Advanced Clinical Practice
Advanced clinical practice roles are increasingly seen as key to the delivery of healthcare services. Both local organisations and national bodies state that there is a need for non-medical multi-professional healthcare professionals to advance their skills and knowledge to provide safe, effective and timely care for those accessing services. These roles are essential to supporting the current workforce challenges, including significant levels of medical consultant vacancies in high pressure specialty services.
Advanced Clinical Practice is defined as “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 education is recommended for entry level which is to be at masters level and which meets the education, training and CPD requirements for Advanced Clinical Practice as identified within the framework.” (Health Education England, 2014).
Piloting and evaluating the role of pharmacists within urgent care centres within LaSE
Emergency care continues to be under great pressure throughout the UK with an ever- increasing number of patients seeking access to unscheduled care. In combination with key staffing challenges and the national cap on agency usage and spend, there is a need to enhance the clinical workforce to manage patients requiring unscheduled care. In keeping with the recommendations of the Five year forward view, this pilot will explore the use of pharmacists in the urgent and emergency care setting.
The pilot builds upon the outcomes of earlier projects exploring the potential impact of pharmacists working in Emergency Departments undertaken by Health Education England (HEE) West Midlands. It was determined that pharmacists with enhanced clinical skills could manage 37% of patients attending with minor illness and minor injuries.
The proposed skills that a pharmacist requires to function as an advanced clinical practitioner include:
- Non-medical prescribing
- Advance patient assessment
- Clinical decision making/diagnostics
- Clinical reasoning
The pilot aims to:
Determine whether following a structured pathway of clinical skills and diagnostic training the pharmacist practitioner has gained sufficient skills to confidently and competently practice at an enhanced clinical level managing patients within defined clinical groups.
Evidence through direct patient contact whether clinically trained pharmacists can have a positive impact on patient flow in an urgent care setting as an integrated workforce model.
Evidence the sustainability of clinically enhanced pharmacists in future workforce planning and justify implementation of new roles into core business
Continue to develop an evidence base for proposing the training and development of advanced clinical pharmacists in urgent and acute care practising as part of a multi-skilled, multi-disciplinary workforce.
Evidence the suitability of the advanced practice pathway as a training model for future development of clinical pharmacists.
Evidence the sustainability of clinically enhanced pharmacists in future workforce planning and justify implementation of new roles into core business.
Whilst working on site as an Urgent Care Pharmacist each trainee will undertake 18-months of training of a three-year Advanced Clinical Practice programme at Level 7 (masters). The modules encompass the broad themes of non-medical prescribing, advanced patient assessment, clinical diagnostics and clinical reasoning. Learning will be aligned to the multi-professional framework for advanced clinical practice in England. In addition, clinical supervision will be provided by allocated medical practitioners and educational supervision provided by an experience pharmacist mentor at each site.
The project will be independently evaluated by Aston University.
- Barking, Havering and Redbridge NHS Trust (Queen’s Hospital, Romford - now concluded)
- Whittington Health
- Medway NHS Foundation Trust
- St George’s Healthcare NHS Trust
- Royal Free London NHS Foundation Trust (Chase Farm and Barnet Hospitals)
- Dartford and Gravesham NHS Trust (Darent Valley Hospital)
- London South Bank University
- Kings College London
- The University of East Anglia (Evaluation – concluded)
- Aston University (Evaluation)
What do we know so far?
18-months into the pilot, the initial evaluation (conducted by The University of East Anglia) has concluded that:
The education and training model utilised was appropriate
Integration to the urgent and emergency care environment, where pharmacists do not traditionally have roles requires careful consideration and management
Early communication with the extended members of the urgent and emergency care team is required to successfully integrate pharmacist advanced clinical practitioners and ensure effective role development
Pharmacists were better located initially in the minor illness rather than major trauma areas
Quality of patient experience resulting from the new role was important, in addition to reassurance that the role represented a positive contribution to workload
The evaluation outcomes were published in Integrated Pharmacy Research and Practice. The full text article can be accessed below.