Download Assistant Practioners - A Good Practice Guide

Assistant Practitioners - Good Practice Guide
Assistant Practioners A Good Practice Guide
Assistant Practitioners - Good Practice Guide
Why read this guide?
This guide has been developed to assist organisations in the identification, development, implementation and governance of Assistant
Practitioner roles as part of an overall workforce strategy.
The role of the Assistant Practitioner
The Skills for Health core standards for assistant practitioners defines the role as follows:
“An assistant practitioner is a worker who competently delivers health and social care to and for people. They have a required level of
knowledge and skill beyond that of the traditional healthcare assistant or support worker. Skills for Health 2015
The role of Assistant Practitioner (AP) has been established within the health service over the last 15 years.
The AP role contains the following components:
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Band 4 NHS Careers Framework
Foundation degree / Higher Apprenticeship
Senior clinical care support worker
Can work independently, working to policies, protocols and guidelines.
Able to work across professional boundaries e.g. nursing, AHP, social work
Within the East of England, there have been tools developed to assist in the identification of the need for the role,as a well as guidance on role
competencies, job descriptions, governance and sustainability of the role see appendices.
Assistant Practitioners - Good Practice Guide
The Need for Assistant Practitioners
The health and care system faces a period of radical change. The case for this change is set out in the NHS Five Year Forward
View (FYFV) and framed as a series of new models of care and care strategies.
'We can design innovative new care models, but they simply won't become a reality unless we have a workforce with the right
numbers, skills, values and behaviours to deliver it'
The Assistant Practitioner role is designed to work across patient pathways and can offer additional flexibility in the delivery of New Care
Models. Additionally APs can be further developed to provide a supply of registered nurses.
In 2013, a Grow Your Own Flexible Nursing Pathway was developed in the east of England which enabled APs to enter pre-registration nurse
education and gain Nurse Registration within 18 months, whilst continuing to practice as an AP and earn a salary.
The role of the AP can also be used to release nursing time for the management of care:
‘Developing the role of the assistant practitioner can help employers ensure they have the right flexible mix of skills to meet complex
patient needs, freeing up registered practitioners to deliver what they have been uniquely trained for’.
NHS Employers 2015
There are many benefits to introducing the role (see below), however, it is essential that the development of numbers required are identified
through the organisational 5-year workforce plan.
Assistant Practitioners - Good Practice Guide
Benefits of employing Assistant Practitioners to:
Organisations
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Increased capacity for registered
professionals by freeing up registered
staff’s time
Flexible multidisciplinary and mono
professional roles
Tailored education and training based on
the needs of the service user/ service.
Increased productivity
Tailored roles to enhance organisational
performance and targets
Skills and knowledge transfer – fill skills
gaps
Enhanced integration of services and
interagency working
Effective communication role across
different clinical settings
Ability to work across care pathways
contributing to new models of care
Service Users
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Enhanced skills and competencies which
are tailored to service users needs and
pathways of care, resulting in quality of
care
Named nurse/ specialist nurse e.g. renal
AP
Development of stronger relationship
with patients,
Improved access to services and
continuity of care
Effective and timely referrals – social and
therapies
AP is seen as approachable
Continuity of care
Extended time to spend with users
Prevention and decrease time spent in
hospital
Access to health, education, employment
activities
Reduce waiting time for services
Staff
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Job satisfaction
Increased competence and confidence in
practice
Salary increase
Increased responsibility and credibility
with service users
Increasing professional recognition
Working more independently than other
support workforce roles
APEL capacity into pre-registration
undergraduate study (Foundation Degree
+ competencies)
Able to apply for Grow your Own Flexible
Nursing Pathway, whilst still earning a
salary
CPD opportunities to continue to improve
competency and knowledge
Development of leadership skills
Coaching skills, mentorship roles and
teaching other staff
Assistant Practitioners - Good Practice Guide
The difference between Assistant Practitioners and Nursing Associates
The AP works at Band 4 and undertakes a 2-year health or social care Foundation Degree, as part of a Higher Apprenticeship, or with an
added set of competencies. The AP educational pathway can give the student AP the experience of exploring work across professional groups
and their role can be mono professional or multidisciplinary, single or cross organisational e.g. the role can be based in nursing or AHP, or
social work or have skills from a range of these professions making a multidisciplinary role.
