What are advanced levels of practice?

Glossary of key terms for advanced levels of practice

• Advanced Clinical Practitioner (ACP)

  ACP is one of many roles at the level of advanced practice. ACPs come from a range of HCPC-regulated and other professions including nursing, midwifery, osteopathy and pharmacy. Also see the term ‘advanced level’’ for a broad description of the knowledge, skills and experiences that underpin all roles at the advanced level of practice including ACP.

• Advanced level

  One of the advanced levels of practice, sitting between enhanced/specialist and consultant.  

  The following definition has been agreed across the four UK countries in the statement ‘Advanced practice in the Allied Health Professions (AHPs)’ to provide clarity about how advanced practice for AHPs is defined: 

  “Advanced practice in allied health professions involves complex decision making, underpinned by a post-registration master’s level award or equivalent undertaken by an experienced practitioner that encompasses all four pillars of practice: clinical practice, leadership and management, education, and research. It is delivered by skilled and experienced registered health and care professionals who exercise significant autonomy, judgement and responsibility in their roles. 

  Advanced practitioners manage complex care in partnership with individuals, families and carers, analysing and synthesising complex problems, often as part of multi-professional teams. They handle clinical risk and uncertainty across significant areas of work, in various settings, developing innovative solutions to expedite access to care, optimise peoples’ experiences, drive population health and prevention and improve outcomes.” 

  The term ‘advanced practice’ is not to be confused with the phrase ‘advanced levels of practice’, which refers to three levels of practice; enhanced/specialist, advanced and consultant.

• Advanced levels of practice

  The advanced levels of practice comprise three levels namely: enhanced / specialist, advanced and consultant. There are professional frameworks in place in each of the four UK nations to support the workforce development of the experienced workforce.  The language differs slightly across the UK, for example, ‘specialist’ is used in Scotland and Northern Ireland, but in England and Wales, ‘enhanced’ is used to describe the same level of practice. There are a range of roles at each level (see also the term ‘levels of practice’).

• Allied Health Professionals (AHPs)

  AHPs is a classification used to describe a range of regulated professions who are regulated by the HCPC or the General Osteopathic Council (GOsC). The allied health professions include art therapists, dietitians, dramatherapists, music therapists, occupational therapists, operating department practitioners, orthoptists, paramedics, physiotherapists, podiatrists, prosthetists and orthotists, radiographers, and speech and language therapists.  However, there are variations across the four UK countries, for example osteopaths are considered AHPs in England only and radiographers and operating department practitioners are considered healthcare scientists in Wales.

• Career development framework

  A career development framework is a structured system that maps how professionals can grow within their careers.  Many professional bodies have profession-specific frameworks that outline the knowledge, skills and experiences which members, registrants and managers can use as part of planning  continuing professional development activities. See also the term ‘four pillars of practice’.

• Chief Allied Health Professions Officers (CAHPOs)

  A CAHPO holds office in each of the four UK nations. They act as the professional leader responsible for advising the governments on matters affecting AHPs. They oversee the strategic direction of the AHP professions, across all levels of practice, and they work closely with health and care regulators.  

  The equivalent of the CAHPOs for healthcare scientist professions is the Chief Scientific Officer.

• Consultant level

  The consultant level is the highest level within the workforce development structure, sitting above the levels of enhanced/specialist and advanced practice.  While no centrally agreed definition exists across the four UK nations, professionals working at the consultant level of practice work across the four pillars of practice (sometimes referred to as domains) and provide consultancy.  In England, the consultant level of practice includes:  

  1. Expert practice: help firmly establish values-based professional practice across pathways, services, organisations and systems, working with individuals, families, carers, communities and others 
  2. Strategic, enabling leadership: provide values-based leadership across the care pathway, services and systems in complex and changing situations 
  3. Learning, developing and improving across the system: develop staff potential, add to, and transform the workforce, help people to learn, develop and improve (in and from practice) promote excellence  
  4. Research and Innovation: develop a ‘knowledge-rich and inquiry’ culture across the service and system that contributes to research outputs driving positive impact on development and quality with regard to innovation and improving capability in staff and systems 
  5. Consultancy across 1-4 across the system using consultancy approaches and opportunities that have maximum impact on practice, services, communities and populations, and which add to and sustain workforce capacity and capability
• Continuing professional development (CPD)

