Advanced Practice or Advanced Clinical Practice has been on the health agenda for over a decade. The nursing profession initially drove this forward, followed by the physiotherapists where it evolved from their extended scope practitioners, particularly in the area of musculo skeletal practice.
In Dietetics there have been a small group of trail blazers over the last 5 -10 years but this picture has changed significantly in the last 2 years, and there are now many more roles and dietitians in training to fill these roles. Advanced Practice roles now exist in complex enteral and parenteral nutrition, disordered eating/eating disorders, obesity, diabetes, neonatal nutrition, gastroenterology etc.
Advanced Practice key points:
- This is an NHS initiative to support workforce shortfalls and help meet rising demands on healthcare
- There are opportunities for dietitians across all 4 nations
- Advanced Practice supports retention of experienced staff
- Degree of implementation across 4 home countries varies depending on the devolved political agenda
- The definitions vary across home countries but the principles are broadly similar
- All Advanced Practice/Advanced Clinical Practice roles vary depending on local need and circumstances.
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Why do we need Advanced Practice?
Why do we need Advanced Practice?
Rising demands for healthcare within the NHS and a need to remodel pathways and “do things differently”. There’s also an urgent need to ensure that services are tailored to patients’ requirements and meet the important equality, diversity and inclusion agenda.
A key function of these Advanced Practice roles is to undertake extensive evaluation and monitoring of the service provided; to adapt it to meet these needs and ensure it is based on the latest evidence. There is dedicated time within these roles to ensure these functions take place.
NHS Health Education England have produced this video as introduction to Advanced Practice:
What is Advanced Practice?
Advanced Practice or Advanced Clinical Practice is defined in detail in the BDA Post Registration Professional Development Framework.
In summary Advanced Practice is:
- Delivered by experienced, registered health and care practitioners
- It is a level of practice characterised by a high degree of autonomy and complex decision making
- Use expertise and decision making skills to inform clinical reasoning approaches
- Initiate, evaluate and modify a range of interventions including prescribing.
The Four Pillars of Advanced Practice
Advanced Practice is working across all 4 pillars of practice, often the clinical pillar is predominant i.e. the greater proportion of your time is spent in clinical practice. In England you must spend a minimum of 1 day per week undertaking clinical practice.
If however you have an education role or a research role, then you may spend a greater amount of time on either of these pillars.
National Frameworks
Each home country has its own framework for advanced practice detailing the 4 pillars of practice. These can be found at: