The term advanced clinical practice can refer to a level of work undertaken in roles that multiple professions can carry out, for example, advanced practitioner in emergency care or primary care. The term can also refer to profession specific advanced level practice, for example, advanced practitioner radiographer, advanced practitioner sonographer. The centre for advancing practice provides an overview for practice in England Welcome - Advanced Practice (hee.nhs.uk)
A main point is that advanced clinical practice is a level of practice, not one specific job role or roles.
It is not the case that to use the title advanced clinical practitioner the individual must be able to independently prescribe. Advanced level practice is employed across a range of health and social care services, not all of which require independent prescribing. It is also not the case that a person undertaking a multi-professional advanced clinical practice role, for example, an advanced clinical practitioner in emergency care, is no longer eligible for registration with their original (sometimes referred to as cognate) profession. For example, a radiographer will still register with the HCPC on a 2 yearly basis. A nurse will register with the nursing and midwifery council.
SoR published an updated education and career framework (ECF) in 2022 which includes sections about post-registration enhanced, advanced and consultant practice. Other sources of information about different levels of practice are available on the webpages: Practice level information | SoR
Accreditation has been a term used by College of Radiographers (CoR) since 2010, when a scheme was set up for accreditation of individual practice. CoR currently offers accreditation for assistant practitioners, practice educators, advanced practitioners, and consultant practitioners.
Accreditation has not been widespread across the AHPs but there is currently an equivalent from the professional bodies for nursing and for pharmacy. The HCPC don’t regulate the use of ‘advanced practice’ as a title therefore CoR made the decision to offer accreditation to members as a form of reassurance for employers and patients with respect to a level of practice across the 4 pillars at advanced level. Accreditation of advanced practice may also facilitate a smoother process for people who wish to transfer between employers.
HEE are in discussion with the professional bodies who do provide accreditation schemes for their members. CoR in conjunction with HEE hope to offer recognition of their accreditation scheme – with the aim that would result in reciprocal entry to HEE advanced practice register for those people who hold current accreditation from their professional body (currently relevant for people working in England).
Accreditation is still of value to members in Wales, Scotland and Northern Ireland for the reasons above and also of value for people who may wish to seek employment in England. The various frameworks and requirements for the UK nations are:
Use of the title advanced clinical practitioner is not regulated. Employers have chosen to use the title for multi-professional staff but there has been a variation in levels of practice therefore HEE have set up the centre for advancing practice in England to introduce consistency. Patients seeing an accredited advanced practitioner will therefore have some assurance of their skills and knowledge. The centre for advancing practice have been working to offer a multi-professional assurance, most likely in the form of offering digital badges, unique to those who meet the criteria for advanced practice. That will possibly be in the form of a QR code that when scanned brings up details on what the individual is accredited for/ against
The centre for advancing practice webpages also give information about how they will accredit advanced practice programmes that meet their criteria or retrospectively accredit what they refer to as legacy programmes Programme accreditation - Advanced Practice (hee.nhs.uk)
People who have completed one of the programmes can apply for centre recognition or alternatively for those working in practice, following a feasibility study in 2021, the centre for advancing practice took the decision to offer ePortfolio (supported) route to practitioners – see the website for further details ePortfolio (supported) Route - Advanced Practice (hee.nhs.uk)
Enhanced practice focuses on expert clinical practice in the professional’s field or sphere of work but not necessarily advanced level across the other three pillars of advanced practice i.e. education, leadership and research. Enhanced level practice makes a significant and essential contribution to patient care and clinical services.
An advanced practitioner is expected to expand their practice across all 4 pillars. Individuals who can evidence that level of practice will be able to join HEE’s register of advanced practitioners / gain a digital badge by a number of routes: either completing a HEE accredited advanced practice master’s; if they have a master’s already completed then they can ask their university to apply for retrospective (legacy) accreditation; or apply for a supported e-portfolio route. Alternatively, assuming a reciprocal agreement is reached between professional bodies and HEE, by providing evidence of accreditation with their relevant professional body.
A person working at the level of enhanced practice is expert in their particular area of clinical practice and likely to hold a PgC or PgD qualification. Further comment is included in a recent editorial in Radiography Journal Enhanced practice: A strategy to resolve the inconsistencies in advanced practice implementation (radiographyonline.com)
Is the title advanced clinical practitioner regulated?