  CPD is the way in which registrants continue to learn and develop throughout their careers, so that they keep their skills and knowledge up to date and are able to practise safely and effectively. The HCPC operates an outcome-focused CPD model, which means that activities are not prescribed nor is there a specified number of CPD hours or activities that registrants must complete.  Registrants are required to maintain a record of their CPD activity, focusing on the outcome of their learning to benefit their individual service user groups.  In some workplaces, registrants working at the level of advanced practice may be required by their employer to record their CPD activities as part of a professional portfolio.

• Delegation

  Delegation involves asking someone to carry out an activity on your behalf. It involves assigning an activity to someone else who has the knowledge, skills and experience needed to carry it out safely and effectively.  The person accepting the delegated activity must continue to be provided with appropriate supervision and support, which reinforces that delegation is a relational activity.

• Enhanced level

  Enhanced practice is a level of practice defined as part of a workforce structure in England and Wales.  In Scotland and Northern Ireland, the term ‘specialist’ is used to describe the same level of practice (see also the term ‘specialist level’). It sits below the advanced and consultant levels of practice. Professionals working at the level of enhanced practice will use a wide variety of job titles and are experienced registered professionals who undertake complex work and manage day to day risks. Like the other levels of advanced practice professionals working at the level of enhanced practice work in multiple settings.

  Enhanced practice can be a precursor to advanced practice, or it can be a valued workplace destination in itself, offering services and service users a consistent level of expertise.

• Four pillars of practice

  The Four pillars of practice are a workforce structure which encompass clinical practice, leadership and management, education, and research. The pillars have been adopted in many resources, including career development frameworks from professional bodies, for all career levels. There is a workforce expectation that professionals working at the levels of advanced and consultant practice work across all four pillars (see also the terms ‘consultant level’ and ‘advanced level’).

• Governance arrangements

  Governance arrangements are structures and processes that lead, direct, and control the quality of service. This may include identifying and minimising risks, ensuring required standards are achieved, and investigating sub-standard performance. Ways that they achieve this include mandatory training for staff, assessment of performance and sharing best practice. Governance arrangements are essential for ensuring the delivery of high-quality and sustainable health and care services.

• Levels of practice

  Levels of practice are workforce structures and are not formal regulatory levels.  Regulatory standards apply across all levels of practice for registrants (see also the term ‘advanced levels of practice’).

• Membership body

  See the term ‘professional body’.

• Multiprofessional / multidisciplinary

  Multiprofessional / multidisciplinary refers to a collaborative approach where various health and care professionals work together to deliver high-quality care. Multiprofessional and multidisciplinary teams and environments emphasise the importance of flexibility, as well as the value of the distinct contributions of each professional. Multiprofessional approaches aim to enhance service user outcomes and improve the overall effectiveness of health and care delivery.

• Professional body

  A professional body represents a profession and advocates its concerns and interests. Membership or professional bodies often will be involved in safeguarding standards and promoting good practice, but they are not regulators and do not hold a statutory (legal) function.

• Professional indemnity

  Registrants are required to have a professional indemnity arrangement in place as a condition of registration with the HCPC.  The arrangement must provide cover appropriate to a registrant’s practice, taking into account the nature and extent of its risks.  It will need to be sufficient to meet any liability that may be incurred if a successful claim is brought against you. For further information, visit the HCPC webpages.

• Professional judgement

  Professional judgement involves the use of accumulated knowledge and experience, as well as critical reasoning, to make an informed professional decision in the specific context of the situation. The ability to use professional judgement to apply the HCPC’s standards and work in the best interest of service users is an essential part of being an autonomous professional.

• Registrant

  A registrant is an individual who is currently on the Register of the relevant regulator for their profession, in this case, the HCPC.