A new role of Nursing Associate is being developed to assist nurses. The role will be awarded a Band 4 on the NHS Careers Framework and
undertake some of the duties that a RN currently undertakes, enabling the RN to spend more time on the assessment and care associated
with both complex needs and advances in treatments. The NA student will undertake a 2-year educational programme at a HEI/College.
There will be bridging courses between the AP and the NA roles.
Organisational Workforce Strategy and planning the roles of Assistant Practitioners
An AP role needs to be planned into the patient care establishment, with a clear set of competencies that will be required for the patient/client
group. (see Appendix 1) Only once this is achieved as part of the workforce plan for that area and agreed within the organisational workforce
strategy, with relevant funding, should a HCA be sponsored to complete a Foundation Degree / enrol on the Higher Apprenticeship. Therefore,
the AP not only has to achieve a foundation degree, but they need to complete a set of core competencies, see Appendix 4 and than added
competencies for the specific role they will be undertaking.
Assistant Practitioners - Good Practice Guide
The difference between a Band 3 HCA and Band 4 Assistant Practitioner
All roles are valued, however to protect quality patient care it is vital that all HCSWs have the underpinning knowledge and skills for
their role.
As with an AP role at Band 4, a Band 3 role should also be planned into the establishment and agreed as part of the organisational workforce
strategy, clearly identifying the competencies that are required and the underpinning knowledge which can be achieved through an Advanced
Apprenticeship.
The NHS Career Framework clearly specifies what a band 3 and band 4 role entails. However, analysis has been undertaken to identify in
more detail the differences.
The following table identifies the differences between undertaking a band 3 role and a band 4 role:
Descriptors
Job Description
Band 3
Providing and receiving routine
information which requires tact or
persuasive skills or where there
are barriers to understanding
Or
providing and receiving complex
or sensitive information
Band 4
Providing and receiving complex,
sensitive or contentious
information, where persuasive,
motivational, negotiating, training,
empathic or re-assurance skills are
required. This may be because
agreement or cooperation is
required or because there are
barriers to understanding
or
providing and receiving highly
complex information.
References
AfC 2013- Communication
Assistant Practitioners - Good Practice Guide
Descriptors
Band 3
Basic level of theoretical
knowledge e.g. equates to NVQ
level 3, RSA 3, City & Guilds
certification or equivalent level of
knowledge.
Understanding of a range of work
procedures and practices, some
of which are non-routine, which
require a base level of theoretical
knowledge.
Judgements involving a range of
facts or situations, which require
analysis or comparison of a range
of options.
Planning and organisation of a
number of complex activities or
programmes, which require the
formulation and adjustment of
plans.
The post requires highly
developed physical skills, where
accuracy is important, e.g.
indicates a skill level that requires
a formal course of training and
regular updating.
Band 4
Intermediate level of theoretical
knowledge (Level 4) equates to a
Higher National or other diploma or
equivalent level of knowledge.
Understanding of a range of work
procedures and practices, the
majority of which are non-routine,
which require intermediate level
theoretical knowledge.
References
AfC 2013 - Knowledge
Judgements involving complex facts
or situations, which require the
analysis, interpretation and
comparison of a range of options.
Planning and organisation of a
broad range of complex activities or
programmes, some of which are
ongoing, which require the
formulation and adjustment of plans
or strategies.
The post requires highly developed
physical skills where a high degree
of precision or speed and high
levels of hand, eye and sensory coordination are essential.
e.g. the skills required for
performing surgical interventions,
intubation, tracheotomies, suturing,
a range of manual physiotherapy
treatments or carrying out
endoscopies.
