Much like the rest of Australia, the Australian Capital Territory (ACT) grapples with significant healthcare challenges, such as an aging population, a rise in chronic and complex diseases, escalating healthcare costs, workforce shortages, and the swift evolution of technologies and treatments12.
In response to these issues, the ACT’s health service delivery aims to deliver the “right care, at the right place, and at the right time”. Achieving this requires not only a paradigm shift in our approach, but also the creation of new roles that can facilitate a robust and sustainable healthcare system.
One such solution lies in the development of Advanced Practice (AP) roles. These roles can significantly enhance patient care by fostering innovative, efficient, and responsive models of care while simultaneously maximising the capacity, adaptability, and retention of the health workforce.4
Internationally, AP roles have been successfully integrated into healthcare delivery, strategy, and policy in a variety of settings, including the UK, Ireland, Scandinavia, and Canada. This demonstrates the potential of these roles in effectively transforming the landscape of healthcare service delivery.
AP is delivered by experienced allied health professionals and is seen as a level of practice characterised by a high degree of autonomy and complex decision making’.6 It involves high levels of clinical skill, knowledge and practice, reinforced and enhanced by its close integration with clinical leadership skills, applied clinical research and evidence based practice capacities, and competence in facilitating the education and learning of other skills.14
AP roles have been demonstrated to have a positive patient outcome (same or better than care delivered through traditional models) and positively impact healthcare services7 8 11; be safe, effective, have high levels of patient satisfaction and produce a range of benefits for service accessibility and efficiency4 7 8 11; create rewarding roles and career pathways for allied health professionals4; maximise workforce capacity and help in workforce retention9.
What can Australia learn from the United Kingdom (UK) experience
The United Kingdom has been at the forefront of coordinating and supporting the Advanced Practice workforce with AP roles working in the NHS for more than 20 years.In 2019, Health Education England (HEE) commissioned one of the most comprehensive surveys to date on the Advanced Practice (ACP) workforce. The survey’s primary objective was to gather foundational data about the existing AP workforce, with the intention of guiding future policy formation and development of the AP field. The survey uncovered a substantial degree of variation across AP roles across the UK. This variation extends to aspects such as educational and training pathways, the skills and competencies of AP practitioners, job descriptions, scopes of practice, and governance structures 5.
This inconsistency in the interpretation of Advanced Practice (ACP) roles across the UK has led to a degree of uncertainty, which has, in turn, impacted workforce planning, support, and development. This lack of clarity has implications for the long-term sustainability of AP roles. These findings underscore the significance of consistency in defining AP roles, outlining educational pathways, stipulating competency requirements, clarifying titles, and establishing supervisory structures. Attaining this uniformity is instrumental to the successful and sustainable implementation of AP roles. Ultimately, this will pave the way towards enhancing patient outcomes and bolstering safety benefits even further5.
Findings are reported as having global significance with international challenges with AP roles identified to be consistent with those in the UK.
In a collaborative effort and in recognition of the challenges of AP roles, Health Education England (HEE), in conjunction with several universities and NHS Trusts, released the ‘Multi-professional Framework for Advanced Clinical Practice in England (2017).6 This framework serves as a benchmark, offering uniformity in the definition, education, capability, and competency required for a health professional to transition into an AP role. However, the influence of this framework on the current governance, education, and support structures for AP has yet to be assessed in a practical context.
In Australia, jurisdictions have created AP roles with internal training and competency requirements, these roles are making similar positive impacts on access, quality of care, patient experience and supporting vital cost-efficiencies 3 12.
- However, we have fragmented and duplicated efforts in approaches to influencing policy, training, and adoption of AP roles into healthcare as each jurisdiction appears to be leading their own work.
- For example, QLD Health published the Allied Health Advanced Clinical Practice Framework (2013)14 to define, guide and underpin AP role development, SA Health have published Clinical Governance for Advanced Practice and Extended Scope of Practice Roles Policy10, the Department of Health and Aging have published the Advanced Nursing Practice Guidelines3, and Victorian Department of Health and Human Services published the Allied Health credentialling, competency and capability framework13. While each approach varies slightly, there are united by common principles and purpose.
Canberra Health Services have identified opportunities for workforce and service delivery redesign which includes formation of AP positions and service innovations. We have:
- Changed the ACT Medicine, Poisons and Therapeutics Goods (Regulation, Section 861A Delegation 2023 No.1) to authorise non-medical prescribing.
- Identified and employed experienced allied health professionals into AP training positions.
- Created an allied health classification structure which has expanded to create career opportunities for health professionals wanting to develop specialised or advanced skillsets
- Collaborated with nursing colleagues to create an AP framework similar to the NHS multi-professional framework.
- Collaborated with university colleagues to establish a multi-professional Masters in Advanced Clinical Practice program.
- Discussed a national approach for AP with the National Chief Allied Health Officer.
Call for action
The ACT is proposing for all Australian jurisdictions to work in partnership to develop a national multi-professional AP framework. We are calling for a national collaborative to standardise and set the standards of AP governance, education and title in Australia.
The benefits of a national approach would include:
- Consistent approach to definition, education, competency and supervision
- Consistent understanding and expectation of AP title and position
- Optimising the expertise of the allied health workforce
- Transferability of AP title and skills across jurisdictions
- Better recognition of AP title and roles across the health workforce
- Innovative, safe, effective, accessible models of care optimising patent care, experience and outcomes
- Collaboration in research activity and promotion of the benefit and value of advanced practice allied health
- Collective influence to unblock some of the barriers to optimisation of APC role (such as funding through Medicare Benefits Scheme)
- Expanding career paths and workforce retention for the allied health workforce.
This article has been revised and reprinted with permission from authors Felicity Martin, Dr Carol McCrum, and Dr Jo Morris, from the Allied Health Office, Canberra Health Services, ACT, Australia.
Join the Advanced Practice Collective, a Community of Practice for advanced allied health practitioners with an interest in continuing professional development and peer group discussion. | Join us for the Advancing Practice Across Australia Summit on Wednesday, March 6, 2024 at the Ann Harding Conference Centre, University of Canberra. This in-person event is a unique opportunity to connect with healthcare leaders and expand your knowledge of advanced clinical practice for the Allied Health, Nursing and Midwifery workforce.
