Advanced Practice: Final research findings

I’m Helen Gough, a podiatrist and registrant member of the HCPC Council since January 2020. I have also been leading the Advanced Practice Expert Reference Group made up of six registrant Council members who are guiding, supporting and advising HCPC on this important project.

This blog will provide an update on the Advanced Practice Research project and will draw on the findings of the final research report which was recently published at the end of January 2021. You can read the final research report here.

My previous blog last October focuses on the work that has already been undertaken.

Key findings

The HCPC commissioned a research team from the University of Bradford to undertake extensive research and engagement (July 2020-January 2021), in order to identify a range of facts, opinions and experiences, from a range of stakeholders, across a range of settings, professions and geographies.

• The research team undertook a survey of HCPC registered professionals undertaking or aspiring to undertake AP, as well as over 30 interviews and focus groups with key stakeholders to elicit their perceptions regarding scope of practice and autonomy of advanced practitioners.
• They also targeted education providers through a survey to those providing AP programmes and both an advisory board and a reference group were created to provide feedback on proposed research plans and project outputs and advocate within their relevant networks and specific professions.
• From these research methods, general findings were that there were at least 1,940 HCPC registrants who consider themselves to be practising (or towards) an AP level across all four UK countries, both in NHS and non-NHS settings and all HCPC professions.
• There is variation amongst registrants about what is considered to be AP level scope of practice vs what isn’t and there appears to be a distinction between more or well established, uni-professional advanced and consultant level of practice and roles, some with professional body or medical college assurance mechanisms, and less established and emerging, multi-professional roles, e.g. First Contact Practitioner, Advanced Clinical Practitioner.
• The ‘advanced practitioner’ and ‘clinical specialist’ titles were in use across all HCPC professions.
• Just over 40% felt that they were working outside of the traditional scope of practice, particularly reported by Orthoptists, Paramedics, and ODPs. It was also found that APs’ held a range of qualifications with only around 50% holding a full master’s degree or higher.

Managers’ expectations of minimum education level required for AP

Nearly as many managers thought that a postgraduate certificate diploma or bachelor’s degree is the minimum requirement, as the managers who selected master’s degree.

Findings also suggest that employers are struggling to support those working at AP level to access education to support all four pillars of AP or value the wider learning and development these pillars provide.

Views on regulation of advanced practice

Nearly 80% of registrant survey participants agreed that the HCPC should be regulating AP. This majority was generally consistent across respondent roles, professions and across the four countries of the UK.

The top four perceived benefits amongst registrants were:

• greater professional standing with other professions
• assurance to employers of knowledge and skills
• greater consistency in education and training standards
• greater standardisation of advanced practice

The majority of education provider respondents also believed that additional regulation of AP is required.

The top three perceived benefits among education providers were:

• Protection and safety of service users
• Greater consistency in education and training (90.9%)
• Assurance to employers (90.9%)

The main disadvantages and challenges of regulating AP were identified by registrants and educators as:

• increased cost of registration 
• difficulty in regulating multi-professional practice 
• duplication of effort with other professional bodies or credentialing organisations.

However, the level of agreement with statements of disadvantages were noticeably less than with the statements of advantages suggesting respondents perceived fewer disadvantages than advantages

Despite these strong perceptions about additional regulation being warranted, the research team stress in the report that ‘no evidence was presented from any participant group that advanced level practice presents a greater risk to the public.’

Research limitations

There were some limitations to the research which provides important context when considering the findings:

• The global COVID-19 pandemic throughout the research phase will have inevitably impacted level of engagement of stakeholders
• We suspect that there are many more AP programme providers in the UK, than the 31 that responded
• Participants were a self-selecting group
• It is qualitative, perceptions/self-reflection based research, as opposed to hard, objective quantitative data, so some areas need further evidence (in particular, data on actual patient safety risk presented by AP).

As such, this research is somewhat inconclusive on whether or not there is a patient safety risk requiring additional regulatory measures, and there are a number of areas where further research and analysis is necessary to satisfy our evidence requirements.

Next steps

The following steps will be taken over the next few months before HCPC Council will consider all the evidence and the options at its July meeting:

• We are hosting a two-part workshop with key stakeholders to identify evidential gaps and further work that needs to be done before HCPC’s Council can make an informed decision about next steps. 
• In early March we are hosting a joint regulator and HEE Centre for Advanced Practice workshop to explore plans for AP and credentialing, alignment, support and areas of overlap.
• In Spring (to allow time for COVID 19 and vaccination pressures to slightly alleviate) we will undertake targeted research with employers from a cross-section of employer types, across settings and geographies.
• Further exploration of any potential data sources in relation to potential additional risk to patient safety presented by advanced practice, including with medical colleges.