AfC 2013 – Analytical and
Judgement Skills
AfC 2013- Planning and
organizational skills
AfC 2013- Physical skills
Assistant Practitioners - Good Practice Guide
Descriptors
Band 3
Provides personal care to
patients/clients
Or
Provides basic clinical technical
services for patients/clients
or
Provides basic clinical advice.
Implements policies for own work
area and proposes policy or
service changes which impact
beyond own area of activity.
Is guided by precedent and
clearly defined occupational
policies, protocols, procedures or
codes of conduct. Work is
managed, rather than supervised,
and results/outcomes are
assessed at agreed intervals.
There is a frequent requirement
for concentration where the work
pattern is unpredictable
Or
There is an occasional
requirement for prolonged
concentration.
Frequent exposure to distressing
or emotional circumstances OR
Occasional exposure to highly
distressing or highly emotional
circumstances
Band 4
Implements clinical care/care
packages
or
Provides clinical technical services
to patients/clients
or
Provides advice in relation to the
care of an individual, or groups of
patients/clients.
Responsible for policy
implementation and for discrete
policy or service development for a
service or more than one area of
activity.
Expected results are defined but the
post holder decides how they are
best achieved and is guided by
principles and broad occupational
policies or regulations. Guidance
may be provided by peers or
external reference points
There is a frequent requirement for
prolonged concentration
Or
There is an occasional requirement
for intense concentration
References
AfC 2013 – Responsibilities for
patient / Client care
Occasional exposure to traumatic
circumstances OR
Frequent exposure to highly
distressing or highly emotional
circumstances.
AfC 2103- Emotional effort
AfC 2013- Responsibility for
policy and service
development implementation
AfC 2013- Freedom to Act
AfC 2013- mental effort
Assistant Practitioners - Good Practice Guide
Descriptors
Practice competencies
Band 3
All essential care competencies
and some enhanced technical
procedures e.g. venapunture
under direct and for defined non
complex care indirect supervision
Band 4
Enhanced care competencies /
technical procedures/ wound care/
administration of medications,
working to protocols and Policies
under indirect supervision
Carry own case load
Give and direct care in a defined
area of practice
Training and Education
NVQ/ QCF level 3/ Advanced
Apprenticeship
QCF level 4 / Foundation Degree
(4/5). Higher Apprenticeship
Progression
Level 4 studies / Bridging course
to apply for Professional
education.
Governance
Underpinning knowledge and
AFC descriptors allows for clinical
care interventions under direct
supervision or for non-complex
essential care indirect supervisor
(some protocols).
Must be able to demonstrate that
the education and training, both
practically and the relevant
underpinning knowledge is
appropriate to the care
administered. In this case at
level 3, basic theoretical
understanding and knowledge
12-18 months accreditation towards
Pre Registration Nursing, as FD at
level 4 and 5. Can map in 18
months APEL to undertake work
based nursing degree.
Underpinning knowledge and AfC
descriptors allows for independent
practice under in direct supervision
delivering total patient care (work to
protocols and policies that are in
place)
Must be able to demonstrate that
the education and training, both
practically and the relevant
underpinning knowledge is
appropriate to the care
administered. In this case at level
4/5 , intermediate- 1st degree level
understanding and knowledge.
Litigation
References
Miller. L et al (2015) ‘Assistant
Practitioners in the NHS in
England’ Skills for Health.
K. Spilsby ( 2013) ‘Support
matters: a mixed methods
scoping study on the use of
assistant staff in the delivery of
community nursing services in
England’ NHS National
Institute for Health and
Research.
AfC 2013
Skills for Health
SFA
NHS Norfolk and Waveney
Assistant Practitioner Working
Group ( 2011) ‘Report on the
Assistant Practitioner Project
‘NHS Norfolk and Waveney
Case studies in health
litigation.
Assistant Practitioners - Good Practice Guide
Descriptors
National Driver
Joined up health care/
social care agenda
Band 3
Tend to be mono professional,/
organization based in line with
the AFC descriptors
Band 4
Can be multi professional, many
examples of cross boundary
working. Also can work between
community and acute organisations
in out reach/in reach posts in
nursing and AHP.
