What is the criteria for Advanced Practice?

What is Advanced Practice or Advanced Clinical Practice?

Each country has defined Advanced Practice (AP) in its documents/frameworks for AHPs. All definitions are broadly similar and include working to the 4 pillars of practice. For further information see our Enhanced Practice to Advanced Practice webpage.

The definitions are as follows:

Advanced Practice/Advanced Clinical Practice is a level of practice which is undertaken by an experienced, registered practitioner with complex decision-making skills. It encompasses 4 pillars of practice (which are slightly different across the UK), these are summarised in the BDA post-registration professional development framework as:

Clinical Practice,
Evidence based Practice research,
Facilitated learning
Leadership

Criteria for Advanced Practice - Identifying the Opportunity

The need for the Advanced Practitioner role will be service specific but there are common themes. All roles will differ due to the unique set of circumstances in each organisation.

Across all 4 nations of the UK, policy and framework documents have some variation but all agree on the following:

Key attributes	Description
Service needs analysis	Is a service needs assessment required? Does the pathway require a redesign? What does service user feedback show?
Workforce gaps - How is this post addressing workforce needs and how could it flex and adapt to meet future needs?	Are there long wait times or a significant back-log? The AP roles should support timely access to care. Fill a workforce gap? Is there a shortage of appropriately skilled medical or other staff to provide the service e.g. Gastoenterologists to deliver the Irritable Bowel Syndrome(IBS) service ? Are you the professional with the best skills/capabilities to deliver this service e.g. as a one stop shop? Increase career opportunities for experienced staff helping retention. Efficient resource use, including other healthcare professionals' time.
Pathway reviewed and ensured it is accessible to all groups within the target population	Meets equality, diversity and inclusion agenda e.g. non-English speaking refugees or recently settled immigrants; travelling families; those living in areas of deprivation. Services for the management of type 2 diabetes meet the needs of those at highest risk.
National Priorities Meets a need in a target population /priority group of patients e.g. mental health, frailty, ketogenic diets, inborn errors of metabolism, gastroenterology etc	Governments have determined the priority areas where there are long patient waits/high demand without the relevant workforce to expand e.g. mental health (including eating disorders), cancer, gastroenterology.
Working across all 4 pillars of practice	Clinical – working at a highly specialist level, generally over a number of years. Leadership – managing and supporting others to deliver a high-quality service. Facilitated Learning/Education – supporting training and development of relevant staff and target groups. Research (and evidence based practice) – supporting audit of own and others work across the pathway; ensuring it is evidence based.
Working at level 7/ masters level	In England, this is either recognized via HEE’s supported ePortfolio route or by undertaking one of the HEE accredited Advanced Clinical Practice courses, which are generally multi professional. In Wales recognition is within the health board with health boards setting their own but similar criteria. “Demonstrable, relevant Masters level education is recommended for entry level” In Scotland, recognition is via Post-registration qualification which shows; evidence of operating/thinking at Master’s level and/or evidence of working towards relevant Master’s level award. In Northern Ireland: “A master’s level qualification or equivalent could therefore include a number of postgraduate short courses, focused mentorship over a prolonged period and/or extensive experience in an area of advanced practice”.
Define capabilities	State what the Advanced Practitioner should be able to do. Further information regarding the capabilities detailed across the 4 pillars can be found at: England Northern Ireland Scotland Wales
Managing complexity and risk	As a registered health care professional, the Advanced Practitioner is managing a discreet part of the patient pathway; the Advanced Practitioner is also responsible for managing the risk in this area. Services are delivered safely as the AP meets the capabilities of the role and escalates appropriately to a senior clinician.
Evaluation – measuring outcomes	Advanced Practitioners demonstrate this by evaluation of stakeholders and service users. Whole service evaluation may be relevant. Advanced Practitioners should be able to demonstrate positive outcomes for the target group by undertaking regular clinical audits. This includes clinical outcomes and patient satisfaction, and possibly comparison to medical led clinics.
Multi professional – not just 1 profession (England and Wales)	Often, but not always, this is defined as an Advanced Practice role that can be undertaken by more than 1 profession, for example: A Dietitian and a diabetes specialist nurse for an Advanced Practitioner role in Diabetes.

These considerations will support Dietitians, and their managers, to develop a business case for Advanced Practitioner roles.