Advanced Practice Toolkit 

6. Supervising Advanced Practice Roles 

TIP: Identify a specific supervisor for all Advanced Practitioner roles in advance, and make sure they are not supervising too many people at the same time. 
TIP: Access and use the national supervision guidance. 
TIP: Identify people who may be able to support with specific aspects of advice and supervision, for example a senior individual in the Advanced Practitioner’s background profession. If this takes place across organisations, check appropriate indemnity arrangements are in place. APs may require additional support from people who are not their formal supervisor. 
TIP: Provide supervision within working hours. 
TIP: Protect regular, proactive supervision, even when things are going well. 
TIP: Consider group and multi-professional supervision opportunities. 
Clinical supervision is essential at all levels of Advanced Practice careers. This is supported by the Health and Care Professionals Council (HCPC), who consider supervision essential in supporting professional practice and reflection, supporting continuing professional development, improving wellbeing, improving the working culture and environment, and leading to better patient outcomes [4; 15; 29]. A rapid literature review study published in the British Medical Journal, looking at clinical supervision across healthcare professions, found that there were many benefits and enabling factors to clinical supervision [39]. The enablers included an open, safe, and supportive environment, a supervisory relationship based on trust, regular, timely supervision, and training for supervisors. This included providing supervision within working hours and highlighting positive as well as negative aspects of the work being reviewed; the opposite of a reactive style where people are “called in” for supervision only when they had made a serious error. 
In one study [26], many participants had protected time, but “the one universal comment from participants was the need for more time with their clinical supervisors.” Proper supervision was important in integrating the role into the practice, and sometimes entailed new structures like team meetings; time for this can be hard to find in primary care and will take proactive arrangement. The study found that access to supervision was variable (see also [48]), and better where the Advanced Practice role was more established. Advanced Practitioners who did not receive regular supervision viewed their position as “unacceptable” even where they acknowledged a lack of time on the part of GPs. Another study found some Advanced Practitioners expected to seek supervision in their own time, and in some cases as an “optional extra” [48]. This leaves people vulnerable and under-supported, and is contrary to professional guidance for all professionals governed by either the NMC or the HCPC. 
In primary care, Advanced Practitioners are usually supervised by GPs. This arrangement can work well, but care must be taken that the GP is an appropriate supervisor with sufficient time to allocate to the role. Although historically supervision had to be led by a doctor or a dentist, it is now open to any suitably qualified professional [10, 16]. Problems can arise if the GP is too steeped in the medical model and are not aware of the specific ethos of the Advanced Practitioner’s profession [25], or if the GP is already overseeing multiple staff in a range of roles and is overwhelmed with this responsibility [25; 28]. Working at a GP alliance or wider level may allow a “critical mass” of other Advanced Practitioners who may be able to offer supervision, either fully, or in support of GP partners [25; 42]. In this case, employers will need to check what indemnity arrangements are in place. Advanced Practitioners will receive better advice and supervision where their supervisor is aware of what their role entails, and have a clear vision for their role [26]. 
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