Advanced practice – what are the opportunities in primary care?

Nursing in Practice speaks with Donna O’Boyle, acting executive director of professional practice at the Nursing and Midwifery Council (NMC), to ask how the NMC has been working to improve advanced practice regulation since soft-launching its principles on advanced practice in May. 

Ms O’Boyle shares how advanced practice can be used and encouraged in primary care and social care to improve care delivery and expand opportunities for nurses working in these sectors. 

Do you think that clarification of the principles of advanced practice will provide clearer opportunities for nurses to progress into more senior roles?

The principles clearly set out what advanced practice means, and distinguishes it from experienced practice. These are such nebulous concepts; we really needed to clarify the principles so that everyone was clear about what advanced practice is.

I think having that shared understanding of what it involves for nurses and midwives will allow professionals to think about their own practice, about how they’d like to develop in their careers, and identify the professional development required to achieve this.

The principles are based around the four pillars of: clinical practice, research, education and leadership. I think by breaking down the principles that way, practitioners can see a roadmap of the areas they need to develop to progress into more senior roles.

Related Article: The changing environment for the Code and revalidation

We’ve obviously seen the four countries of the UK developing their own workforce plan, but overall all the chief nursing officers in the UK are asking for clarity around advanced practice.

I think that as we come towards our standards of proficiency – which we’re developing soon – that will give even more clarity about the knowledge that’s required in advanced practice, and that clear pathway for people to go forward and to see what roles they would like to do.

What responsibility do employers have in encouraging nurses into advanced practice roles?

Employers absolutely have responsibility to support their employees that are filling these roles, because they decide where advanced practice roles are needed in their services.

Advanced practice is such a broad-brush opportunity in general practice and social care. Employers need to make sure that they define the support employees want and what they are capable of in advanced practice. It’s about creating that correct environment with clear job descriptions.

In particular, robust governance is needed together with access to supervision, to provide real opportunities for continuing professional development (CPD) and advancement.

If we look at long-term conditions, for example, advanced practitioners are absolutely essential to ensuring that care in this area is delivered safely.

Employers should translate our regulatory expectations into real-world opportunities and career paths, especially as advanced practice roles expand right across primary and community care. They’re vital.

What would you like to see in the upcoming workforce plan regarding advanced practice?

What we want to do is work together with the four countries. We have got to remember the NMC as a four-country regulator.

Related Article: NMC ‘does not foresee’ A level language requirements impacting register  

It’s always a challenge to achieve this, because each of the countries has their own approach – their own policy around health – so we need to make sure our work at the NMC is wide ranging.

It’s about ensuring that we can provide the support for each nation.

The NMC doesn’t set policy – we have to be very clear about that – but we can absolutely support the workforce plans for each of the four countries by ensuring they have the tools needed to identify what advanced practice is, and how countries can safely utilise and deploy it.

Given the government’s shift towards community-based care, does the NMC have any plans to change or increase regulations for those working in GP practices or the community?

Our overall focus is on public protection. So, any changes we make are to ensure people receive safe and effective care wherever it’s delivered.

That’s an absolutely critical aspect of the delivery of care that our community nurses support. We already updated our post-registration standards in 2022 for specialist community public health nurses (SCPHNs) and their Specialist Practitioner Qualification (SPQ), so they are fit for purpose and they support that practice in our community settings.

I think the principles for advanced practice set a clear direction of travel, and they’ll be followed by these new standards of proficiency and education programme standards for advanced practice so that everyone, no matter where they work, knows exactly what it looks like.

Related Article: NMC plans to cut 145 jobs at regulator

We’re also taking forward developments to modernise and update our Code and revalidation. That’s a symbiotic piece of work – to take the Code and revaluation together and future-proof them so we can make them fit for purpose, to strengthen our professional accountability, and incorporate advanced practice when do regulate it.

That’s a really big priority for us as an organisation; it’s very important.

Donna O’Boyle is acting executive director of professional practice at The Nursing and Midwifery Council