for Advancing Practice, which was established to support the quality assurance of advanced practice education and training.
The Centre and its associated regional faculties for advancing practice have enabled the requirements of the multi-professional framework to be scaled across the country and helped make advanced practice a recognisable, governable and deployable embedded feature of healthcare provision, which has the capacity to be dependably factored into workforce planning. Through its quality assurance processes, such as the programme accreditation of MSc advanced practice courses, the Centre has been standardising approaches to multi-professional advanced practice education and training to ensure efficiency and effectiveness in NHS investments for advanced practice. The Centre also promotes transparency in understanding equivalency of qualifications and skills for advanced practice, by ensuring advanced practitioner graduates that accredited programmes have similar outcomes for demonstrating the capabilities of HEE's Multi-Professional Framework (2017). There is a high level of engagement between universities in England and the Centre's programme accreditation processes, with 101 MSc advanced practice programmes from 39 universities accredited, to date. The principle of programme accreditation for quality assuring advanced practice education has been supported by key partners such as the Association of Advanced Practice Educators UK (AAPE UK).
Following the publication of the NHS Long Term Plan (2019), the Centre has overseen the development of credentials to address high-priority population health and patient care needs, and contribute to workforce transformation. Centre-endorsed credential specifications provide national capability and curriculum frameworks in high priority areas for transformation. They articulate the capabilities required for safe and effective advanced-level practice in defined areas, with these area-specific capabilities aligning with the capabilities defined in HEE's Multi-Professional Framework (2017). Credential specifications are produced by expert groups, including patient representatives and service users, and are considered for Centre endorsement through a process of independent review. Once endorsed, they are published as open-source documents on the Centre's website. To date, those published cover mental health, acute medicine, learning disability, rehabilitation, older people, autism, pelvic health, public health, and palliative and end of life care. All will be subject to periodic review to ensure they remain current and responsive to changing needs.
Centre-endorsed credential specifications are designed to be delivered by universities that hold Centre programme accreditation. They are primarily intended for delivery within universities' accredited programmes, either as area-specific pathways through programmes, or as optional modules within them. However, they can also be made available on a standalone basis specifically for take-up by practitioners who either already hold an advanced practice MSc qualification, or who successfully complete the Centre's ePortfolio (supported) route. Credentials' delivery and take-up should develop relevant advanced practice capability and capacity in response to changing population, patient and service delivery needs. In this way, they will contribute to demonstrating the value and impact of advanced practice workforce development and deployment.
To enable a greater shared understanding of the preparation of advanced practitioners, the Centre for Advancing Practice has created an ‘Advanced’ digital badge, which offers standardised recognition of the quality assurance of the education, training and learning experience of advanced practitioners. The Centre's ‘Advanced’ digital badge is available to both graduates of MSc advanced practice programmes that have been accredited by the Centre for Advancing Practice, or for existing, experienced advanced practitioners who have completed the Centre's ePortfolio (supported) Route.
The Centre's ePortfolio (supported) Route links directly with the Centre's ‘Advanced’ digital badge. The badge is designed to recognise the quality assurance of the equivalence of the educational and experiential preparation of existing, experienced advanced practitioners within the workforce. This scheme has been running since 2022 and now has three cohorts of approximately 1500 advanced practitioners (in total), from a wide range of clinical settings and professions.
These practitioners are supported by education providers to develop and assess their ePortfolios, and demonstrate their mapping equivalence to the capabilities across the four pillars of HEE's Multi-Professional Framework (2017). Applicants from core specialty areas have been grouped together with relevant education providers to ensure mutual understanding and build expertise. Some colleagues have already successfully submitted their completed portfolios and are now eligible to download the Centre's ‘Advanced’ digital badge, which denotes the quality assurance of their preparation as advanced practitioners.
As working in partnership with colleagues and organisations advocating for advancing practice is key to ensuring the success of the Centre's work, we have been delighted to be continuing our collaborations with both AAPE UK and the Council of Deans of Health.
The Centre's liaison with AAPE UK is currently focused on promoting and supporting the delivery of advanced practice credentials as an integral part of universities' advanced practice education provision. Through a series of AAPE UK-hosted webinars, we have been sharing, discussing and gaining feedback on our intended approach, as well as assuring the quality of credentials' delivery in ways that combine proportionality with due rigour. This will help us to identify how we can optimise enablers, address barriers to credentials' implementation and realise their intended benefits.
In partnership with the Centre, the Council of Deans of Health is working on an advanced practice project that aims to continue to engage universities with advancing practice developments. The initiative has produced a series of co-hosted webinars related to different aspects of advancing practice for all involved in this area, which have all been well attended with high levels of engagement and interest.
Looking ahead, the Centre plans to continue these important collaborations by exploring issues related to the workforce development of clinical academics for educating advanced practitioner trainees. This focus will ensure that those involved in advanced practice teaching are enabled to maintain their clinical practice recency, while concurrently developing their academic experience within the education pillar of HEE's Multi-Professional Framework (2017).
Organisations such as AAPE UK and the Council of Deans of Health have a UK-wide remit and, while the Centre's remit is mostly focused on England, we have been recently facilitating discussions with colleagues involved in advanced practice across the four nations of the UK to understand more clearly where both commonalities and points of difference on our approaches to advanced practice lie. Those deliberations are planned to be continued this year to develop and publish a consensus statement on advanced practice. This publication will represent a shared position for progressing an advanced practice strategy on a UK-wide basis.
Reflecting on a fabulous visit of international collaboration has given us a chance to see how far the work on advancing practice has progressed with stakeholders across the country. This work will continue to transform services by expediting access to care, and improving experiences and outcomes for patients, families and carers.
Finally, please remember this journal is intended for all in the advancing practice community to share our experiences, insights and innovations, as well as develop our collective knowledge and skills, so please do contribute. This can be either as an author or a peer reviewer. For more information, please get in contact with the journal editor, Sean Boyle, at: sean.boyle@markallengroup.com.