Education – the passport to the future: Supporting our clinicians from graduation to advanced practice.
Webinar Blog and Q&A summary, 10 Feb 12:30-13:45
Connect Health “Change” brings you the eighth in a series of webinars to make and embed transformation in healthcare. Aimed at system leaders and clinicians across the NHS, the webinars provide practical solutions to the challenging issues we are all grappling with.
Advanced clinical Practice (ACP) is a rapidly developing area of practice that has gained much recognition. The recent Advanced Practice Roadmap from Health Education England has laid out a clear structure of governance and education development that will allow first contact and advanced practitioners to develop the high standards of skills required for primary care. But how can we support staff educationally to achieve this?
This webinar discussed how the roadmap translates into practice; the importance of having supported education programmes and how level 7 education be achieved, through HEIs and via the portfolio route.
Delegate feedback
- “Short presentations succinct and to the point. Also good time given for questions. I always like that you have emailed the link to the webinar”
- “The inclusion of multiple stakeholders”
- “Range of speakers from a variety of backgrounds offered different perspectives on the topics covered.”
Watch the Webinar in Full
Q&A
Ashley James, National Clinical Education Lead, Connect Health – introduces the Academy – Effective and practical implementation of portfolio education at a large scale.
Question 1: In terms of education and practice, where do you see the next steps happening to support career development?
Answer: It’s about that translation of knowledge and skills that may be traditionally acquired in weekend courses or talk courses and how that translates into clinical practice. For, example, this is so that the transition from stage one to stage two of the FCP roadmap, stage two being so important. It is to make sure that we’re translating anything that we learn knowledge-wise into clinical practice. That’s where we should concentrate our efforts over the next few years, which is why the roadmap provides those different stages so well.
Question 2: What is the main thing that you think this approach offers that’s different to how it was before?
Answer: It’s in the structure. It’s having that curriculum, not just for the roadmap but across all of our education streams. It gives people direction.
There’s so much information out there at the moment. So, if you’re just a clinician in the wilderness, there’s so many different tangents that you could go off on in terms of education. Including courses and learning material which are all on the internet. They are based on the competency framework which allows that guidance much more carefully.
Question 3: In the road map, it mentions that you have to tick the checklist to pass the first stage and second stage. Could you please clarify where I can find checklists for the verification stage 1 and 2?
Answer: Yeah – the checklist is in the appendices of the roadmap for what you need to do at each stage. So stage 1 as mentioned, is very much about knowledge and skills and stage 2 on the checklist expands into things that you need to do within primary care, within practice. It’s taken from the GP trainers. There’s lots of the things very similar to what the GPs have to do in those environments. There are things like case-based discussions, where you have to talk through with your supervisor in detail the clinical reasoning around a particular case. There are clinical examination techniques/assessments that you have to do. CETS (Clinical Examination Technique) might be things like a Cranial Nerve Exam, or it might be taking blood pressure for example in a primary care environment. You would need to require supervision and sign off of those skills in addition to normal MSK practice. Those clinical examination techniques, in an MSK environment and more for FCPs that may have come from a non-MSK background, who need to go through shoulder assessment, knee assessment, for example. As MSK practitioners, it’s unlikely that you’ll need to do that. All of that information is in the roadmap. In the appendices, there is a checklist of those things that you have to do as part of the team who trains the supervisors, your FCP supervisor will also be able to provide you with guidance on what is needed at both stages, to ensure that when your portfolio is submitted it’s full of everything that it needs to be at the right level.
Question 4: What do you say about how FCPs had been recruited at band five or six, and where is the true structured recruitment guideline?
Answer: Yes, I think this potentially relates to one of the other questions where it talks about when the road map becomes live. Essentially, from April 2022, the CQC are on board with this and it will become part of governance checks to ensure that the right people are being recruited into the right roles.
Now, we need to be clear of the difference between banding and ability, in terms of academic attainment or the level that someone is at. You’re able to be on the FCP list if once you’re three years qualified, you have demonstrated your ability and you’ve been signed off at level seven by your supervisor. There’s a clear distinction to make between a band and a level of practice. Those governance structures will be in place once the road map is live.
Question 5: Does the Connect Health curriculum include any Paediatric MSK content. If it does, is it mapped across any specific competency framework?
Answer: At the moment no, it’s not mapped against any paediatric curriculum or competency framework. We don’t see a great deal of paediatric patients through our work at the moment.
Question 6: What is the one thing that you would recommend that we focus on to implement improve education going forward?