References
Miller . L et al (2015) ‘Assistant
Practitioners in the NHS in
England’ Skills for Health.
Training and education to become an Assistant Practitioner
To undertake the role of an Assistant Practitioner there is currently two routes for education. It is usually expected that a
Foundation Degree (FD) level or a Higher Apprenticeship Level 5 will be undertaken to achieve the qualification to
undertake the role. HCAs can undertake a stand-alone health/social care FD, with in house competencies for the specific
role of AP. However, the organisation may choose to support the candidate on a Higher Apprenticeship, which is a
standard, which incorporates on the job training to become an AP and achieve a nationally recognised qualification, which
could be a healthcare/ social care FD or equivalent qualification at level 5. The type of qualification can be agreed with the
employer and employee to which pathway is best suited for both parties. HEI and FEs offer the Foundation Degree and/or
the Higher Apprenticeship. The Higher Apprenticeship can also be mapped to the Foundation Degree.
Assistant Practitioners - Good Practice Guide
Governance of the AP role
What is Clinical Governance?
"Clinical governance is about ensuring that patients are safe and risks are managed. “Janet Seaton, Clinical governance facilitator,
NHS24
Clinical governance can be defined as a framework through which UK National Health Service (NHS) organisations and their staff are
accountable for continuously improving the quality of patient care. NHS staff need to ensure that the appropriate systems and
processes are in place to monitor clinical practice and safeguard high quality of care. DFID 2001
Below is a framework, which was developed by Managers, AP’s and Practice Development Leads across the Norfolk and Suffolk Health
System
Responsibly of the AP
Adhere to their Scope of Practice; see
Appendix 2 pages 67-74
Responsibilities of Line Manager
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Be responsible for their own learning and
development, maintaining current,
evidence based best practice through
Continuous Professional Development
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Responsibilities of the Employer
The work allocated to an AP is not outside
their Scope of Practice
The work of the AP is reviewed
continuously.
There is evidence of adherence to the AP Scope
of Practice.
There is evidence that AP’s have the
necessary up to date qualifications and
competencies
Supports AP’s to attend relevant study days
/ courses.
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Maintain their competencies
The AP role is audited at least once a year
Adhere to organizational and agree
guidelines, policies and protocols for
The AP works to agreed protocols, guidelines
and policies
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Adequate study leave is agreed within a Study
Leave Policy
The AP has access to support mechanisms,
including website information
AP has access to CPD training and education
including courses/ study days to maintain and
develop AP roles.
There are audit processes in place to audit the
work and progress of the AP
Protocols, guidelines and policies have been
produced to support the practice of AP’s. These
Assistant Practitioners - Good Practice Guide
Assistant Practitioners
Ask advice or refer to a Registered
Practitioner when unsure or not
competent to undertake a process of care
have been produced by Registered Practitioners
and agreed through organizational governance
structures
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AP’s have the opportunity to develop
practice
Appropriate action is taken where an AP is
not performing at the desired standard
There are mechanisms in place to support the
practice of APs
Note: The following assumptions have been made:
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Their line manager, or practice supervisor will be a Registered Practitioner
The organisation will monitor the use of general policies and guidelines for all staff
The AP will be subjected to the usual NHS disciplinary procedures.
CPD for APs is seen as good practice as described in the following case study:
CPD Study Days for Assistant Practitioners
What was the problem?
Assistant Practitioners did not have access to Higher Education study days to support or update their practice
How was the issue addressed?
The Norfolk and Suffolk AP Working Group Commissioned the University of East Anglia and University College Suffolk to develop study days in the
following subjects
 Transitioning to the AP role
 Managing your Continuous Professional Development
 Service improvement and Innovation
What did this achieve?
AP’s in acute care, community and mental health had the opportunity to attend study days to help their development and to learn about innovation and
undertake a project to improve their area of service
The Transitioning to AP role gave the following skill
Assistant Practitioners - Good Practice Guide
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Concept of role change
Responsibility and professionalism
Self awareness, confidence and the process of change.