• Regulator

  The primary aim of a regulator is to protect the public. The HCPC is a statutory regulator which carries out legal functions relating to a profession (or professions). HCPC regulates 15 health and care professions in the UK and protects the public by setting standards for professionals’ education and training and practice, approving programmes which professionals must complete to register with the regulator, keeping a register of professionals (known as registrants) who meet the standards and taking action if professionals on the Register to not meet the standards.

• Regulatory standards

  Regulatory standards are expectations set by regulators, like the HCPC, that regulated individuals must meet. Regulatory standards sit alongside laws and other guidelines to ensure safe and effective practice. HCPC standards include: 

  The standards of proficiency: These set clear expectations of registrants’ knowledge and abilities when they start practising, and all registrants must meet these standards to join the HCPC Register. Once on the Register, registrants must continue to meet the standards of proficiency that apply to their scope of practice. 

  The standards of conduct, performance and ethics: These set out expectations for registrants’ behaviour and what the public can expect from a health and care professional, and are the ethical framework within which all registrants must work. These standards help to inform decisions about the character of professionals who apply to the HCPC Register, and are used when a concern is raised about a registrants’ practice. 

  The standards of continuing professional development: These set expectations around demonstrating continuing learning and development. Registrants must meet these standards when undertaking CPD activities, and are used when a CPD audit is undertaken. 

  The standards relevant to education and training: These set expectations for how education and training programmes should prepare learners for professional practice. These standards are used to assess education and training programmes and approve suitable programmes to give successful graduates eligibility to apply to the HCPC Register. 

• Scope of practice

  Scope of practice is the area or areas where a professional has the knowledge, skills and experience to practise lawfully, safely and effectively, in a way that meets the standards and does not pose any danger to the public or to themselves. An individual’s scope of practice is likely to change over time with additional knowledge, skills, and experience, and for some, additional qualifications.

  Scope of practice is a living process comprising two inter-related elements: individual and profession.  Both evolve and change over time. An individual’s scope of practice may extend beyond the generally accepted boundaries of the origin profession with appropriate experience, education, training and organisational oversight.

  Any change in a scope of practice must be to effectively meet service user needs and be done so with organisational oversight and governance (where appropriate).

• Scope optimisation

  Scope optimisation involves identifying ways to make the best use of the whole workforce at all levels of practice, in terms of their time, knowledge and skills to benefit service users.  Scope optimisation can be realised through effective delegation across the entire workforce (including delegating to the support workforce).

• Sectors

  The term encompasses all the areas where registrants work including public sector health and care settings, academic institutions, third sector, private sector and many more.

• Service user

  Service user is a broad phrase that refers to anyone who uses or are affected by the services of professionals registered with the HCPC. This can include patients, families, carers, students and learners, colleagues, people who are line-managed by a registrant and more.

• Specialist level

  Specialist practice is a level of practice defined as part of a workforce structure in Scotland and Northern Ireland.  In England and Wales, the term ‘enhanced’ is used to describe the same level of practice (see also the term ‘enhanced level’). It sits below the advanced and consultant levels of practice.  Professionals working at the level of specialist practice will use a wide variety of job titles and are experienced registered professionals who undertake complex work and manage day to day risks. Like the other levels of advanced practice professionals working at the level of specialist practice work in multiple settings.  

  The level of specialist practice can be a precursor to advanced practice, or it can be a valued workplace destination in itself, offering services and service users a consistent level of expertise.

• Supervision

  Supervision is a core component to maintain safe and effective practice in all sectors and settings.  It is a process of professional learning and development that enables individuals to reflect on and develop their knowledge and skills through agreed and regular support with another professional.

• System-wide

  System-wide refers to an approach that happens across an entire system rather than in individual settings or sectors. It signifies that changes, policies or effects are applicable and relevant throughout every component of a system.

• Title

  The word title may refer to the job title of a particular role, or the designated titles for professions which are protected by law. Protected titles are the designated titles that professionals are only entitled to use while practising in the UK if they are on the relevant register held by a statutory regulator, like the HCPC. The HCPC regulates protected titles for 15 professions. 

  Job titles are set by employing organisations and can vary between sectors and organisations.  These titles may include the designated/protected title of your profession and your level of practice. Apart from the use of protected titles, the regulator does not set or limit the titles a professional may work under.