EONS Magazine Winter/Spring 2019 edition

Mind the gap – The role of the Advanced Clinical Practitioner

Matthew Fowler describes how ACPs are undertaking procedures autonomously, running clinics, prescribing chemotherapy, reviewing patients presenting unwell and function at an advanced level within the MDT. He finds the role is challenging yet rewarding.

Matt travels to Guernsey in the Channel Islands to do a haematology clinic where he reviews patients independently, performs bone marrow biopsies and supports a nurse-led telephone clinic

Matt travels to Guernsey in the Channel Islands to do a haematology clinic where he reviews patients independently, performs bone marrow biopsies and supports a nurse-led telephone clinic

Back in 2015, I was tasked with setting up a service at my hospital for haematology and oncology patients that has revolutionised the way we deliver care to our patients. The role of the Advanced Nurse Practitioner (ANP) has been around for many years, however due to a reduction in the working hours of junior doctors as well as ever increasing complex needs of patients NHS England; the role of the Advanced Clinical Practitioner (ACP) was introduced. The ACP is defined by Health Education England (2015) as:

“A registered practitioner with an expert knowledge base, complex decision-making skills and clinical competencies for expanded autonomous scope of practice, the characteristics of which are shaped by the context in which the individual practises. […] It is demonstrable at master’s level and meets education, training and continuing professional development requirements for advanced clinical practice as identified in the framework.” 

In 2015, the haematology and oncology directorate introduced the role of the Advanced Clinical Practitioner (ACP). A nurse practitioner with an extensive background in the specialty was tasked with setting up the service and also employed a trainee ACP to further complement the service. The initial aims and objectives of the service were to gain further academic qualifications to undertake the role as well as gain competency in clinical procedures previously undertaken by the medical team.

Matt Fowler in practice

Matt Fowler in practice

Both ACPs completed the Post Graduate Certificate in Advanced clinical practice at Warwick medical school and as they had both already obtained MSc programmes and were qualified non-medical prescribers this was the only academic work required. Procedure competency was required to undertake lumbar punctures, bone marrow biopsies, PICC line insertions and Hickman line removals. Both ACPs were required to maintain chemotherapy administration and apheresis competencies. The trainee ACP focussed primarily on setting up haematology clinics whilst the senior ACP set up clinics in oncology in Birmingham and haematology in the Channel Islands. Within 12 months of setting up the service the trainee ACP achieved all her competencies and both ACPs are undertaking procedures autonomously, running clinics, prescribing chemotherapy, reviewing patients presenting unwell and function at an advanced level within the MDT. Not without its challenges, yet hugely rewarding; we have already doubled the team and now have a further trainee ACP as well as a fully qualified ACP. A business case has been developed to expand the team to a total of 6 ACPs and it is proposed that with the expansion in the team the following services will be delivered by the ACP team:
  • Weekend service supporting both the Haematology Registrar and nursing teams on the in-patient haematology ward, reviewing unwell patients, clerking new admissions, supporting the acute oncology triage line as well as prescribing medication, reviewing blood results and authorising blood products
  • Support the acute oncology team across all 3 hospital sites to review unwell oncology and haematology patients presenting with undifferentiated diagnoses
  • I am currently receiving 1:1 intensive training to insert arm portacaths for patients with metastatic colorectal and breast cancer; once competencies have been achieved then this service will be rolled out to patients receiving adjuvant treatment and the remainder of the team will be trained
  • 2 ACPs are currently receiving training to insert femoral vascular catheters so as to avoid delays for patients requiring apheresis
  • We are in the process of moving our stem cell autograft patients from the in-patient setting to the ambulatory setting; this will provide opportunities for the ACP team to work in both primary care as well as secondary care
  • Low intensity conditioning for allografts will also be moving to the ambulatory setting and the ACPs will be heavily involved in the care, assessment and ongoing monitoring for these patients.

Pie chart of activity

Pie chart of activity

Matthew Fowler is based at the University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK