Advanced Practice: breaking the glass ceiling

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• Advanced Practice breaking the glass ceiling
• Liz Salem

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• Drivers for change
• What is an Advanced Practitioner?
• What is advance practice?
• Greater Manchester experience
• Advance practice framework
• National developments

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• Rationale for developing Advanced Practitioners
• Pressures from the European Working Time
  Directive reduction in junior doctors hours
  impact on service provision
• Modernising Medical Careers
• New Consultant contract
• Demographics of the workforce e.g. aging
  workforce / retirements
• Shortage of medical staff e.g. vacant Consultant
  posts / Psychiatrists

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• A commitment to do things differently look at
  skill mix rather than traditional roles
• Providing professional / registered staff with
  the opportunity to advance their skills and
  knowledge and provide them with an opportunity
  for career progression
• New service models out of hours, diagnostic
  treatment centres, case management etc. Need to
  work across services e.g. acute/community
• NHS Plan workforce and service modernisation
  and developments i.e. more staff working
  differently, flexibly, new skill mixes, and as a
  team

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• Advanced practitioner
• The definition used by the DH outlines that an
  advanced practitioner is a clinically autonomous
  practitioner, defines the scope of practice of
  others and continuously develops clinical
  practice within a defined field. Advanced
  Practice forms the continuum from practitioner to
  emergent consultant
• An experienced non-medical registered
  professional who has developed his or her
  knowledge to a very high standard in a specific
  and often high level of practice. This high
  standard is such that not only is the individual
  the expert in the base domain - but can also
  accept the full responsibilities for providing
  those services hitherto undertaken by others, in
  defined circumstances. (Sargent 2003)

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• Specialist someone who is trained in a
  particular branch of a profession
• Generalist someone who is competent in several
  different fields or activities
• N.B. someone can undertake advanced skills but
  would not necessarily be an Advanced Practitioner
  a role needs to be viewed as a whole

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• Advanced Level of Practice
• Autonomous practitioner
• Expert practitioner
• Transformational leadership
• A high level of communication influencing
  skills, deals with complexity
• Develops policy, does not work through protocols
• Utilisation application of research evidence
  based practice knowledge
• A progressive, critical thinker / challenger a
  change agent
• Work across organisations and different agencies

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• Provide advanced levels of clinical practice,
  knowledge and skills
• Be self directed, manage risk, have high levels
  of communication skills, high level
  decision-maker and be a member of a wider
  clinical/ service team
• Include in many cases managing medications
  including assessment, review and prescribing
• Include having their own patient/client caseload
  with decision making responsibilities
• In most cases undertake a physical examination
  and history taking, diagnosis and treatment
  planning

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• What is Advance practice in podiatry?
• Podiatric surgery
• Non-medical prescribing
• Diagnostics interpretation
• Non-invasive vascular assessment
• Admit patients into beds
• Injection therapy
• Ultrasound assisted injection therapy
• Soft tissue manipulation
• Therapeutic footwear

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Consultant Generalist
Consultant Specialist
9 8 7
An Advanced Generalist with Competencies in
several different fields from across the
different professions
An Advanced Specialist with Specialist skills
within own profession
Advanced Practitioner
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• Greater Manchester experience
• Started 2005 wider workforce modernisation
• Meet needs of services staff in the future

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• Advanced Practitioners
• Masters in Advanced Practice Health Social
  Care
• 2 year programme
• Fees and mentorship paid by NHS North West
• 2 days per week protected time
• 2 days per week backfill
• Work based learning
• Organisations have to fully fund posts

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• Success?
• 3 year evaluations
• Added value of the role
• Financial impact of role on skill mix
• Fit for purpose

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• Advance Practice Framework requirements
• Multi-professional
• Post Graduate Pathway
• Modular, Flexible delivery, Accessible
• Responsive to Service Priorities Role Redesign,
  menu of optional modules, NWBL modules.
• Scope to assimilate/APEL existing practitioners
  who have acquired the appropriate competences.
• Portable, transferability across CL, N.West?
• KSF Core Dimensions
• Value for Money - Output Focused, Fit for
  Purpose, Competence based

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• National developments
• Registration and second registration
• National modernisation roles e.g. anaesthetic
  practitioner
• Recognition by professional bodies
• Development of standards for advance practice
• Modernisation of nursing

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• Thank you
• Any Questions???

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• References
• DH, Health Professionals Learning Beyond
  Registration, Developing a Shared Framework for
  Health Professional Learning Beyond Registration,
  University of Salford (2004)
• DH, Learning Together A framework for Lifelong
  in the NHS (2001)
• Skills for Health National Workforce Competence
  Framework
• Acton Shapiro Evaluating the Implementation and
  Impact of Advanced Practitioners across Greater
  Manchester Summary Report from Year 1 (2006)