Answer: I think for me it’s that structure that I talked about, so having that guidance and structure. There’s lots of information, and lots of ways people can go with education at the moment and having that structure and the competency framework across not just FCP and APP but across all areas of development is something we need.
Dr Giles Hazan, GPwER MSK Medicine, Sussex Partnership Foundation Trust, BASEM Education Committee Member, RCGP Representative (MSK) and Versus Arthritis Core Skills Trainer – will discuss the central role of developing the GP standards and GPwER education and accreditation.
Question 1: Is there any potential for GPs with extended roles, Advanced Practitioners and FCPs to be able to train together?
Answer: Absolutely, that’s going to be a big part as we’re growing this community of interested groups and individuals, we’re seeing more and more crossover. I’ve been working with the MACP to deliver some courses, and we’re looking at how physiotherapy organisations might be able to support courses for GPs and so on. There’s enormous opportunity and one of the key next steps is to identify those educational needs across the specialities and identifying the skill mix that is out there to meet those needs.
As you look at the work that Ash and the rest of the team are doing at Connect, about an example of how that could be put into a really meaningful structure. I think the opportunities are endless and that’s very much a part of the conversation for the rest of this year.
Question 2: Where do you see doctors in MSK and AHPs in five years, in terms of mutual standards in education competency and practice?
Answer: There’s very clearly significant areas of overlap and you know when you look at the standards that are out there, there is clear benefit to us all working off the same core standards. It is equally important to recognise the differences that are out there, the USP for each of us in our different roles.
I think interdisciplinary education and interdisciplinary working doesn’t mean we’re all exactly the same, it’s also recognising the differences and our strengths that we retain and whether it’s the generalist medical training (I’ve come back to that being now probably the most valuable thing I’ve done in terms of applying that to MSK) so, I think we’ll get better at celebrating the differences and the similarities. We will likely all align the competency frameworks for GPs in extended roles – well the one that we’re developing has very much been aligned to meet the same core standards so I think there will be a lot more coming together of those pathways.
Question 3: What is the one thing that you would recommend that we focus on to improve education going forward?
Answer: I’d have to put a vote in for interdisciplinary learning. Learning together, work together, would break down some of the boundaries.
Kay Hurst, Senior Lecturer, Faculty of Health, Psychology & Social Care, Manchester Metropolitan University – The route to advanced practice and the role of HEI.
Question 1: What steps can an individual now take independently to prepare and build evidence for the portfolio?
Answer: People can start by setting up a journal club, they can certainly formalise maybe an article they’re reading and actually keep some evidence of that. They can also formalise those reflections that they’re having, and the verbal reflections, make those written.
In terms of those conversations that they may be having with their mentors or supervisors, let’s get those down on a paper record, when they took place, what day they took place, what the actions were and so on. The last thing to say, is to maybe embark on some kind of level seven study at HEI.
Question 2: Kay, when is the next module being delivered? I’m due to start my FCP role in March and keen to undergo a Level 7 education module.
Answer: We currently have a module called First Contact Practitioner and Advanced MSK Practice – a 20 credit module that runs twice a year, every academic year. It runs February, which has obviously started now, and we’ve got April. But April 21 is full. We have just agreed that we’re going to move the module in February 22 to September 21. This means the next occurrence that will be available, is September 21 and it’s still available at the moment.
Question 3: Can we clarify whether the FCP module is for stage one and stage two or just stage one?
Answer: The current module we’ve got would be addressing stage one but people would then have to be able to do a portfolio to address stage two in practice and that’s the current situation. So the current module addresses just stage one and that next runs in September 21.
Question 4: What is the one thing that you would recommend that we focus on to improve education going forward?
Answer: I would start gathering information a bit like a treasure hunt, Amanda so they need to start gathering information. It might be journal appraisals, it might be records of discussions with supervisors, records of reflections that you’ve actually taken place on. Start gathering it in the meantime, while you’re sorting out what’s going to happen next.
Dr Neil Langridge, NHS Consultant Physiotherapist Southern Health NHS Trust, Visiting Fellow at University of Winchester, President of APPN (Advanced Practice Physiotherapy Network) and Education Lead at MACP (Musculoskeletal Association of Chartered Physiotherapists) – The need for education to be able to support the implementation of the roadmap for Advanced Clinical Practice in MSK physiotherapy.
Question 1: How will all this good stuff become normal custom and practice for all working in MSK? What about revalidation?
Answer: There are a number of different factors that need to align for that to happen. I think that coming together or undergraduate and postgraduate programmes that are aligned is going to be really important. We are breeding undergraduates that have an understanding and appreciation of a portfolio. Secondly, as I mentioned the in-practice development of career pathways that are linked to attainment points, that are subsequently linked to frameworks, means that this will have to be the default to gain a career progression. You will have to show competency and capability that is externally validated and nationally recognised. Once that is part of policy, there is no deviation from that.
