Advanced Practice Project: An update on important developments

I’m Helen Gough, a podiatrist and registrant member of the HCPC Council. Since May 2020, I have also been leading the Advanced Practice Expert Reference Group, made up of six registrant Council members, who guided, supported and advised HCPC on this important project.

This blog post will provide an update on the development of the HCPC’s Advanced Practice project following our full Council decision on 1 July (please see the full options analysis and recommendations paper that informed the Council decision on our website at Enc 08).

What we have done

In response to calls from HCPC stakeholders, we began a review in May 2020 into regulation of advanced practice – looking at the risk presented by registrants advancing their practice, whether the current regulatory approach is mitigating any risk, and seeking to provide clarity on our position on it.

We carried out mixed methods and targeted research with input from more than 4000 stakeholders across relevant stakeholder groups within the UK, including HCPC registrants, service users, members of nursing and medical professions, other regulators (both systems and professional), national education bodies, higher education institutions professional bodies, trade unions, and representatives of the governments in each of the four countries of the UK. We are extremely grateful to all of you who inputted into our research and engagement; we could not have made an informed decision without the rich insight, knowledge and experience you shared.

At the outset of our review we set out four possible broad outcomes and kept a genuinely open mind in regards to all options. These options were to (1) do nothing; (2) develop a policy position statement; (3) signpost to external resources; and (4) develop a full standards, education quality assurance, and annotation approach.

Our findings

Our review identified how complex this landscape is. We found that there is neither consensus about what advanced practice is (a necessary precursor to regulation) nor consensus that additional regulation is the right solution to the issue at this time. While most stakeholders instinctively favoured regulation, some did not. Amongst those who did, there was no clear view on how regulation could work in practice.

In short, the review found that there’s not sufficient evidence to meet the high threshold required for a new regulatory framework to be developed at this stage (please see the HCPC’s annotations policy for more detail on the threshold to introduce standards, education quality assurance and annotation). However, there was strong consensus that regulators, registrants and other stakeholders would benefit from a clearer, shared definition of advanced practice and high-level guiding principles.

Option 2 – develop a policy position statement - has therefore been agreed by HCPC’s Council, which will entail HCPC taking a leading role in the development of a definition and guiding principles for advanced practice. In addition, HCPC will continue to monitor and review the developing advanced practice landscape, responding to changes where necessary.

This option provides for a proportionate approach in circumstances where there is not consensus on the risk presented by our registrants advancing their practice, and in the context of considerable variation and lack of shared definitions.

This option enables us to use our position as a four-country regulator of 15 health and care professions to build and influence a shared understanding of what advanced practice is and is not, and to remain open and responsive as this landscape changes.

It will provide the consistency over terminology that stakeholders have called for, particularly regarding the meaning of advanced practice. This option provides for collaboration with other regulators to develop a shared understanding, definitions and principles of advanced practice that would create consistency, transferability, flexibility and fairness across multiple professions – this will reflect how advanced practice operates in the practical setting and wider system.

We hope that an agreed definition and high-level guiding principles will reduce registrant concerns about advancing their scope of practice and will enable them to communicate with their employers and service users about their scope. It will also provide for a consistent and unified four country approach, which is what so many called for.

Whilst this may not be the outcome that some were hoping for, we must be guided by the evidence on risk and ensure proportionality when considering the introduction of a new regulatory approach. We will continue to be at the forefront, leading this important work and remaining open and responsive to a changing landscape.

We recognise that this is a rapidly evolving and complex area and we must keep our finger on the pulse, while giving time for advanced practice to become more established and potentially stabilised within the system

Next Steps

Now that the HCPC Council has approved the recommendation to develop a shared definition of advanced practice and guiding principles, we turn our attention to scoping and planning that work. We will continue our valued collaboration and engagements with stakeholders as this work develops and to ensure that we remain informed about the advance practice landscape.

Many thanks to those who have engaged with this project. We look forward to continuing to work together on this important area.

For further information please contact policy@hcpc-uk.org.