Advanced Practice, is defined by the respective frameworks across all 4 nations. Each framework sets the minimum standard for the safe and effective practice at this level. This document lists general criteria taken from the BDA Post Registration Professional Development Framework for both enhanced and advanced practice, and should aid you in identifying the differences between the two levels and what you need to do to progress.
The Advanced Practice frameworks include the four pillars that underpin practice:
The term Advanced Practitioner is used as a consensus umbrella term to encompass the wide range of registrants who work at Advanced Practice level across the four pillars, often with variable job role titles, across a range of professional backgrounds and settings.
These advanced capabilities can be demonstrated in different ways depending on the setting or role that the practitioner is practising, which means that there is flexibility for employers to determine how Advanced Practitioners demonstrate these capabilities, based on person centred care around the service, patient, team, and organisational needs.
Advanced Practitioners can demonstrate expertise and professional judgement to achieve these capabilities in areas such as: clinical examination, diagnostic decision making and therapeutics, collaborative communication skills in consultations, critical thinking, and clinical decision-making, and the leadership they demonstrate in their teams and services.
Defining the level of practice can be complex, and there is recognised ambiguity across all professions. When you graduate and begin in clinical practice, this is defined as at academic level 5. As you develop your practice, ie. move into enhanced or extended practice with disease specific or management responsibilities, you may be considered to be working at an enhanced level, defined as level 6. This may or may not be associated with academic studies, described as level 6 (academic level). Advanced Practice is defined as level 7 (masters level) practice. Your capability and responsibilities, specialist or generalist, will be reflected in your job description, and therefore also often reflected in your Agenda for Change banding. These levels do not necessarily correlate with your Agenda for Change banding, but the academic level or level of practice you are working at.
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| Level 5 | Level 6 | Level 7 | Level 8 |
| Bachelor's degree or equivalent ; some graduates new to the profession have Masters level qualification but have limited clinical experience | Developing depth of practice to +/- Masters Degree level | Masters Level (or equivalent) across the 4 pillars of practice | Doctorate level |
| New graduate | Extended or Enhanced Practice | Advanced Practice | Consultant practice |
Each level may be a destination in itself, but this illustrates how a newly registered dietitian can progress through the levels to consultant practice. Further details defining Enhanced and Advanced Practice are in the table below.
Details of what constitutes consultant practice can be found here.
Enhanced practice
Enhanced level is defined as having an in-depth knowledge and understanding of an area of practice and routinely delivering a high standard of practice. Enhanced practice is a level of practice healthcare professionals can attain and is used to describe the practice of highly experienced, knowledgeable healthcare professionals.
It is important to recognise that use of the term advanced in a job title does not necessarily correlate with the post holder working at an Advanced Practice level. You may be undertaking some extended scope roles. For example: using cognitive behavioural therapy to support people living with obesity, replacing gastrostomy tubes in the community, inserting peripheral midlines for IV feeding, ordering, interpreting and taking action on abnormal blood results and supplementary prescribing prescription only medicines. These roles alone do not necessarily mean you are working at Advanced Practice level as Advanced Practice relates to all 4 pillars mentioned above.
A study identified many job titles that included the term ‘Advanced’. The significant difference between extended or specialist roles and Advanced Practice roles are that the latter will have advanced skills outside of their traditional skill set. For example, an extended role Dietitian may place and manage a variety of feeding tubes, considered to be a specialist extension of a role. An Advanced Practitioner, would have advanced skills outside of the tradition or indeed extended skill set e.g. advanced clinical assessment and decision making, diagnosis, interpreting the relevant investigations and then delivering treatment.
The tables below are divided by the 4 pillars of practice.
By comparing the details under each of these pillars, you should be able to analyse what level you should be working towards, by each pillar. This should help you understand where your level of practice is, and to identify your areas for development to enable progression. In England this becomes clearer when gaining recognition by the ePortfolio route. Routes of recognition tend to be more locally determined in N. Ireland, Scotland and Wales.