We need to have alignment of all the professional groups and the professional bodies, to get behind what is actually required for this to happen. That might be for example, I mentioned job plans, we need to have effective equivalence in having time inside our own normal practice for continuing professional development whether that is actually to sign people off and verify them as a supervisor or it’s to actually gain that supervision yourself.
Lastly, there needs to be a pre-requisite within our training (undergraduate and postgraduate) with time to build effective supervision skills. You get started with the FCP model and that’s a real step forward. It needs to be across all disciplines, and it needs to be part of normal development. If you’re looking at the four pillars of education, that needs to be central to being a level seven supervisor, that you can demonstrate supervision and mentorship at that level. There needs to be those alignments and collaborations, but I think those would be the bricks to start building the house around that answer.
Question 2: Are there any plans to develop a roadmap specifically for Paediatric FCP roles?
Answer: Well that’s not within my gift and I’m certainly not an expert in paediatrics. I guess that one I would throw that back to HEE. It’s a connected roadmap and I would suggest that could be looked at as part of the MSK standards and bolt-on. We could look at that as part of the wider Advanced Practice Standards once we have those agreed, developed, and integrated as a Rheumatology/Pain Management and Paediatrics. Perhaps we can then increase the roadmap links towards that framework.
Question 3: Can you clarify if the roadmap is in alignment with FCP’s working in primary care and the multi-professional framework for advancing practice in England 2017 is aligned with the Advanced Practitioner role?
Answer: The background to those three frameworks is that there is a piece of research that is about to be published that mapped the IFOMPT standards directly to the multi-professional Advanced Practice Framework, so they are in alignment. From that, the stage one and stage three within the roadmap, those capabilities are drawn directly from the IFOMPT standards, and also it maps to the MSK core capabilities framework. If you look at the roadmap you’ll see, and each capability is cross-referenced against the IFOMPT standards which will be the Advanced Practice Standards for MSK. It is also cross-referenced against the MSK core capabilities framework and once you go to the back of that document, you’ll see where the FCP does not meet the IFOMPT standard.
Question 4: Do we need to do a formal FCP HEI module if we have done an MSc in the last 5 years? If so where is a list of courses which can be mapped? If we haven’t done an MSc, do we need to do a HEI module?
Answer: Firstly, it does depend on whether your master’s degree maps to the stage one and if it is an MSc Masters that will map to stage one outside that. You would have to do that mapping work yourself, to see if that’s the case and get that signed off for stage two. There is no master’s degree prior to any FCP modules that are mapped to stage two. If you have a full MSc and you’ve been working in community orthopaedic triage or secondary care orthopaedics you have a long MSK background. You still need to provide your stage two sign off which is through the workplace-based assessment toolkit and it will require a primary care sign off so it’s in practice assessment of your primary care knowledge skills and attributes within that setting.
Question 5: How does a roadmap align if you decide to change from FCP to APP for example, would you need to start again on the roadmap?
Answer: Great news on that one, is one of the key aims was not for clinicians to have to do that I mentioned in the presentation getting more for less, so effectively what you’ll see is the capabilities within the roadmap are mapped to both. If you do what you perceive to be an FCP competent capability it will be cross-referenced against the IFOMPT standards, so as you work your way up you effectively are clearing a lot of the clinical pillar of your Advanced Practice.
There is obviously further developments towards Advanced Practice that the IFOMPT standards are over and above the SCP requirements but go through the roadmap and it is explained about how the capabilities map across both pathways. Try and visualise that as you work your way up through FCP, for arguments sake, don’t quote me on this, you might be 30 or 40 percent up through your Advanced Practice portfolio and you could additionally add in a university module to that or you could continue on a portfolio route, building up your skills knowledge and experience through your supervisors sign off until it’s ready for submission.
Question 6: What is the one thing that you would recommend that we focus on to implement improve education going forward?
Answer: I would advise anyone looking to build towards the Advanced Practice processes, to look at every clinical experience or every learning opportunity through multiple lenses. Get used to looking at the same thing in different ways. Look at it from a research perspective, an education perspective, and a clinical practice perspective. Be able to compare and contrast those influences on that learning experience, that will then start to demonstrate a synthesis rather than a description and that will culturally and organically take you into level seven practice.
Watch the webinar again, which includes further insight from the speakers including a full Q&A session, and read more about the speakers here:
Wednesday 10 February 2021
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