Enhanced practice

When the Long-Term Workforce Plan for England was launched in 2023, it provided a clear commitment to developing the workforce in enhanced, advanced and consultant level practice – essential both for staff retention and patient care.

In this article we are going to be looking at the structured training and career pathways being created for those operating at enhanced level practice across the allied health professions. 

Introducing enhanced practice

Those working at enhanced level practice work across all health and social care settings, providing much valued patient care. They draw on a substantial knowledge base, understanding and experience to manage complexity and risk autonomously and proficiently. 

As each profession’s scope and input to patient care is different, the skills and knowledge required are different across professions. For physiotherapy, with its broad scope of practice, it is no wonder that there hasn’t been a simple ‘enhanced practice career path’.

It’s equally true that enhanced practice is both a transition point into advanced practice and a career destination in itself. It’s because of this duality that Abi Henderson, CSP head of workforce and education, notes that ‘opportunities developed within the enhanced practice space need to be flexible’. Abi confirms the CSP welcomes the investment by NHS England in the apprenticeship development, anticipating that ‘the investment in structured CPD will support the creation of flexible yet standardised approach to developing courses, and with it a welcome professional development route for our much-valued physiotherapy workforce, particularly for newly registered staff who will be able to see a clearly defined pathway at the start of their career.’ 

Enhanced clinical practice (ECP) apprenticeships

For enhanced practice this investment began with the apprenticeship standard for ECP (rolled out in May 2021) and continued with the creation of schema and curricula that underpin the ECP apprenticeship design.

Claire Arditto, NHS England’s regional head of allied health professions (AHPs) and health and care professions, believes ‘the opportunities for physiotherapists to develop competencies and capabilities towards or within the enhanced level of practice will be significantly improved via access to profession specific ECP apprenticeship programmes.’ 

She adds that ‘the ECP apprenticeship, the schemas and model curricula that underpin the apprenticeships will support the delivery of high-quality profession-specific educational programmes, alongside embedding work-based learning. This will provide individuals with access to funded, validated, high quality educational opportunities to support career development and ultimately patient care.’

Abi agrees and adds that she also hopes that education providers will now have the tools to develop learning that is meaningful for employers and the physiotherapy workforce in order to meet population need. She also hopes for development of post-registration education across the rest of the UK.

Claire notes that ‘the journey towards their creation has been highly complex, bringing together plural innovation partnerships across education, professional bodies, employers and subject matter experts, but the end result is a significant milestone in supporting career development for our AHP workforce.’

Developing schema and curricula

Louise Henstock, directorate lead for learning and teaching at the University of Salford and Kim Stuart, associate professor of occupational therapy at Coventry University, were tasked with co-leading the innovation partnership to develop nationally recognised, profession specific schema that maps to the apprenticeship standard, as well developing model curricula across seven AHPs. They say,

This project was a fantastic opportunity to help shape the career structure for enhanced practice across AHPs, helping to realise the full potential of the skill mix found within the health and social care workforce.

Their innovation partnership sought views from novice practitioners, profession-specific leads, AHP workforce leads, employers, and professional bodies (including the CSP). The schema and curricula were developed with equity, diversity and belonging (EDB) at their heart.

Using the schema

Louise and Kim advise that ‘the schema is primarily aimed at education providers to facilitate the design and delivery of postgraduate education. The schema, which aligns to profession-specific frameworks, provides enhanced level and profession specific descriptors that map to the apprenticeship standard and occupational duties for enhanced practice’. They say, ‘it also provides examples of evidence that may be used to demonstrate learning (either as part of a module/CPD or on-the-job training), pathway examples that illustrate current workforce priorities.’ 

They add, ‘equally the schema can be used by employers to provide a guide to expectations at this level of practice, with pathway examples and suggestions of evidence that may be used to demonstrate learning as part of on-the-job training. It can also be used to guide equity, diversity, inclusion and belonging (EDIB) when recruiting and training practitioners at an enhanced level.’

Employers wishing to use the schema should use it alongside the employer’s guide to enhanced practice apprenticeships.

Finally, Louise and Kim note that ‘the schema can be used by those training and working as a guide to their level of practice, expectations of education and training required, and suggestions of evidence that may be used to demonstrate learning as part of off- and on-the-job training.’

So, if you are considering an apprenticeship for your own development, look at the schema too.

What can you expect from ECP apprenticeships, when ready?

Much like pre-registration apprenticeships, success hinges on a shared commitment between the employers, apprentices and education providers to ensure that learning exposes apprentices to a wide range of clinical, professional, and personal development across all four pillars within uni- and multi-professional teams. Kim and Louise note, ‘this method (work-based learning) provides a dual function of meeting the learning needs of the employees, developing their knowledge, skills, and behaviours, and also meeting the workforce development needs of the organisation.’

So what’s next?

With the project complete, it’s now up to the education providers to develop routes and the employers to invest in mentoring and educating the workforce ready for them to take full advantage of this opportunity. 

If you are currently working at enhanced practice level, it’s worth bookmarking the links [see box] and discussing with your manager about whether this might be the right opportunity for you.