- Pillar 1 - Clinical Practice
- Pillar 2 - Research and Evidence-based Practice
- Pillar 3 - Facilitated Learning
- Pillar 4 - Leadership
Pillar 1 - Clinical Practice
| Enhanced level | Advanced Level | |
| Practices safely and effectively |
Uses freedom to act within own scope of practice and Is able to manage more complex situations. Completes assessment, diagnosis and planning in a suitable time frame. Uses complex decision making but confers with others for overall plan. Has a specific body of knowledge. Ensures efficient, evidence-based practice. May extend their role with appropriate training and support. Understands the wider risks associated with their scope of practice and ensures systems are in place to proactively manage these risks. They may defer major decision making to a more senior manager/clinician. |
Uses freedom to act and manages situations that are complex and unpredictable. Is able to have a holistic view and take an efficient and evidence-based approach. Is able to modify plans for highly complex situations and works closely with colleagues to proactively manage risks, including complete management of episodes of care. Has a highly developed specific body of knowledge. Seeks to extend and advance their practice to the benefit of service users and colleagues. Creates and evaluates new developments and innovations. Identifies patterns and risks within the system and actively escalates concerns and leads on seeking solutions. Manages risks. |
| Service users |
Often manages a caseload, sometimes providing interventions as part of a dedicated clinical pathway. Seeks to coordinate services for the benefit of service users to ensure equitable access to services, for example, people with a disability who may have difficulty accessing clinic spaces, children of families where English is the second language or homeless people. Actively evaluates interventions against services user outcomes. Acts and takes initiative to implement interventions and follow through to completion. |
Manages defined episodes of clinical care independently from beginning to end. Involves service users in the design and evaluation of services. This should take into account equality, diversity and inclusion. Supports others to develop their service user focus ensuring all minority/vulnerable groups are included, where appropriate. |
| Communication |
Confidently communicates complex, sensitive information to a variety of stakeholders with the aim of influencing decisions and actions. All written information includes culturally appropriate foods which reflect the local demographics and population. |
Applies communication skills in challenging situations, including grief, distress, ambivalence or conflict, agreeing goals and working with multiple participants to advance best practice ideas, and influence policy at local, national and international level. Creates a climate of trust with others and is consistently truthful and honest in their dealings with others. |
Pillar 2 - Research and Evidence-based Practice
| Enhanced level | Advanced level | |
| Evidence informed Practice |
Promotes a culture of evidence-based practice. Demonstrates solid understanding of key evidence relevant to their practice and basic awareness and understanding of the latest research in the field. Is able to use evidence to inform practice, ensuring reflection and evaluation of effectiveness and outcomes. Supports others to access, understand, appraise and translate evidence into practice. Contributes to local evidence-based guidance. |
Demonstrates an in-depth understanding of latest evidence in the scope of practice. Demonstrates understanding of evidence from related fields and integrates into practice. Leads, or contributes to, local, regional or national evidence-based guidance. Disseminates findings to uni- and/or multi professional groups. Anticipates and offers support relating to evidence where needed. |
| Outcomes |
Demonstrates in depth understanding and application of a range of outcomes and quality measures, and supports others in their understanding and application. Measures, collates and uses data to evaluate the effectiveness of interventions or service delivery. Analyses and acts on results of quality measures to determine need for change or improvement with guidance. Shares results locally and seeks to benchmark data locally or regionally. This should include relevant data on equality, diversity and inclusion. |
Promotes and facilitates a culture of clinical effectiveness and measuring and evaluating performance. Links team outcomes and quality measures to local, regional and national priorities, and is able to communicate how team outcomes are contributing to these. Supports the team to measure, collate, analyse and evaluate data to evaluate effectiveness of interventions or service delivery and determine need for change or improvement. Tracks and benchmarks progress and results, and fosters accountability. |
| Service evaluation and quality Improvement |
Designs and undertakes local service evaluation and audit projects relevant to their scope of practice. Supports staff to undertake service evaluation, audit projects and translate findings into practice. Disseminates findings and uses them to identify service improvements. Takes responsibility for their own actions, outcomes and any user challenges to their practice, and works to improve. Actively challenges poor practice that undermines the quality of the services, or the delivery of expected outcomes and ensures that equality, diversity and inclusion of all local people. |
Coordinates large scale service evaluation and audit projects relevant to organisational priorities. For example, multi-professional services. May participate in peer review systems. Invites input from others in order to better evaluate or improve services. Develops service evaluation and audit activity, and/or integrates work into larger and broader quality improvement. Creates shared ownership and visibility of the quality improvement and evaluation activities. |
