NHD STUDENT BLOG SERIES

Getting to grips with Advanced Practice

Siân is now working with the British Dietetic Association as Professional Practice Manager. She previously worked as an Assistant Professor at the University of Nottingham. She has worked in a range of clinical areas, specialising in learning disabilities, palliative care and nutritional support.

Twitter@: siancunningham2

Siân Cunningham, MSc, RD, AFHEA

Professional Practice Manager, BDA

Advanced practice, or Advanced Clinical Practice, is an NHS initiative to help provide better healthcare, ensuring patients see the right clinician in the right place at the right time. Advanced practice offers an exciting opportunity for dietitians to be recognised for their extensive knowledge, skills and experience!

In the past, dietitians wanting to move up to higher roles with greater autonomy and levels of responsibility (i.e. Band 8a on NHS Agenda for Change) needed to move into managerial roles, which saw a reduction in their capacity to carry out clinical practice. For many clinicians working with patients is one of the most enjoyable parts of the job.  Advanced practice allows for progression and recognition of higher-level working whilst retaining and maintaining clinical practice, skills and knowledge!

Advanced Practice is not new; over the past few years more and more Dietitians have been taking up these roles, paving the way for the rest of us. Advanced practice roles were initially carried out by nurses and then physiotherapists, before other Allied Health Professionals (AHPs) began working in this space.

Dietitians working in this space have exciting and varied roles in areas such as nutrition support, including enteral and parenteral nutrition, eating disorders, specialist weight management, neonatal, paediatrics and gastroenterology to name a few. You can find some case studies showcasing these roles on the BDA web pages.(2)

Advanced practice is not one specific role, the role varies depending on the needs of the service that you are working in and the population that you serve. 

An important part of advanced practice roles is to carry out monitoring and evaluation of dietetic practice and to use this information to improve dietetic practice and ultimately patient care!

We need more dietitians across the workforce to be collecting outcomes, evaluating services and publishing their research to continue to advance the profession. This means that advanced practitioners are carrying out important work for the profession.

Training and education

Advanced practice is a level of practice carried out by a dietitian who is experienced, registered and has complex decision-making skills.  The BDA post-registration professional development framework (2021) outlines in greater detail the capabilities expected of dietitians working at this level. 

To be able to call yourself an advanced practitioner, your role must include the four pillars of dietetic practice. These are:

  1. Practice 
  2. Evidence-based practice research
  3. Facilitated learning
  4. Leadership

In England, you need to be able to demonstrate that you can meet the capabilities required of an advanced practitioner.(2) You can do this through completion of an e-portfolio (supported route) or an MSc in Advanced Practice (Level 7). Requirements differ slightly across the four nations, and you can find out more on the BDA Advanced Practice web pages.

What is the difference between Advanced Practice and Advanced Clinical Practice?

You may see Advanced Practice or Advanced Clinical Practice used. These terms are interchangeable and ultimately mean the same thing when talking about a level of practice in which a practitioner has demonstrated their ability to work autonomously at Level 7 (Masters Level) across the four pillars of practice.

Is there such a thing as an Advanced Practice Dietitian?

This is where it can get confusing (for us all!). As a dietitian, you are one of the professional groups that can become an advanced practitioner, alongside other AHPs, including physios, pharmacists, paramedics, occupational therapists and podiatrists.

If you take the relevant training and are employed in an advanced practitioner role, you are a dietitian who is qualified as an advanced practitioner, not as an Advanced Practice Dietitian. This is because you will have met the four pillars of advanced practice and will be working outside of your dietetic scope of practice (that you acquire by completing your undergraduate degree). 

You may see Advanced Dietitian used in job titles, often for Band 7 posts. This is intended to demonstrate the experience and skill of the dietitian. However, unless they have met the conditions outlined above, they are not an Advanced Practitioner.

How long does it take to become an advanced practitioner?

Not all of you will want to! The majority of the dietetic workforce works within the enhanced clinical practice space (Band 6/7 in the NHS) and this offers a rewarding and exciting career. For those who do find themselves thinking about advanced practice, you would need significant experience before starting to work towards these roles. Advanced practice gives you the opportunity to further develop your career and can be the next step before consultant practice (Academic Level 8). 

If you want to find out more about this exciting area, you can visit the BDA web pages or join the specialist interest group for learning and support.