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Advanced Clinical Practice
Innovation and engagement
June 2016
Professor Mark Radford
Chief Nursing Officer
University Hospitals Coventry and Warwickshire NHS Trust
& Associate Director of Nursing , NHS Improvement
Vision – to enable a
skilled and knowledgeable
Advanced Practice
workforce to be used
effectively to enhance the
capacity of the existing
health workforce to
ensure a quality service
for patients, now and in
the futureAcademic
Framework
Curriculum
diversity
Competence
diversity
Academic
and
Professional
uncertainty
of ACP
Role Diversity
Deployment
challenges
Regulation
and
management
What matters to patients ?
• Accessibility
• Convenience
• Time spent
• Decision making/Diagnosis
• Gateway knowledge to specialist
• Navigation
• Caring
• Continuity
State
•Legislation
•Policy
Corporate
•Business model
•Productivity and
Performance
•Finance
•Governance (Policy and
Procedure)
Profession
•Licensing
•Regulation
•Educational
requirements
•Knowledge and
Expertise
Macro
Division of
Labour
Radford, 2012 . PhD
The Division of labour
Radford, 2012 . PhD
Band 2
Band 3
Band 5 -
RN
Band 6
Band 8 ACP
Junior Doc
Unwarranted variation in scope and
competence
Skills/knowledge adaption
Adaptive
medical
Redundant
Medical
Clinical
knowledge
Professional
medical
Technical
Medical
Nursing
Care
Examples include cannulation,
venepuncture and catheterisation
Examples include PIC, CVP,
arterial lines, ultrasound
scanning.
history taking, examination, diagnosis
and ordering tests and investigations
such as radiology tests
conducting assessments on junior
doctors, conducting audit on the
medical process or outcomes.
Clinically, giving diagnosis,
prognosis and referral
Radford, 2012 . PhD
What stops it ?
State
•Legislation
•Policy
Corporate
•Business model
•Productivity and
Performance
•Finance
•Governance (Policy and
Procedure)
Profession
•Licensing
•Regulation
•Educational requirements
•Knowledge and Expertise
Macro
Division of
Labour
A lot !
Very Little
Very Little
Radford, 2012 . PhD
Working to the top of your license
The Institute of Medicine in 2010
• Each care team member works within a different scope of
practice, so that a Advanced Practitioner can do more than an
RN, an RN can do more than a HCA, and so on.
• The idea of operating at the top of your license means
practicing to the full extent of your education and training,
instead of spending time doing something that could be
effectively done by someone else.
Band 2
Band 3
Band 5 -
RN
Band 6
Band 8 ACP
Doc
What's possible
What you do now
Training
& Ed
Training
& Ed
Training
& Ed
ACP Program HEE(WM)
https://www.hee.nhs.uk/sites/default/files/documents/ACP%20Fr
amework%20for%20the%20WM.PDF
ACP Program HEE(WM)
Vision – to enable a
skilled and knowledgeable
Advanced Practice
workforce to be used
effectively to enhance the
capacity of the existing
health workforce to
ensure a quality service
for patients, now and in
the futureAcademic
Framework
Curriculum
diversity
Competence
diversity
Academic
and
Professional
uncertainty
of ACP
Role Diversity
Deployment
challenges
Regulation
and
management
• Curriculum and
Competence
• Consensus across all HEI’s
• Clear outlined model and
framework
• Defined 80% core curriculum
• Covers Primary, Secondary ,
(Nurse, Midwife and AHP)
MH and LD
• 20% local academic and
speciality variation
• ACP Deployment model in
HEE (WM)
• Agreed model & definition
• Alignment of educational
and professional
educational standards
• Nomenclature and grading
harmonisation
• 15/16 - 200 Student ACP’s
in training
UHCW – Advanced Practice teams
• Acute Med
• General Med
• Gynaecology
• Trauma
• Cardiac surgery
• Cardiology
• Gerontology
• Anaesthesia
• ED
• Neonatology
Chief Nursing Officer
University Hospitals Coventry & Warwickshire NHS Trust
Clifford Bridge Road
Coventry
CV2 2DX
Tel: 024 7696 4000

