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New clinical roles within the NHS

In a large organisation such as the NHS where there is a near constant process of service redesign, it is inevitable that new roles will be created from time-to-time. While it is true that new clinical roles spring up from new approaches to service delivery, they may also arise from new ideas on career progression or out of necessity, for example when there is a shortage of doctors (see Advanced Critical Care Practitioners).

Currently, with NHS funding stretched, a medical recruitment and retention crisis and the ongoing agenda of moving care into the community, we are seeing an unprecedented 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. It is not intended to be an exhaustive examination of each role and does not cover political context or concerns about the new roles. For those who wish to know more we have provided links to further reading.

You can read about the full range of established clinical roles on the health careers website.

 

Roles

  • Advanced clinical practitioners (ACPs)

    Numbers: Unknown

    Care settings: pan-NHS

     

    The role

    This term 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. 

    HEE have recently produced the following definition of Advanced Clinical Practice:

    “Advanced Clinical Practice is delivered by experienced registered healthcare practitioners.  It is a level of practice characterised by a high level of autonomy and complex decision-making.  This is underpinned by a masters level award or equivalent that encompasses the four pillars of clinical practice, management and leadership, education and research, with demonstration of core and area specific clinical competence.

    Advanced Clinical Practice embodies the ability to manage complete clinical care in partnership with patients/carers.  It includes the analysis and synthesis of complex problems across a range of settings, enabling innovative solutions to enhance patient experience and improve outcomes”.


    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. HEE recently produced a National Framework for Multi-Professional Advanced Clinical Practice which identifies core capabilities and standards.


    Further Reading

    Health Education England website


  • Clinical pharmacists

    NumbersOn course for around 2000 in general practice for 2021 if the current programme is successful

    Care Settings: General Practice

    Presence in the UK 

    Since 2016, NHS England has been working in conjunction with partner organisations including the BMA to dramatically increase the presence of clinical pharmacists in general practice, with time-limited central funding provided.


    The Role

    Clinical pharmacists can provide:

    Clinical services - working with GPs and patients to address medicine adherence, reviewing patients on complex medicine regimens, triaging and managing common ailments, responding to acute medicine requests and 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 and overseeing the practice’s repeat prescription policy

    Audit and education

    Medicines management

    Pharmacists can hold minor ailment clinics, freeing up GP appointments and time. They can also be responsible for all prescription-related queries and clinical medicines reviews can be handed over from GPs to the pharmacist. Equally, in the case of a dispensing practice, a pharmacist can take responsibility for effective business management of the dispensary


    Training eligibility

    Open to pharmacists registered with the General Pharmaceutical Council (GPhC)


    Training programme

    The General Practice Forward View programme includes an education and training pathway that clinical pharmacists will follow to support their continual professional development.


    Regulation

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


    Further reading

    Clinical pharmacists in General Practice - BMA website

    Clinical pharmacists in General Pracctice - NHS England website

     

  • First contact practitioner (FCP) for musculoskeletal services

    Care settings: Primary Care


    Presence in the UK

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


    The role

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

    It Facilitates a shift from the traditional provision of community or hospital based therapy services to physiotherapists being 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 & 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 and 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 Health and Care Professions Council (HCPC).


  • General practice assistants

    Numbers: Unknown / pilot stage

    Settings: General Practice

    Nomenclature: Sometimes referred to as ‘Medical Assistants’


    The Role

    The General Practice Assistant role is currently being piloted by Health Education England in areas of London and the North West of England. While there has been considerable discussion in the trade press about this role it does not yet have a clear definition, with the different pilot areas taking different approaches as to whether it includes a clinical aspect or is purely administrative. Evaluations of the pilots are expected towards the end of 2018.

     

  • Medical associate professions (MAPs)

    HEE’s (Health Education England) MAPs (Medical Associate Professions) work stream has been established to:

    • develop a single MAP career and training framework;
    • define the role of Medical Associate Professionals and other non-medical roles being developed and consider how the further development of these roles could be streamlined and supported nationally
    • create an overarching professional title to form a common professional identity. 

    In October 2017, the government launched a consultation on the regulation of the MAPs professions. The BMA has responded to this consultation and we are currently waiting to hear about next steps.

    The four MAPs roles are:

    1. Advanced critical care practitioners (ACCP)
    2. Physician associates (PA)
    3. Physicians' assistants (anaesthesia)
    4. Surgical care practitioners

    MAPS further reading:

    HEE website

    HEE article on The Guardian website

  • Advanced critical care practitioners (ACCP)

    The ACCP role in critical care is designed to contribute to the care and management of critically ill patients and their families. It offers structured clinical career progression for members of the critical care team. 

    Care settings: Critical Care Units


    Presence in the UK

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


    The role 

    ACCPs undertake extensive assessment and management of critically ill patients, prescribing medications and performing invasive interventions. These clinical activities, previously in the domain of medical practitioners, require the authorisation of the ACCP’s employer.


    Training eligibility

    Most current ACCP trainees have a background in nursing, but they could also be from one of the allied health professions, such as physiotherapy. Candidates will be educated to degree level and have significant clinical experience in their field of work.


    Training programme

    Trainee ACCPs must complete a two-year programme that leads to a postgraduate diploma or Master's degree. Trainees are also employed by an NHS organisation for the duration of their training. Teaching within hospitals is overseen by a local clinical lead who is responsible for the delivery of the clinical components of the training. 


    Regulation

    Dependent on the outcome of the 2017 consultation that sought views on introducing statutory regulation for each of the MAPs professions. 


