Advanced Practice Toolkit 

2. Designing an Advanced Practitioner role 

2.1 What clinical need will the Advanced Practitioner fill? 

TIP: Have a clear idea what the clinical need for an Advanced Practitioner is and communicate it with colleagues. 
TIP: Where possible, collect baseline data on the clinical need for the role before appointing an Advanced Practitioner, which will allow comparison with the situation once the person is in place. 
Whilst identifying that clinical need should be given, Edwards [10; Appendix one] reports that this is not always clearly done. 
In the context of advanced practice being the only non-management route for career advancement for some health professionals, there can be pressure to put people through the training without a clear clinical need. This pressure is especially acute if there is funding available for their training or post-training role. For instance, people may be trained as Advanced Practitioners to retain them or to provide a rationale for them stepping into a leadership role. There may also be a non-clinical need for an advanced practitioner, for example if the organisation requires a research or education lead. However, even in that situation, the role is likely to be both more successful and more acceptable to colleagues if the need for a senior position is well established and explained. The boundaries of this role may need to be clearly defined with clear responsibilities [48] and although flexibility in the role is necessary, this needs to be within limits to avoid people being forced outside their clinical capabilities and ensure patient safety [48]. 
The clinical need and role boundaries can be supported by a job description, person specification and job plan [48]. There is more information about this in the section on recruitment. Nottinghamshire has created standardised recruitment documentation, but if the role is intended to meet a specific need (e.g. education lead or research lead) there is advice available from the Nottinghamshire Advanced Practice Lead. It is important to note that if the job description, person specification and subsequent job plan differ too far from the reality of the role, this may result in indemnity issues. 
It will be helpful to collect baseline data on the situation in your organisation to illustrate that clinical need before the Advanced Practitioner comes into post. This can be outcome metrics, key performance indicators (KPIs), Quality and Outcome Framework (QOF) levels, patient reported outcomes or complaints, or feedback from colleagues. Having baseline data will allow you to re-measure these outcomes once the person is in post and establish the extent to which the role has met your needs. In turn, this will increase the likelihood of the role being well accepted, meeting the needs of the organisation, and will allow job plans to be re-negotiated if necessary. 
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