ADVANCED CLINICAL PRACTITIONERS Imperial Experience

1. ADVANCED CLINICAL PRACTITIONERS Imperial Experience Mary Dawood Consultant Nurse

2. The London Scene • Fair to say London lags behind much of the country in establishing ACP roles • Need has not been so stark or perhaps acknowledged • Varying levels and different models emerging but little consensus about the way forward

3. National Picture • NHS recruitment crisis 2016 • Ian Cumming, chief executive of Health Education England, said there would be a shortfall in nurses until at least 2020. • Figures in December 2015, showed the NHS in England, Wales and Northern Ireland had more than 23,443 vacant nursing posts and 6,207 vacancies for doctors. • That equates to a vacancy rate of 7% for doctors and 10% for nurses compared with an average vacancy rate of 2.7% for the general economy as assessed by the Office for National Statistics.

5. London’s context

6. NWL

7. Imperial Programme • Demonstrating the need in NWLondon • Unable to fill middle grade posts • Bid to HENWL • Funding from HENWL • Course Fees • Ring Fenced Time for learning • Backfill • Consultant Nurse to oversee the project

8. Understandable Response • We don’t have enough nurses ,why are we taking on doctors roles ? • We need our Band 7,s shift leading • We can’t backfill Band 7 posts

9. Progress to date • 6 ACP’s in training completing first year • 2 in their second year • 3 more starting this September • Slowly gaining acceptance • Increasing interest from PAMS ,(physio and paramedics • A long way to go to credentialing • Some surprising results

10. Challenges for Programme Leaders • Communicating the need to colleagues • Gaining acceptance • Lack of coherence • Managing Expectations • Dealing with the convoluted processes of NHS finance • Identifying the right people for the role

11. Challenges for students • Masters level expectations • Sufficient development time allotted / achieved • Increasing responsibility • Individual pace of learning / styles / needs • Socialisation into the role

12. Socialisation into the role

13. Socialisation • Confidence • Legitimacy • Indemnity • Patients Expectations • Gaining trust of colleagues • Acceptance

14. Issues for the Medics • Shortage of Consultants to supervise • Lack of understanding of commitment needed • Difficulty in benchmarking • Scepticism/ dismissive attitude about programme from some Consultant colleagues

15. Which Master’s programme? Finding the right programme, most are generic with variable approaches to the practical component Liaising with HEI,s ensuring the programmes delivered are fit for purpose Developing a working relationship with the HEI

16. Programme example • Programme and module learning outcomes mapped to existing advanced nursing standards • Part-time, one day a week attendance at HEI • 2 day Induction and pre-course workbooks • For Postgraduate Diploma complete six 20 credit modules • Module delivery – face to face & blended learning • Prescribed sequence of compulsory modules

17. Tips for setting up a programme • The multidisciplinary team must have a shared goal • Detailed business case • Make sure the programme is adequately funded and endorsed by the Trust both medical and nursing, over estimate rather than underestimate • Consider indemnity issues and the need for clinical supervision • Have a different uniform • Ensure Admin support for the programme

18. Choosing Applicants • Test for tenacity at the outset, this is a tough programme • Match your students to the needs of the service • As far as possible ensure you have a champion for the duration of the programmei.e appoint a Consultant nurse to oversee the programme • Allocate dedicated consultant time in terms of PA to the programme

19. Summary • Becoming an ACP is not for the fainthearted • Tough Programme • Needs commitment from all stakeholders as well as students • Is not a substitute for doctors • Not a cheap alternative • Is a satisfying career pathway for clinically focused professionals