Pillar 3 - Facilitated Learning
| Enhanced level | Advanced level | |
| Develop resources to improve knowledge | Uses a broad range of teaching and learning techniques to ensure all population groups can access the health information, along with understandings of adult/children/young people learning, to develop and deliver a range of learning opportunities to a range of services users and multi professional team members. |
Designs and delivers programmes to develop individuals and services that support the delivery of best practice and meet the strategic aims of their organisation. Evaluates programmes of education and uses this evaluation to improve delivery. Provides information and resources to improve knowledge. Actively develops a learning culture in the team. |
| Information and resource development |
Produces and supports the production of resources that reflect the evidence base and best practice in the subject., and are culturally relevant to the local population. Understands information usability and quality tools. Is aware of various sources of information about food /nutritional products available in their work area that meets different needs / levels of health literacy. Knows how to go about producing ‘good’ information. |
Leads the identification of need for resources and secures their development for local use. Understands the research and evidence base relating to the usability and quality of food /nutritional products information sources. Understands the evidence-base around information that meets different needs and the impact. Understands what information is needed in an organisation to meet the needs of service users and staff. |
| Mentoring and supervision |
Actively participates in the development of supervision and mentoring programmes, including for pre registration learners and entry Level dietitians. Coaches others to find their own solutions |
Leading and coordinating mentoring and supervision for their team, including pre registration learners. Empowers individuals to solve problems and improve processes and practice. Provides supervision or mentoring for colleagues. Builds a well-functioning, multi-skilled team using mentoring and coaching. |
| Self development |
Identifies development needs and is proactive in developing or finding opportunities to develop self. Uses reflection and supervision to actively improve own service delivery. |
Has a strategic view of own development needs; aligning personal goals with organisational strategy. |
Pillar 4 - Leadership
| Enhanced level | Advanced level | |
| Strategy and Vision |
Has in-depth knowledge of national, regional and local strategies and policies, and their application in the development and planning of services, in their area of practice. Contributes to the development of local strategy, and to the policy and actions that deliver the strategy. Influences local and regional policy to ensure dietetics is embedded. |
Actively contributes to the development of national and regional strategies, and leads local strategy and policy development. Helps others to understand the importance of their contribution to the development of local strategy, and generates their team members' commitment to the strategy. Seeks out new opportunities requiring dietetic input and embeds them locally. |
| Managing change | Actively and effectively leads and participates in change and developments within their area of practice. |
Recognises, leads and manages change, taking into account cultural and political considerations. Understands the concerns of their team, addresses them, and engages their team in the change process. Is able to function effectively in a rapidly changing environment. |
| Advocacy |
Is able to use a variety of communication methods and interpersonal skills to engage others. Uses social media and other communication systems independently to deliver evidence-based information to stakeholders. Can adapt their behaviour and communication style to meet the specific needs of the target audience. |
Leads on advocacy strategies, actively engaging stakeholders to bring about change within local and regional spheres of influence. Leads the application of social media and other communication systems to support the development of others and the communication of evidence-based information to stakeholders. |
| Quality of Service |
Actively participates in projects which will improve the quality of the service and leads on aspects of the project as appropriate. Can articulate the impact of their practice in their area of work clearly to stakeholders. |
Accepts leadership roles in local, regional and national organisations and committees which seek to improve outcomes for service users. Accepts leadership roles to promote dietetics, nutrition and the profession. Demonstrates to decision makers the positive impact of a dietitian working in their area. |
In addition, you will require the following to move towards Advanced Practice:
- Undertaken and passed the relevant postgraduate courses, for example: Physical Assessment and Clinical reasoning (PACR) Paediatric masters level modules, non-medical prescribing qualification.
- Actively challenge poor clinical practices and behaviours that don’t meet the Standards of Conduct Performance and Ethics (HCPC), Standards of Proficiency for Dietitians (HCPC), Code of Professional Conduct (BDA).
For each pillar record your training and development as below :
| Learning/development need |
Development objective |
Achievement date | Strategies to use | Outcomes/evidence |
| What area do you need to address? | What specific goal will help you achieve it? | When do you hope to achieve it? | How will you achieve it? | How will you know you have achieved it? |