1. Framework for Advanced Nursing, Midwifery and Allied Health Professional Practice in Wales Charlette Middlemiss & Stuart Silcox Associate Directors Workforce, Education and Development Services (WEDS)

2. Overview Purpose and development Policy drivers Terminology and Definition Pillars of Advanced Practice Education Workforce Planning Governance 1

3. The Framework (2010) was developed to: Guide the development, implementation and evaluation of AP roles Provide clarity and consistency of the role’s implementation Governance structures to underpin and develop the role in Nursing, Midwifery and Allied Health Professionals across NHS Wales 2

4. Development Multidisciplinary professional group Drawn on previously published resources:  Scottish Advanced Practice Toolkit  Modernising Nursing Careers  Modernising Medical Careers  Midwifery 2020  Modernising Allied Health Professionals 3

5. Terminology and Definition Specialist – Generalist continuum Specialist practice relates to a specific context, e.g. client group, skill set or an organisational context Advanced Practice relates to the Novice to Expert continuum Advanced Practice characterised by high levels of clinical skill, competence and autonomous decision-making 4

6. Advanced Practice Definition A role requiring a Registered Practitioner to have acquired an expert knowledge base, complex decision-making skills and clinical competences for expanded scope of practice, the characteristics of which are shaped by the context in which the individual practices. Demonstrable, relevant Masters level education. 5

7. Pillars of Advanced Practice Advanced Practice clinical role with strong education/ research elements Advanced Practice clinical role with a large management element 6

8. Education Masters/CQFW level 7 education must underpin all Advanced Practitioner role developments in Wales Other frameworks to consider:  A Strategy for the Development of a Flexible and Sustainable Workforce (May 2008)  Post Registration Career Framework for Nurses in Wales (September 2009)  The NHS Career Framework Partnership working between NHS Organisations and Education Providers Portfolio Assessment – Model for Wales 7

9. Workforce Planning for Advanced Practitioner NHS Organisations will need to determine whether new posts are required at advanced practice level by: Service needs analysis Engagement with Stakeholders JD, KSF outline/governance and accountability arrangements Identification of contribution/robust evaluation 8

10. Existing Post Holders Annual PDP/KSF process Those holding the title must ensure their role meets the requirements of this Framework. Not meeting the criteria = development towards Unable to meet role requirements = local management process should be followed 9

11. Governance Ensuring AP Roles have maximum impact Promoting AP Roles in the Organisation Record keeping 10

12. Planning for Evaluation Key questions What objective outcomes are expected and when? When will these outcomes be achieved? What are the facilitators and barriers? Strategies to maximise role facilitators and minimise role barriers? What resource and support is required for role development? 11

13. Workforce Development Existing Advanced Practice Roles Identification of roles meeting the Advanced Practice Framework Personal Development Planning and KSF process to meet the requirements of Advanced Practice New Advanced Practice Roles Identified through the Integrated Workforce Planning Process Role development considered as part of service development and not in professional isolation Organisational Approval Process linked to existing systems 12

14. Role Impact Analysis Robust metrics to measure the impact and benefits within the 4 domains Outcome focus on  safety and efficiency  organisational impact  acceptance and satisfaction  costs 13

15. Summary Advanced practice is a ‘level of practice’ rather than a specific role Consistent approach in level of skills, theoretical knowledge (Masters CQFW Level 7) and decision making ability Applicable across all areas of practice All pillars must be present but focus may vary Approval process for new developments Evaluation of the role is essential 14

16. REPORT: NHS Wales Advanced Practice Framework Charlette Middlemiss & Stuart Silcox Associate Directors Workforce, Education and Development Services (WEDS)

17. Review Process 16 Corporate leads interviewed Sample of APs from cross section of clinical specialities interviewed Analysis and theming against the Framework WODs identify corporate leads

18. What did we learn? 17

19. Findings: Use of the AP Framework Structure to help inform and support practice Minority of organisations adopted a systematic approach to review their AP workforce Communication = mixed Some corporate responsibility devolved At an operational level extensive variation in the use of the Framework Conclusions Use was variable, not fully embedded in any HB or Trust in NHS Wales. Recommendations Organisations should: Adopt a systematic corporate led approach to using the Framework 18

20. Governance Ministerial letter (2010) informed organisations to: “fully utilise the Framework and ensure mechanisms are in place to review the use of the AP title for existing and new posts” 19

21. Governance Mixed responses to approval and reporting to the Board/Committee(s) Some line managers unaware of clinical work of APs Some organisations engaged stakeholders and promoted AP posts At a corporate and operational level only a minority of organisations/APs had developed metrics and were reporting outcomes Many = supportive clinical management 20

22. Conclusion Board approval to adopt the Framework was variable. This poses a potential risk to patient safety and to the operation of a coherent and efficient clinical workforce. The position was compounded by the variation of clinical audit by and of APs. There were some example of robust independent clinical audit. Recommendations Organisations should: Review governance arrangements for their AP workforce Ensure and support APs to develop clinical practice measures Ensure consistency across the organisation for the acceptance and adoption of practices by APs Ensure and support clinical supervision and mentorship 21

23. Education, Training and Development Majority of organisations unaware of educational status Majority had/working towards Masters Level and maintaining a portfolio = organisations support Some organisations = lack of support for study leave Piecemeal education prevented use of newly acquired skills and delivery of holistic care Peer support limited = relationships and networking key to success 22

24. Conclusion Organisations had varying approaches to applying the education and development of newly acquired skills by APs. 23

25. Recommendations Organisations should: Work with education providers to identify flexible approaches to educational provision e.g. work based learning Work with education providers to develop a commissioning model for AP courses which reflects service needs. Work with education to review/consolidate the content of AP courses Ensure APs utilise skills acquired on educational programmes Support establishment of Professional Clinical Networks 24

26. Workforce Planning AfC Bands – 7-8 (6) – inappropriate use of title Numbers ranged from 0-100 Majority using the workforce planning process Succession planning ad hoc and reactive More developed in nursing Joint appointments with Universities facilitated Exit interviews not carried out when APs left 25

27. Conclusion The Framework provides a tangible and informative resource. Communication and universal adoption of the Framework was deficient in every NHS Wales organisation. APs are making significant contributions towards service development and improved patient care. APs offer a senior, skilled and highly experience resource; but, are an untapped resource faced with a number of barriers and frustrations. The AP workforce can only contribute to organisational improvement and performance if they are used and supported to practice. Using the Framework will assist organisations to ensure robust governance. Implementing the recommendations from the Review will ensure more consistent use of the Framework and will enable APs to work effectively and organisations to gain maximum impact from these key clinical roles. 26