Radiographers are currently registered with the HCPC. If they extend their role to advanced clinical practice there is no current protected title or statutory registration as an advanced clinical practitioner. If advanced clinical practitioner were to be a protected title or annotation on the register, the health and care professions council (HCPC) would be the appropriate regulator for radiographers. Currently (2022) the HCPC have not released any decisions, there is further information and a report on the HCPC webpages:
The term credential is used by HEE to refer to a unit of learning Credentials - Advanced Practice (hee.nhs.uk) HEE provide a glossary of terms used at the centre for advancing practice
HEE are currently commissioning work around multi-professional learning for areas of clinical practice where there is no current provision of post registration modules. They’re calling them units of learning, credentials. HEE are developing credential specifications, with an approval and assurance process, that will be delivered by education providers. SoR have contributed to the development of credentials for Older People, Learning Disability, Autism, and have commented on the MSK first contact work. There is ongoing work to explore credentialling for radiotherapy advanced practice. At the moment (Spring 2022) Society of Radiographers (SoR) and College of Radiographers (CoR) are working with HEE and other stakeholders to develop a non-surgical oncology advanced clinical practice framework which will be circulated for consultation later this year. The purpose of the work is to support the education and development of the advanced clinical practitioner working or training within non-surgical oncology. It is intended that the document will be used in conjunction with Multi-professional framework for advanced clinical practice in England.pdf (hee.nhs.uk) and Workplace Supervision for Advanced Clinical Practice: An integrated multi-professional approach for practitioner development (hee.nhs.uk)
The 4 nations publications all detail the 4 pillars of advancing practice but it’s not clear if I need a full a master’s level qualification – do I need a full MSc to be called an advanced practitioner?
The national government bodies are not regulators so they can’t insist but they do strongly advise (and influence employers) with respect to qualification, that decision will ultimately be taken by employers in the absence of the regulator stipulating MSc. It has been the CoR aspiration that advanced practitioners should hold a full master’s degree. All of the four nations documents state minimum MSc level study for advanced clinical practice; if you click on the links and search the documents for the word master’s or abbreviation MSc that will help you find the sections a little more quickly for further details.
For further context, also see: Multiprofessional consultant-level practice capability and impact framework
NHS employers refer to enhanced and advanced practitioners, differentiating that the advanced practitioner would manage a whole episode of a patient’s clinical care – how does that fit with radiographer advanced practitioners in clinical imaging and radiotherapy?
The setting of the advanced practice and needs of the local population will influence the context of a complete episode of care. For example, a clinical scientist or medical physicist may not have direct clinical contact with patients but still fulfil an advanced level role in that profession. The main point is that advanced practice is a level of work, within either a multi-professional or uni-professional role. Therefore It is the needs of the role and the people who use the services that set out what a complete episode of clinical care constitutes in that area of practice. It may be a single visit to a department that constitutes a whole episode of care in clinical imaging, likely multiple visits in radiotherapy.
The whole episode of a patient’s clinical care in diagnostic and therapeutic radiography is determined by the needs of the person, their clinical pathway and the need for any further screening, diagnosis, treatment or ongoing surveillance. For example, an advanced practice reporting radiographer would perform a clinical evaluation and recommend further imaging or referral to a specialist as appropriate. Direct clinical care includes a range of activities alongside supporting professional activities, additional NHS/Trust responsibilities and funded external duties.
See for example: aps-job-planning-best-practice-guide-2019.pdf (england.nhs.uk)
You may have a range of people available to you for a chat, for example:
You could contact your lead advanced practitioner or consultant radiographer, an organisational/trust lead for advancing practice, or a centre for advancing practice regional faculty AHP/ radiographer lead. There are HEE regional leads for advancing practice listed on the centre for advancing practice website Regional Faculties for Advancing Practice - Advanced Practice (hee.nhs.uk)
Education providers who offer advanced clinical practice MSc / Apprenticeships will have a course lead available Directory of post-registration courses | CoR (collegeofradiographers.ac.uk)
In diagnostic radiography in England, the emerging regional multi-professional imaging academies will also have a radiography lead to contact.
Nuclear medicine technologists / sonographers on an assured voluntary register are eligible to apply for CoR advanced practitioner accreditation. A person needs to hold membership with the SoR to be able to access the CoR accreditation service, which is free to SoR members.
More information about access to apprenticeship routes in England can be found here.
Page last updated 9 September 2022