    Further reading

    Intensive Care Society blog

     
  • Physician associates (PA)

    Care settings: All

    Presence in the UK: First appeared in 2003

    Nomenclature: Formerly known as ‘Physician Assistants’ 

    The role

    The Department of Health in England defines the PA as:
    "…a new healthcare professional who, while not a doctor, works to the medical model, with the attitudes, skills and knowledge base to deliver holistic care and treatment within the general medical and/or general practice team under defined levels of supervision”. 

    According to the Health Careers website, PAs:

    • support doctors in the diagnosis and management of patients
    • might work in a GP surgery or be based in a hospital
    • will have direct contact with patients
    • will be a graduate who has undertaken post-graduate training
    • will work under the direct supervision of a doctor
    • will be trained to perform a number of day-to-day tasks including:
      • taking medical histories
      • performing examinations 
      • diagnosing illnesses 
      • analysing test results 
      • developing management plans

    Training eligibility

    A science-related first-class degree is usually required to get onto a PA training programme. Alternatively, a registered healthcare professional, such as a nurse, allied health professional or midwife, can also apply to become a PA.


    Training programme

    PA training (postgraduate diploma) lasts two years, with students studying for 46-48 weeks each year.

    Although it involves aspects of an undergraduate or postgraduate medical degree, the training focuses principally on general adult medicine in hospital and general practice, rather than specialty care. Training includes significant theoretical learning in the key areas of medicine. There are also 1,600 hours of clinical training, taking place in a range of settings, including 350 hours in general hospital medicine.
    PAs will also typically spend 80 hours in:

    • mental health
    • surgery
    • obstetrics and gynaecology
    • paediatrics

    Regulation

    Dependent on the outcome of the 2017 consultation sought views on introducing statutory regulation for each of the MAPs professions. 

    Further reading

    Physician Associates in the UK

    The Faculty of Physician Associates

     

  • Physicians' assistants (anaesthesia)

    Care settings: Hospitals

    Presence in the UK:  First appeared in 2004

    Nomenclature:  Formerly known as Anaesthesia Practitioners


    The role 

    PA(A)s are highly trained and skilled practitioners that work within an anaesthetic team under the direction and supervision of a Consultant Anaesthetist.  The PA(A)’s role enables one medically qualified anaesthetist to simultaneously conduct anaesthesia in two places (those places being adjacent or very close together in the operating suite).


    Training eligibility

    Individuals already registered as healthcare professionals (e.g. nurses or operating department practitioners) with at least three years clinical experience and/or degree level studies are eligible to apply for the training programme. Additionally, graduates with a biomedical science or biological science 2:1 honours degree or better are also eligible to apply.


    Training programme

    PA(A)s are fully trained professionals that have completed a Physicians’ Assistant (Anaesthesia) Postgraduate Diploma.  They are trained both in the underlying scientific and medical knowledge pertinent to anaesthesia, and in the skills of administering anaesthesia.

    The PA(A) postgraduate diploma is a 27-month full-time course combining academic study and clinical training.  The course comprises 12 modules which introduce trainee PA(A)s to the clinical practice of anaesthesia, applied physics, the anaesthetic machine and monitoring principles.  In later modules trainees study anatomy and physiology related to anaesthesia and surgery.  The final assessments are based on the management of life-threatening emergencies and advanced practice.  


    Regulation

    Dependent on the outcome of the 2017 consultation that sought views on introducing statutory regulation for each of the MAPs professions. 


    Further reading

    The Royal College of Anaesthetists website


  • Surgical care practitioners

    Care settings: Hospital

    Presence in the UK: First appeared in 1989


    The role

    Surgical care practitioners provide care in an operating theatre, on wards and in clinics. They are trained to undertake some surgical procedures under appropriate supervision and within their allowed scope of practice. They are directly responsible to the consultant surgeon.


    Training eligibility

    Must already be a registered healthcare professional (nurse, ODP or other allied health professional) who is looking to extend the scope of their practice to work as a member of a surgical team.


    Training programme

    Candidates undergo a two year part-time clinically based course at a Higher Education Institution. A national curriculum framework was published in April 2006 and represents the definitive statement of the requirements (including national standards for competence in theoretical and clinical skills) for Surgical Care Practitioner training to be provided by Universities, Higher Education Institutions and Trusts in the UK. 

    Higher Education Institutions may choose to seek accreditation from The Royal College of Surgeons of England for programmes of study for surgical care practitioner courses. The accreditation process includes a review of all the programme documents and materials and the likelihood of a panel visit. 


    Regulation

    Dependent on the outcome of the 2017 consultation that sought views on introducing statutory regulation for each of the MAPs professions. 


    Further reading

    Royal College of Surgeons website


  • Mental health therapists

    Care settings: Primary Care

    Presence in the UK

    It is unclear when specialised mental health therapists began working in the NHS, and there are currently mental health workers working in primary care in different capacities in some regions of England. The General Practice Forward View published by NHS England in 2016 promised an additional 3,000 mental health therapists working in primary care by 2020/21.

    The role 

    Not so much a new role as new care settings and ways of working for existing types of mental health worker. This project remains in the development stage, but the idea will be to help enable GP practices or groups of practices to embed mental health workers within their multidisciplinary team.

    Further reading

    NHS Clinical Commissioners report ‘Of Primary Importance’

  • Nursing associates

    Numbers: 1,000 in training with a second wave of 1,000 on the way 
    Settings: To be confirmed

    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 in their careers to become a registered nurse.

    Training eligibility

    To be confirmed

    Training programme

    Selected test site partnerships will deliver the education and training for the trainee nursing associate role.

    Regulation

    Following a consultation process, it was announced in 2017 that the NMC (Nursing & Midwifery Council) would be the regulator for nursing associates.

    Further reading

    Health Education England website

    Nursing & Midwifery Council website