In health and social care, the titles, 'expert', 'specialist' and 'advanced', are used interchangeably, resulting in a lack of consistency and potential confusion.
Over the past few years, our four home countries have sought to define Advanced Practice (AP) (also known as Advanced Clinical Practice (ACP) with AP frameworks that include four pillars of practice (a variation of the following: clinical practice, Education, Research, Leadership and Management):
For a healthcare professional to be considered to be working at AP level, they will need to be able to evidence that they are working at (educational) level 7 in each of the four pillars identified in the AP frameworks above.
The clinical practice pillar may include the following: physical examinations, ordering and interpreting diagnostic tests, managing undifferentiated diagnosis, performing clinical procedures, formulating treatment plans, coordinating care and prescribing medications.
Once qualified as an AP, the role should be paid indicative of agenda for change pay band 8a.
The BDA Post-Registration Professional Development Framework defines AP in dietetics in the ‘Advanced’ section.
Why are AP roles being developed?
In 2018 the Kings Fund reported that in England alone, there was a shortage of more than 100,000 staff in NHS trusts. It was projected that this gap could increase to more than 350,000 by 2030 if staff leaving the workforce early continues to rise and those newly trained/international recruits do not rise sufficiently. Further challenges including: an aging population, higher public expectations of care and advances in medical and digital technologies adds to the current pressure. The NHS five year forward recognised AP roles as one solution to the current workforce issues. Health Education England then committed to funding a further 400 entrants to advanced clinical practice training in the 2020 People Plan.
These roles are developed to help upskill the workforce to help provide the right care in the right place at the right time to service users. This enables service users more timely access to care and makes the best use of sources including other healthcare professionals’ time.
AP positions are driven by service need, meaning that these roles are developed not just for promotional opportunities for healthcare professionals (although they do provide progression in clinical practice roles) but because the service requires an AP role.
Types of AP
There are different types of AP to cover different service needs:
Generic AP
An AP role in a general medical area of practice, for example, an AP in intestinal failure (for more information, see DT articles ‘ACP on intestinal failure unit’ below). These roles are usually advertised to any non-medical registered healthcare professional. Responsibilities include those usually undertaken by junior or middle-grade doctors.
Specialist Dietetic AP
An AP role in a specialist area of dietetic practice, for example, a dietetic AP in enteral nutrition (see enteral nutrition ACP JD below). These roles are either developed as a result of a dietitian already doing this role and therefore a job description written to reflect this or they are advertised specifically to dietitians. Responsibilities differ depending on the specialist area of practice.
Primary Care AP
These are new roles within the primary care setting.
HEE, with support from the BDA, have produced a Roadmap to Practice for First Contact Dietitians and Advanced Practitioners in Priamry Care (see the Primary Care webpage for more information).
Training Options
There are currently two main training routes in England for AP:
- Masters’ level taught AP programme/Masters’ level taught degree apprenticeship programme. A list of HEE accredited programmes can be found here.
- ePortoflio - a compilation of learned experience and master’s modules to support additional formative study. The relevant competency framework would need to be followed. For example, if the role is in Primary Care and you are based in England, you will need to follow the Dietetic Primary Care Roadmap.
Both of these training routes require a portfolio of evidence to show the dietitian is working at (educational) level 7 in each of the four pillars identified in the AP frameworks above. The route of training will differ dependent on whether you are already practicing in this way or would like to develop your practice in this way. For example, if the dietitian is already working at level 7 in clinical practice and research but feels they need additional training in some aspects of the four pillars, they may choose to access additional masters modules to cover this gap.
In England, HEE have established the Centre for Advancing Practice ‘The Centre’. The Centre supports education and training for advanced practitioners in England. More about this, including access to the ePortfolio route, can be found here.
HEE are working to develop a suite of multi-professional credentials that will enable practitioners to expand their professional competencies. Please see their website for a list of these.
What is the BDA currently doing to support AP members?
We have a member-only BDA Advanced Practitioner Basecamp for advanced practitioners or those working toward advanced practice. The Basecamp is a communication platform which members can join to share knowledge, experience, resources and pose questions to other members. Please email us if you would like to be added to the Basecamp.
We have included some resources in the section below, please get in touch if you would like to share further resources or feel there are resources that you would like to be included that are not currently included.
Helpful Resources
For helpful resources relating to Advanced Practice, log in to your BDA account and click here.