Advanced Clinical Practice at University Hospitals of Derby and Burton NHS Foundation Trust

I would be a very strong advocate for
the introduction of ACPs I wouldn’t wish to go back to a time when we didn’t have them. When you put that black qualified
ACP lanyard on you feel very visible. We’re seeing ACPs increasingly playing a critical part in the delivery of services on our wards
and in our our departments. I think it’s revolutionised the career pathway for
nurses and AHPs. This is about a workforce that that has additional
skills and actually we’re all one workforce that are there delivering
health care to patients. Specialist medicine was our first division that
developed a workforce plan really that included ACPs within it,
this wasn’t medical substitution this isn’t about a nurse coming in to do the
doctor’s job it was about the start of enhancing our teams to make our team
work look very different to how it to has done in years gone by where it’s
very clearly defined if you were a nurse, a doctor, a physio. We needed the board to
take a leap of faith really that this was going to be a long term solution to
quite a difficult problem that we were in, we had high agency costs throughout
the year on additional medical staff and a lot of our business case was
about turning turning that agency spend down and reinvesting it in much more
sustainable and helpful role that would complement the the junior doctors we had
at the time. The strategy that University Hospital Derby and Burton decided to opt for was
a practitioner that was capable of being flexible to meet patient needs
and therefore needed to be somebody with a very broad skill set. They take on areas
of advanced practice which historically might have been undertaken
by medical staff but they’re nurses, AHPs, paramedics that are very experienced in
their field that want to continue to develop and can offer something to
patients. My professional background is that I’m a nurse I’ve pretty
much worked on Medical Admissions Unit since qualifying I was a ward
sister for 2-3 years and during that time I felt that actually I enjoyed
being at the patient bedside but maybe wanted to explore some some management
as well so I became a night nurse practitioner. And I think it was that that really focused my mind
on actually the thing that I enjoy most is being at that patient bedside and
that’s where I want to take my career and I think that’s where I want to
advance my skills. We made the decision as a trust that
we would recruit into a qualified ACP post and they would work towards that
qualification and we do that by 80% training on the job and 20% training off
the job. When I joined I’d already got my assessment skills and non-
medical prescribing skills so I was building on those in almost sort
of an apprenticeship role, working with the patients, working supervised
with the consultants here building a portfolio of clinical evidence to
demonstrate my competence within these new skill areas and new knowledge areas. We developed a framework internally and we work with the universities, we designed
what level of skills we thought an advanced clinical practitioner should
have so there was a generic set of skills and competencies but then there
were also specialty specific ones. There’s a Masters program that supports
that so the individuals have to be able to move through that Masters program
it’s hugely benefited the care of patients and families you’ve got a
practitioner that has advanced skills but also they’ve got all that
intuition and training that a nurse or an AHP has in relation to really
advanced communication skills, working with families, working as part of a team. Because they come from different backgrounds although they’re they’re
trained using the medical model they bring those other skills with them that is a
real contribution to the whole of the team. One of the massive
benefits that we have of having an ACP workforce is that
we can move an experienced advanced level practitioner to go and work on a
ward that isn’t used to looking after these kinds of patients medical patients,
by putting an ACP as the support up there they not only can help manage the
patients medically but they also provide clinical leadership and support to the
nursing teams and the AHP teams. Our retention rate of our ACPs since
2004 is 93% which is excellent we’ve worked really hard on retaining
them because the huge value that we get from them understanding systems and
processes within this organisation that’s a massive value in terms of
patient safety. Their presence is enhancing the working life and
particularly the training of the junior doctors, so it’s not just about them
going home on time which was an important driver initially because of
the cost of the trust but it’s about their ability for instance to attend
training so from a junior doctor perspective I think they embrace the
presence of the ACPs. I think one of the challenges facing an
organisation considering whether they want to establish the ACP role
within their trust is that it requires to some degree a leap of faith you need
to have a sense of confidence that it will deliver the improvements that you
seek and I think it’s been a real revelation to see the impact of ACPs
on the delivery of our services.

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