Advanced and enhanced clinical practice

Learn more about advanced and enhanced clinical practitioners and what they can do to support your multi-disciplinary teams.

29 January 2021

Advanced Clinical Practice

Advanced clinical practice is a level of practice healthcare professionals can attain. Advanced clinical practitioners (ACPs) are from a range of professional backgrounds such as nursing, pharmacy, paramedics, occupational therapy, healthcare science and midwifery.

ACPs are educated to masters level and have developed the skills and knowledge to allow them to take on expanded roles and scope of practice. Healthcare professionals at this level can enhance capacity and capability within multi-professional teams by providing clinical leadership and enabling collaboration across the multidisciplinary team. They help to improve clinical continuity and provide high-quality care for patients.

Multi-professional framework for advanced clinical practice

In 2017, Health Education England and NHS England and NHS Improvement worked in partnership to develop a national framework for advanced clinical practice, which ensures that there is national consistency and understanding about what the ACP role is. This is the first time that a national framework has existed in England and has established a shared understanding of the ACP role and how they can be deployed to deliver better patient care.

The framework offers opportunities for mid-career development of new skills such as prevention, shared decision making, and self-care. The framework includes:

  • a national definition of the role
  • what the requirements for entry are
  • guidance and principles that ACPs should adhere to in their professional practice
  • a clear career pathway into and within the profession.

View the multi-professional framework for advanced clinical practice in England.

What can ACPs do?

Health and care professionals working at an advanced clinical practice level will be able to evidence the underpinning competencies, skills and behaviours applicable to the specialty or health and care setting and job role they are working within. As part of the framework for advanced clinical practice, ACPs must be able to evidence additional core capabilities across four pillars: clinical practice, leadership and management, education and research.

ACPs can demonstrate expertise and professional judgement to achieve these capabilities in areas such as: diagnostics and therapeutics, enhanced skills in consultation, critical thinking and clinical decision-making, and the leadership they demonstrate within their teams.

These can be demonstrated in different ways depending on the setting or role the ACP is practicing, which means that there is flexibility for employers to determine how ACPs demonstrate these capabilities, based on service, patient, team and organisational needs.

Workplace supervision of trainee ACPs

Existing workplace supervision practices may not map neatly to the learning needs of developing multi-professional advanced clinical practitioners or trainees. A range of practical and comprehensive guidance for the workplace supervision of trainee ACPs can be found in HEE's supervision for advanced clinical practice resource.

Find out more

There is now a level seven (master's level) apprenticeship in advanced clinical practice available, which can be funded through the apprenticeship levy. Visit the Skills for Health website for further information. For more information about Health Education England's work on advanced clinical practice, please visit the HEE website.

Watch how Nottingham University Hospitals NHS Trust who are using the apprenticeship route to train their Advanced Clinical Practitioners in this video.

Health Education England has added credentials for health and care professionals working in learning disabilities and autism services, to expand their professional competencies. For a full list of the credentials available, please visit the Health Education England website.

Enhanced clinical practice 

Enhanced clinical practice is another level of practice healthcare professionals can attain and was launched in May 2021. Enhanced clinical practitioners (ECPs) work as part of a multi-disciplinary clinical team across a wide range of settings, including hospitals, community clinics, individual’s homes and in dental and general practices. 

The ECP apprenticeship is a level six course and can be funded through the apprenticeship levy with a typical duration of 18 months. Employers can opt to use level seven education within the apprenticeship if they would like to.

There is no definitive list of professional backgrounds that are suited to ECPs, this apprenticeship is about the level of practice so is not limited to traditional boundaries of clinical specialisms. 

What is the difference between an ACP and an ECP?

The ECP is an extended role rather than an advanced role. ECPs work at an enhanced level of practice with specific knowledge and skills in a field of expertise. They manage a discrete aspect of a patient’s care within their current level of practice, which will be particular to a specific context. This is in contrast to ACPs who have developed their knowledge and skills to an advanced level of practice and would manage the whole episode of a patient’s clinical care, from the time they first present, through to the end of the episode. The ECP apprenticeship can form part of a career framework that can  lead to an ACP role. 

Find out more

Find full details of the apprenticeship standards on the Institute for Apprenticeships website

Watch this webinar from Skills for Health to learn more about enhanced clinical practice and how to implement ECP apprenticeships. (Even though the event data has passed, the sign up link will take you to the recording).

Learn how employers in the NHS are using apprenticeships to develop their workforce.

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