Assertiveness, emotional resilience and raising concerns
Applying personal strategies for assertiveness and managing change in your workplace
The Managing your CPD gave them the following skills
 CPD and portfolio development
 Updating and keeping updated
 Research methods
 Recording ether CPD
The Service Improvement and Innovations gave the AP the following skills
 Introduction and tools for Service Improvement
 Process mapping
 Case for change and Stakeholder management
 What gets measured
 Action plans
What was learnt from this?
That AP’s require help to maintain their growth as practitioners, and by facilitating the opportunity for APs from a range of organisations this can be
achieved. In turn this gives assurance to organisations that APs are up to date and able to continue to develop their practice, with skills for self
development as well as participating in organisational innovations
Funding the education and training of an Assistant Practitioner
With the introduction of the apprenticeship levy in May 2017, funding for the Higher Apprenticeship standard is capped
within a banding. For up to date information on funding please use the following link:
https://www.gov.uk/government/publications/apprenticeship-funding-bands.
Assistant Practitioners - Good Practice Guide
Good Practice Examples
The following 4 examples are AP roles which either cross boundaries or are required for specialist area. More information
on each role can be accessed from the host Trust.
Luton and Dunstable University Hospital
Assistant Practitioners in Complexed Elderly Medicine
What was the problem?
We have had APs in specialist areas like theatres for some years but there was a need to introduce them into ward establishments in complex elderly
medicine
How was the issue addressed?
APs were introduced into Complexed elderly medicine, working across professional teams and organisations. After 2 years We undertook a short
evaluation by sending out questionnaires to the teams that have APs established within them, we had 36 responses
What did this achieve?
The following feedback was received.
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The overall feedback was that the AP’s assessed and planned care 'well' or 'very well'
Highest scores almost universally were in essential care tasks, hygiene nutritional needs; 'moving and handling'; promoting patient safety with
regards to 'pressure ulcer prevention'; 'Falls prevention' and 'urinary catheter care'.
There was also positive feedback under the 'Makes appropriate referrals and recommendations to specialist practitioners or services';
'Concerns escalated appropriately’; 'Actively coaches and supervises less experienced staff'; Evaluates care delivered and documents outcomes';
What was learnt from this?
This feedback we be used to inform the programme leads at the university and our ward sisters, so we can focus on continuing to improve the education
and outcomes of APs.
Contact details for further information:
Carmel Synan- Jones - [email protected]
Assistant Practitioners - Good Practice Guide
Norfolk and Norwich University Hospital
Assistant Practitioners in Bowel Screening Programmes
What was the problem?
NNUH is a national centre for Bowel Screening and to progress the work, they needed to capture live procedural data during Bowel Screening. The
introduction of the band 4 role was for the purpose of capturing live procedural data on the bowel scope screening programme
How was the issue addressed?
APs were trained and educated to work within the treatment room, recovery and also assisting with elements of the bowel screening programme
What did this achieve?
The centre is one of six centres used as a pilot site and each centre used a different workforce model. NNUH was the only centre to employ APs in this
role. There has been a lot of interest in the NNUH model and as the programme is rolled out nationally other centres are looking to introduce band 4s in the
same way.
What was learnt from this?
By looking at the workforce requirement and the competencies and skills required then the AP was the best role to develop.
Contact details for further information:
Julie Boyd – [email protected]
Assistant Practitioners - Good Practice Guide
East and North Herts NHS Trust
Assistant Practitioners in Renal Medicine (ENHT)
What was the problem?
The renal department introduced the role of Assistant Practitioner Clinical Training Assistant within the Renal E&T team in 2007 to help support new staff
as they joined the department.
Benefits were quickly realised and the role was introduced into the ENHT haemodialysis units.
How was the issue addressed?
APs undertake clinical practical teaching and supervision of inexperienced staff, perform renal specific bedside interventions and supervise care planning.
