Advanced clinical practitioners (ACPs) are healthcare professionals who have extended their scope of practice with skills and knowledge at level 7 (master’s level), and the role has been highlighted as an essential component in the NHS long term plan.(1)

In 2017, Health Education England (HEE), now NHS England, released a framework for healthcare professionals working as, or training to be, an ACP, which states the four pillars that ACPs need to demonstrate: clinical, research, education and leadership.(2) Whilst nursing has been well established in ACP roles, in more recent years there has been an increase in allied health professions (AHPs), such as physiotherapists, pharmacists and dietitians, training and working as ACPs.

HOW DO YOU BECOME AN ACP?

I have recently completed a master’s course in Advanced Clinical Practice (pending results!).

The course, undertaken part-time so it can be achieved alongside your current role, is three years. However, as I had previously gained credits by completing level 7 modules in non-medical prescribing (which is a compulsory element of the programme) and in First Contact Practice in Primary care (for which the credits could be carried over to my University), my course was completed in two years.

Modules undertaken on the course included: core knowledge on anatomy and physiology and two modules of diagnostics covering ‘systems’ cardiology, respiratory, gastroenterology, dermatology, MSK, neurology, renal, mental health and ENT.

The final year was dissertation year which included a portfolio of clinical evidence to demonstrate you are clinically sound to assess/diagnose/treat patients presenting with a variety of symptoms in at least five systems, and a written portfolio.

CLINICAL EVIDENCE

The five systems I chose were:

1. Gastroenterology - the main bulk of my patient case load
2. Endocrinology - I see diabetes/weight management patients in my role
3. Renal - I am exposed to patients presenting with UTIs / AKIs and spent time on the renal unit to gain evidence for this
4. Mental health - this crosses over with many of my patients! The intricacies of stress-related weight gain, comfort eating, the management of patients with eating disorders and exposure to mental health conditions such as schizophrenia
5. Frailty - I also support patients with malnutrition

Throughout the course, you have a clinical supervisor, who is someone in your workplace who will support you to obtain your evidence and sign off your clinical competencies. Examples of evidence can be anonymised patient notes, courses, reflections, critiquing local guidelines and shadowing colleagues.

WRITTEN PORTFOLIO

Alongside the clinical portfolio was a 9000-word essay detailing how you meet the other three pillars of advanced practice in your role. For me, these elements of my role are covered by the following:

1. Leadership - being a team lead leader and supervisor for trainees
2. Education - delivering education sessions to trainees and patients
3. Research - critically analysing research in day-to-day practice and how changes in research influences practice

(Please note this is my own experience at one University – other courses may differ.)

HOW CAN DIETITIANS AS ACPS HELP?

I have been running joint clinics alongside my supervisor, a gastroenterology consultant, with the aim of taking these on independently once qualified for management of complex functional bowel disorders and other gastroenterology conditions.

The main benefits I have noted in this clinic are the impact the skills of general assessment, red flag screening, ordering investigations and the use of medication management, alongside the holistic and dietary management I provide to patients. I hope to utilise these extended skills in gastroenterology and in my primary care role, to see more patients in their GP surgery and prevent unnecessary referrals to secondary care.

Gastroenterology is an area where dietetic ACPs have had input previously – the dietitians in Sheffield have demonstrated some excellent work in supporting with two-week wait referrals and managing IBS patients. Christian Shaw, dietetic ACP, discusses this more in the following video: https://www.youtube.com/watch?v=CXYD7lV1SRA.

Colleagues working towards ACP roles in diabetes acknowledge the positive impact they can have in diabetes management too. With increasing volume and complexity of patients with diabetes, an ACP diabetes role hopes to support the primary care case load, whilst reducing the demand on specialist secondary care services. In addition to this, there are dietitian ACPs working in renal, intestinal failure, placing feeding tubes and undertaking endoscopies... the list goes on!

There is now a BDA specialist group for Advanced Practice, as well as a sub-group for non-medical prescribing for those currently or who are interested in extending their dietetic role.

Rebecca R Gasche, RD

Rebecca is a First Contact Dietitian with Chester South PCN and
a Trainee ACP. She works in the Nutrition and Dietetic Service at
Cheshire West Integrated Care Partnership

References

1. National Health Service (2019). NHS Long Term Plan. Retrieved from https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf
2. Health Education England. (2017). Multi-professional framework for advanced clinical practice in England. London: Health Education England.