Advanced practice toolkit

Advanced practice has been evolving across the four UK countries since the 1980s. Definitions, scope of practice and educational preparation have been refined over this time and are continuing to develop. More information about how advanced practice developed in the UK can be found in the Association of Advanced Practice Educators (AAPEUK) Student Handbook page 4.

Developing and increasing the number of advanced practitioners is a significant element of the Scottish Government strategy to develop and retain experienced clinicians within the workforce. Work began on the Transforming Roles programme in 2014/2015 and is now in the process of being revisited.

The Transforming Roles programme aims to provide strategic oversight, direction and governance through:

• Developing and transforming nursing, midwifery and allied health professions (NMAHP) roles to meet the current and future needs of Scotland’s health and care system.
• Ensuring nationally consistent, sustainable and progressive roles, education and career pathways across professions, services and Boards.
• Career structure and clarity around levels of practice.
• Clarity in understanding roles.
• Development of roles using a consistent process.

Since 2017 the education of advanced practitioners has experienced greater standardisation and clarity. In many cases a typical journey is now likely to involve:

• Application for a training post
• Specific training programme or module (a Master’s programme tied in with supervised practice and work-based learning)
• Assessed as competent for role
• Undertaking Advanced Practitioner role
• Continuing professional development within an Advanced Practitioner role

Currently the development of a national approach to advanced practice is a key strand of the new Workforce Transformation model featured in the diagram below, which underpins Transforming Roles.

The Scottish Government produced an Allied Health Professions (AHP) workforce and education review in Feb 2023 which will contribute to a national approach to advanced practice amongst different professions.

At present (Nov 2023) Advancing Midwifery Practice and Advanced Clinical Practitioners in Midwifery are being considered as part of the Midwifery Career and Education Framework for Scotland activity. Until now, the Transforming Roles Programme in Scotland has not had specific activity in the midwifery space and there is a need to understand both the service and educational needs for such developments. NHS Education for Scotland (NES) is working closely with the Chief Midwifery Officer in Scotland to develop a Midwifery Career and Education Framework for Scotland. The early focus may be on remote and rural practice.

Health Education England (HEE) have published the Advanced Clinical Practice in Midwifery Capabilities Framework in Nov 2022 to support the development of new midwifery roles.

The Royal College of Emergency Medicine and the Faculty of Intensive Care Medicine (RCEM) recognised the reduction of availability of medical staff in emergency and intensive care settings. They undertook extensive and robust work in considering the options to ensure the maintenance of safe and effective practice. This work led to staff development opportunities for nurses and allied health professionals culminating in the production of curriculum frameworks for Advanced Clinical Practitioners (ACPs). The title reflects a focus on clinical practice which was the key to this role development and practitioners can now apply for credential status with these organisations.

The Royal College of Emergency Medicine issued a statement in May 2022 affirming healthcare requires a diverse workforce and the role of the ACP is both welcomed and valued.

For further information on workforce development see the Workforce section.

Shaping the future of AHP advanced practice roles in Scotland

The Scottish Government NHS Recovery Plan aims to transform care delivery to address current challenges and ensure long-term sustainability. A key component of this transformation is maximising Allied Health Professional (AHP) skills at all levels of practice, as outlined in the Scottish Government’s AHP Education and Workforce Policy Review.  Advanced practice roles are crucial to this agenda, offering benefits such as:  

• Improved access and patient experience  
• Reduced waiting times and hospital admissions  
• Addressing workforce gaps  
• New career opportunities and improved job satisfaction for staff  

However, the development of these roles has raised critical questions about defining advanced practice and identifying the core skills and capabilities required.   

Scoping of AHP Advanced Practice in Scotland 

NHS Education for Scotland’s recent report Scoping of AHP Advanced Practice in Scotland revealed encouraging support for AHP advanced practice roles within some NHS Boards.  This includes the establishment of Leads for AHP Advanced Practice, the development of policies and strategies and the creation of local networks and support groups. Additionally, most services actively evaluate the impact of AHP advanced practice roles, employing a wide range of methods to assess their effectiveness.  However, the report also identified several key challenges including: 

• Inconsistent support for AHP advanced practice across Boards 
• Challenges in identifying AHP Advanced Practitioners due to incomplete workforce data 
• Absence of a national definition and competency frameworks  
• Lack of standardised job plans and evaluation tools  
• Limited awareness of existing resources such as the NES Multiprofessional Advanced Practice Toolkit and Advanced Practice Academies 

NES Commission Transforming Roles AHP advanced practice roles in Scotland 

In response to these findings and the AHP Education and Workforce Policy Review, the Scottish Government has commissioned NES, in collaboration with the Scottish Directors of AHPs to support the development of AHP advanced practice roles.  The commission has four key objectives: 

1. Establishing a consistent national definition for AHP advanced practice roles  
2. Establishing consistent national job titles for AHP advanced practice roles 
3. Developing an AHP-specific Transforming Roles paper to provide clear direction for advanced practice roles in Scotland   
4. Creating robust systems for developing knowledge, skills and behaviours frameworks in priority areas of AHP practice. 

Engaging with Stakeholders and the AHP Community 

The success of this commission will rely heavily on collaboration and engagement with key stakeholders. Three groups will be established: a Steering Group, Stakeholder Group and Reference Group.  Work is underway to disseminate findings from the Scoping of AHP Advanced Practice in Scotland report and raise awareness of the commission and its goals.  

Anticipated Impact 

This commission is expected to transform the future of AHP advanced practice roles in Scotland by: 

• Establishing a consistent definition of AHP Advanced Practice across professions 
• Standardising job titles to enhance workforce clarity and coherence 
• Enabling workforce systems to easily identify AHPs in advanced practice roles, facilitating better workforce planning and development 
• Enhancing governance and quality assurance of AHP advanced practice roles. 

This work will play a crucial role in supporting NHS Scotland’s recovery, ensuring that the skills and contributions of AHPs are fully maximised for the benefit of patients and the wider healthcare system. 

For more information contact: 

Dr Valerie Blair, AHP Programme Director, NES Valerie.blair@nhs.scot or 

Dr Anna Julian, Senior Educator, NES anna.julian@nhs.scot or 

Kirsty McLachlan, Senior Educator, NES kirsty.mclachlan@nhs.scot or 

Lynsey Ferguson, Specialist Lead, NES lynsey.ferguson@nhs.scot or 

Sheila Wilson, Specialist Lead, NES sheila.wilson3@nhs.scot  

Useful resources

Advanced Practitioner Survey

https://sway.cloud.microsoft/Nk3AOn8hICRN6Urv?ref=LinkAHP AP Commission Briefing.docx