Advanced clinical practice and nurse-led clinics: a time to progress

Abstract

This article discusses the evolving role of advanced clinical practitioners in outpatient clinics and investigates required competency and governance and how this translates into patient care. Until recently, there has been little clear guidance in terms of how to cultivate and develop staff to the level of practice required for autonomous management of the patient pathway. This has been variable, dependent on the employing organisation and the enthusiasm for advanced practice at a senior level. The current frameworks and competency documents available are identified and how the competent practitioner can provide safe, effective care. The authors use their own practice within gynaecology as an example.

Scoping the application of primary care advanced clinical practice roles in England

“…In order to address inconsistencies in ACP roles and competence, suggestions have been made to develop a standard definition of the role, describe expected practice levels, and determine minimum educational standards, although these definitions have tended to focus on nursing practice (for example; Department of Health, 2010; Pearce and Breen, 2018;RCN, 2018 Despite the publication of ACP definitions and standards, some professional staff propose that consistency will be difficult to achieve without registration of the ACP role. From a nursing perspective, the RCN (2010) called for consultation a decade ago, and the recent Blake Stevenson (2019) review of standards of specialist post registration education, commissioned by the Nursing and Midwifery Council (NMC), acknowledged the need for further consultation.…”

The advanced clinical practice pharmacy role and its implementation to practice in England

“…In addition to role confusion, Barnes, Ashraf and Din (2017) and Pearce and Breen (2018) both discuss the evolving and expansion of professional roles with pharmacists and nurses respectively. Responding to the argument of ACPs moving away from traditional nursing roles, Pearce and Breen (2018) reflect on their own practice as ACP nurses, explaining that 'many nurses educated to a higher level will not stay within the profession unless nurtured and developed to support job satisfaction' (Pearce & Breen, 2018: p.445).…”

“…Lewis Widely recognised within and beyond healthcare, governance is fundamental to sustainability and the success of ACP (HEE, 2017). Pearce and Breen (2018) and Wright and colleagues (2018) discussed the governance of ACP, with both papers highlighting the requirement for a robust governance framework to ensure fitness for practice. In agreement, HEE states, 'individual and organisational governance need to be robust and within legal, regulatory and professional frameworks' (HEE, 2017: p.13).…”

“…In agreement to sustain and retain a future ACP role, HEE (2017), RPS (2013), Pearce and Breen (2018), Nuffield Trust (2016) and Nelson and colleagues (2019) all point out the need to evaluate the impact of ACP roles and service user outcome and experience. Nelson and colleagues (2019) state the challenge of this, and similarly with the case study described by the Nuffield Trust (2016), could only gauge impact through anecdotal positive feedback.…”

“…Often a cause of confusion among patients and HCPs alike, many authors report that the historic ambiguity of ACP role and scope of practice is finally becoming clearer with the introduction of a national framework and definition (Pearce & Breen, 2018). There is a consistent opinion that the HEE framework is a much-needed approach to understand, recognise, and standardise ACP, which is often cited as a challenge when implementing such a role (Wright et al, 2018;Nelson et al, 2019).…”