Currently we are training our APs to independently check named intravenous medication when a second registrant is not available.
What did this achieve?
Improvements in supporting new staff by expanding the supervisory capacity of the role, developing the skills of inexperienced staff and releasing staff from
certain activities to enable them to focus on other aspects of their role.
What was learnt from this?
APs have a lot to offer within the clinical area enabling staff to work differently.
Contact details for further information:
Jo Emery – [email protected]
Assistant Practitioners - Good Practice Guide
Provide
Associate Infection Prevention Practitioner (AIPP)
What was the problem?
The role was originally developed as part of an overall programme under ‘Harm free Care’ to reduce the number of Catheter Associated Urinary Tract
Infections (CAUTIs) and Urinary Tract Infections (UTIs) on our three community hospital wards. Urinary tract infections are the second most common
clinical indication for antibiotic prescribing in Primary Care and account for about 17% of all healthcare associated infections. Moreover, 97% of healthcare
urinary tract infections are associated with catheters, indicating that catheters represent a potential ‘harm’ to our patients
How was the issue addressed?
The infection prevention team and ward managers appointed three Band 4 Associate Practitioners (AIPPs) to assist with infection prevention and harm
free care on the community wards. The appointments have led to improved communication amongst the ward staff and effective, timely reporting to the
infection prevention team. Ward staff have fully engaged in the programme to stop unnecessary urine dipsticks in patients over the age of 65 years and
are more likely to challenge unnecessary antibiotic prescribing; overall this has improved the patient experience and patients have better outcomes.
What did this achieve?
Since their appointments, the AIPPs have been involved in the development of a simple guide for symptoms of urinary tract infections, a catheter
passport, catheter pathway, removal of urine dipsticks, presented a poster to regional conference and are part of the CAUTI/UTI audit programme.
As part of their work, they looked at the reporting of urinary tract infections and noted that our documentation, often states ‘UTI’ only. The AIPPs were
tasked with reminding the ward teams to always report the clinical symptoms and to send appropriate urine samples. The AIPPs continued to audit the
ward documentation, encouraging all staff to clearly document the clinical signs and symptoms of UTI. They noted that occasionally we were prescribing
antibiotics from a urine dipstick result, and not on clinical symptoms. These findings were discussed at the task and finish group set up by North Essex
Clinical Commissioning Groups to develop and publish a guide to ‘diagnosis and management of UTI in a community setting’. We adopted this guidance
and now use it in all our training. The AIPPs have worked hard to get the message across to all services – ‘do not use dipsticks for patients over 65 years
of age and never for catheterised patients.’
In their roles, the AIPPs act as facilitators of good infection prevention and control practice on the wards with an additional surveillance role for UTIs and
CAUTIs. Each month, the Associate Nurses complete audits; hand hygiene, catheter, isolation of patients, mattress audits, IV, enteral feeds, commode
and decontamination of equipment. These audits are collated and added to an infection prevention dashboard for all services.
What was learnt from this?
That by introducing AIPP there will be evidence , through measurement, of improved patient outcomes , which can be demonstrated by an overall
reduction of urine dipstick tests, reporting of clinical symptoms and microbiology results, reduced antibiotic prescribing and improved knowledge of the
management of CAUTIs/UTI on the wards.
Contact details for further information:
Julia Shields – Julia.shields @nhs.net / Judi Wren - [email protected]
Assistant Practitioners - Good Practice Guide
Appendix
Other guidance available on HEE website:
https://www.hee.nhs.uk/hee-your-area/east-england/our-work/attracting-developing-our-workforce/nursing-midwifery/supplyimprovement-programme
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Assistant Practitioner Tool Kit – Norfolk, A toolkit to assist the implementation of Assistant Practitioners across the Norfolk Health
Economy, 2011
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Report on Assistant Practitioner Project, 2012
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Guide to Flexible Nursing Pathway, 2017
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Clinical Competencies
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Service Evaluation: Assessing the impact of using Assistant/ Associate Practitioners in health care setting. 2014