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CAHPO 2016. Workshop 2: Mark Radford

  • 1. Advanced Clinical Practice Innovation and engagement June 2016 Professor Mark Radford Chief Nursing Officer University Hospitals Coventry and Warwickshire NHS Trust & Associate Director of Nursing , NHS Improvement
  • 2. Vision – to enable a skilled and knowledgeable Advanced Practice workforce to be used effectively to enhance the capacity of the existing health workforce to ensure a quality service for patients, now and in the futureAcademic Framework Curriculum diversity Competence diversity Academic and Professional uncertainty of ACP Role Diversity Deployment challenges Regulation and management
  • 3. What matters to patients ? • Accessibility • Convenience • Time spent • Decision making/Diagnosis • Gateway knowledge to specialist • Navigation • Caring • Continuity
  • 4. State •Legislation •Policy Corporate •Business model •Productivity and Performance •Finance •Governance (Policy and Procedure) Profession •Licensing •Regulation •Educational requirements •Knowledge and Expertise Macro Division of Labour Radford, 2012 . PhD
  • 5. The Division of labour Radford, 2012 . PhD
  • 6. Band 2 Band 3 Band 5 - RN Band 6 Band 8 ACP Junior Doc Unwarranted variation in scope and competence
  • 7. Skills/knowledge adaption Adaptive medical Redundant Medical Clinical knowledge Professional medical Technical Medical Nursing Care Examples include cannulation, venepuncture and catheterisation Examples include PIC, CVP, arterial lines, ultrasound scanning. history taking, examination, diagnosis and ordering tests and investigations such as radiology tests conducting assessments on junior doctors, conducting audit on the medical process or outcomes. Clinically, giving diagnosis, prognosis and referral Radford, 2012 . PhD
  • 8. What stops it ? State •Legislation •Policy Corporate •Business model •Productivity and Performance •Finance •Governance (Policy and Procedure) Profession •Licensing •Regulation •Educational requirements •Knowledge and Expertise Macro Division of Labour A lot ! Very Little Very Little Radford, 2012 . PhD
  • 9. Working to the top of your license The Institute of Medicine in 2010 • Each care team member works within a different scope of practice, so that a Advanced Practitioner can do more than an RN, an RN can do more than a HCA, and so on. • The idea of operating at the top of your license means practicing to the full extent of your education and training, instead of spending time doing something that could be effectively done by someone else.
  • 10. Band 2 Band 3 Band 5 - RN Band 6 Band 8 ACP Doc What's possible What you do now Training & Ed Training & Ed Training & Ed
  • 13. Vision – to enable a skilled and knowledgeable Advanced Practice workforce to be used effectively to enhance the capacity of the existing health workforce to ensure a quality service for patients, now and in the futureAcademic Framework Curriculum diversity Competence diversity Academic and Professional uncertainty of ACP Role Diversity Deployment challenges Regulation and management
  • 14. • Curriculum and Competence • Consensus across all HEI’s • Clear outlined model and framework • Defined 80% core curriculum • Covers Primary, Secondary , (Nurse, Midwife and AHP) MH and LD • 20% local academic and speciality variation
  • 15. • ACP Deployment model in HEE (WM) • Agreed model & definition • Alignment of educational and professional educational standards • Nomenclature and grading harmonisation • 15/16 - 200 Student ACP’s in training
  • 16. UHCW – Advanced Practice teams • Acute Med • General Med • Gynaecology • Trauma • Cardiac surgery • Cardiology • Gerontology • Anaesthesia • ED • Neonatology
  • 17. Chief Nursing Officer University Hospitals Coventry & Warwickshire NHS Trust Clifford Bridge Road Coventry CV2 2DX Tel: 024 7696 4000