New clinical roles in the NHS

A broad guide to some of the newer clinical roles that have been introduced to the NHS as part of new models of service delivery or to ease workload pressures.

Location: England
Audience: All doctors
Updated: Tuesday 8 September 2020
NHS Structure Article Illustration

Currently, with NHS funding stretched, a medical recruitment and retention crisis and a focus on moving care into the community, we are seeing a period of new clinical role development.

This guide is designed to provide members with a broad outline of the new clinical roles that are emerging within the NHS.

 

Advanced clinical practitioners (ACPs)

Numbers

The number of ACPs working in the NHS is unknown.

 

The role

The term ACP does not apply to a specific role, but is a catch-all term for practitioners across the NHS who have progressed to an advanced level.

ACPs can be found practising across a range of fields, such as nursing, pharmacy, emergency medical services (paramedics) and adult and children's therapies.

Read more from Health Education England.

Regulation

Regulation is at the level of the ACP’s core profession.

There is no regulation specific to the advanced role, nor is statutory registration of a practitioner’s standard level work necessary to work at ACP level.

Read more in HEE's national framework for multi-professional advanced clinical practice.

Clinical pharmacists

Numbers

Since 2016, NHS England has been working in conjunction with partner organisations including the BMA to increase clinical pharmacists in general practice.

Initially, time-limited central funding was provided through the clinical pharmacists in general practice programme. This ended in April 2019 and funding is now available on an ongoing basis through primary care networks.

As of December 2019, there are 2023 clinical pharmacists working in general practice in England.

The role

Clinical services

  • Checking medicine adherence.
  • Reviewing patients on complex medicine regimens.
  • Triaging and managing common ailments.
  • Responding to acute medicine requests.
  • Managing and prescribing for long-term conditions (often in conjunction with the practice nurse).

Prescription management

  • Dealing with medication for patients recently discharged from hospital.
  • Supporting the practice to deliver on the QIPP and QOF agenda and enhanced services.
  • Delivering repeat prescription reviews.
  • Being the point of contact for all medicine-related queries.
  • Overseeing the practice’s repeat prescription policy.

Other possible responsibilities

  • Audit and education.
  • Medicines management.
  • Holding minor ailment clinics.
  • Responsibility for all prescription-related queries.
  • Business management of the dispensary.

Read more about clinical pharmacists in general practice from the BMA and NHS England.

Training

Training is open to pharmacists registered with the GPhC (General Pharmaceutical Council).

The primary care pharmacy education pathway is available to support continual professional development.

Regulation

As with all pharmacists, clinical pharmacists are regulated by the GPhC (General Pharmaceutical Council).

First contact practitioner for MSK services (FCP)

Numbers

105 as of December 2019.

Guidance to CCGs on commissioning this role was created in 2018. Some practices have been employing physiotherapists in different capacities for some time.

From April 2020, funding for FCPs will be available through PCNs (primary care networks).

The role

FCPs are qualified, autonomous clinical practitioners who can assess, diagnose, treat and  discharge a person without a medical referral.

Usually a part of community or hospital based therapy services, physios can now be part of the frontline general practice team.

Physios working in this role can be accessed directly by self-referral or staff in GP practices can direct patients to them.

Training

As a minimum, FCPs need to meet the criteria of the HEE and NHSE capability framework and be supported by appropriate governance and indemnity.

A physiotherapy degree (BSc) is required to work as a physiotherapist in any setting. Full time courses take three years. There are two-year accelerated MSc courses available to those who already have a BSc degree in a relevant subject.

Regulation

To practise as a physiotherapist in any setting, an individual must be registered with the HCPC (Health and Care Professions Council).

General practice assistants

The primary purpose of GP assistants (sometimes known as medical assistants) is to reduce GPs’ administrative burden.

Following on from several pilots, Health Education England training hubs have been running a ‘spread and adopt’ programme to promote the role locally.

In some areas a purely administrative GP assistant role has been tried. In others, such as the north west, a hybrid clinical/admin role has been used which is based on a role developed in the US.

 

Medical associate professions (MAPs)

Advanced critical care practitioners (ACCP)

The first training course was at Northumbria University in 2009. This role was developed in direct response to medical staffing shortages.

As of 2019, there were around 130 ACCPs working in the NHS.

Eligibility for an ACCP role relies on an individual already being a registered healthcare professional.

This means that they will be subject to some form of statutory regulation, but there is no role-specific regulation for ACCPs.

Physician associates (PA)

First appeared in 2003. The NHS interim people plan estimates there will be around 2,800 physician associate graduates by the end of 2020, rising to over 5,900 by the end of 2023.

Currently PAs are not subject to any statutory regulation, however they are to be regulated by the GMC. Regulation will not be in place until late 2021 at the earliest.

Read our guidance on employing physician associates in general practice.

Anaesthesia associates (AA)

Formerly known as physician’s assistants (anaesthesia) and anaesthesia practitioners.

First appeared in 2004. There are currently around 180 AAs working in the NHS.

Currently AAs are not subject to any statutory regulation, however they are to be regulated by the GMC. Regulation will not be in place until late 2021 at the earliest.

Surgical care practitioners (SCP)

First appeared in 1989. There are currently around 200 SCPs working in the NHS.

Eligibility for SCP roles relies on an individual already being a registered healthcare professional.

This means that they will be subject to some form of statutory regulation, but there is no role-specific regulation for SCPs.

Mental health therapists

Numbers

The General Practice Forward View promised an additional 3,000 mental health therapists working in primary care by 2020/21.

NHS Digital data showed that as of September 2019, only 17 IAPT (improving access to psychological therapies) staff were working in general practice as of December 2019.

The role

Not so much a new role, rather new care settings and ways of working for existing types of mental health worker. The idea is to help enable GP practices or groups of practices embed mental health workers.

Nursing associates

Numbers
  • 114 in general practice in as of December 2019.

  • 724 in secondary care as of October 2019.

  • 2836 in training as of October 2019.

The role

Nursing associates will sit alongside existing nursing care support workers and fully qualified registered nurses to deliver hands on care for patients.

The role will also provide a route for those who want to progress to become a registered nurse.

Training

As a minimum, trainee nursing associates will need GCSEs grade 9 to 4 (A to C) in maths and English, or functional skills level 2 in maths and English.

They will also need to demonstrate:

  • their ability to study to level 5 foundation degree level
  • the values and behaviours of the NHS constitution
  • a commitment to completing the nursing associate apprenticeship programme.

To become a registered nursing associate, individuals must pass a foundation degree awarded by an NMC-approved provider, typically taken over two years.

The programme includes both academic and work-based learning and prepares trainees to work with people of all ages and in a variety of settings. Training can be either direct entry or through an apprenticeship.

Regulation

Nursing associates are regulated by the NMC (Nursing & Midwifery Council).