Advanced Clinical Practice working with people who have a learning disability and/or autism

Advanced Clinical practice is an emerging role in healthcare. Physiotherapists have been at the forefront of the development of the role in many areas of clinical practice. Health Education England are currently expanding the advanced clinical practice role within a number of specific areas of healthcare. One of these is in Learning Disability and Autism.

The National Executive Committee are currently working with the Health Education England to support the development of the framework into a Masters level unit of assessed learning and the implementation of the advanced clinical practice role into learning disability and/or autism services.

Dear membership

Health Education England (HEE) published the Advanced Clinical Practice capabilities framework when working with people who have a learning disability and/or autism in April 2020. Many of you will have been involved in the development of the framework during the public consultant which happened in March 2019. The framework describes the enhanced capabilities for advanced clinical practice delivered by Allied Health Professional’s (AHPs) and nursing staff in learning disabilities and autism services. The document includes ‘core capabilities’ relevant to all advanced clinical practice, and also ‘profession and role specific’ capabilities based upon the person’s profession and/or clinical area of practice. The AHPs who may have specialist roles when working with people who have a learning disability and/or autism include:

  • Occupational Therapists
  • Physiotherapists
  • Dietitians
  • Arts Therapists (Art, Drama and Music)
  • Speech and Language Therapists
  • Orthoptists.

The framework is available at:

https://www.skillsforhealth.org.uk/images/services/cstf/ACP%20in%20LDA%20Framework.pdf 

On reading the framework, many of you will note that you are meeting many of the capabilities within your current practice. Indeed, a number of the capabilities describes the core knowledge and skills that would be expected of the entire learning disability workforce. However, professional groups are unlikely to have the breadth of knowledge of all the disciplines outlined in the framework. It is this broad multi and inter-disciplinary understanding that the programme aims to develop and assess.

The definition of advanced clinical practice is:

“Advanced clinical practice is delivered by experienced, registered health and care practitioners. It is a level of practice characterised by a high degree of autonomy and complex decision making. This is underpinned by a master’s level award or equivalent that encompasses the four pillars of clinical practice, leadership and management, education and research, with demonstration of core capabilities and area specific clinical competence.

Advanced clinical practice embodies the ability to manage clinical care in partnership with individuals, families and carers. It includes the analysis and synthesis of complex problems across a range of settings, enabling innovative solutions to enhance people’s experience and improve outcomes.”

For a detailed description of the capabilities for advanced clinical practice in England and the key principles for the implementation of advanced clinical practice refer to the Multi-professional framework available at:

https://www.hee.nhs.uk/sites/default/files/documents/Multi-professional%20framework%20for%20advanced%20clinical%20practice%20in%20England.pdf

Many of you will have heard about the developing advanced clinical practitioner role across different areas of physiotherapy and healthcare. And you may know friends and colleagues that are undertaking the programme or are already advanced clinical practitioners in their specific domains.

The capabilities framework when working with people who have a learning disability and/or autism is one of a growing number of curricula/frameworks that cover specific areas of healthcare. These frameworks are developed into credentials which are a unit of assessed learning related to a particular area of practice awarded by an education provider, normally at Masters level. The Centre of Advancing Practice validates the credentials if it meets the multi-professional requirements and quality assurance processes. Once validated, a credential can be delivered and awarded by an education provider. The full list of credentials that are current available or are in development are available at https://www.hee.nhs.uk/our-work/advanced-practice/credentials.

The framework for learning disability and/or autism is currently in the stage of being developed into a unit of assessed learning. HEE requested the ACPPLD to support this process and the development of the advanced clinical practice role in learning disability and/or autism services. There are currently four strands to this work:

  1. Reviewing the capability framework
  2. Supporting the development of the framework into a unit of assessed learning
  3. Workforce development
  4. Exploring how advanced clinical practice is being implemented into physiotherapist practice

1. Reviewing the framework:

The physiotherapy specific capability in the framework is Movement and Posture (Page 35). At present, the domain focuses on posture and postural management; but not the other physiotherapy related problems common to people with a learning disability. As a result the section does not comprehensively described the physiotherapy needs of adults with learning disability or the role of the specialist learning disability physiotherapist. It is important to recognise that the capability does not set out to describe the role of physiotherapist in the same level of detail as the standards of practice. It would not be reasonable to for an advanced clinical practitioner to work at the same level as a specialist professional.

The NEC are currently working with HEE to review and update the movement and posture capability so that it includes falls, mobility problems, respiratory problems (other than those related to dysphagia) and health promotion/engagement in physical activity. The publication of the standards of practice for physiotherapists working with adults with a learning disability has supported these discussions. A body of evidence highlighting the physiotherapy related problems of adults with a learning disability and the role of physiotherapists have in managing them was published after the developed of the framework. We have met with HEE representatives and they are committed to amending the framework. They recognise the potential role advanced clinical practitioner could have in managing these common health concerns.

The framework states it is designed for educational and training providers, service commissioner, practitioners, service user and the public. This makes it important that the framework is accurate. If not, it could lead to the development of educational programmes that are not accurate and fully representative; a lack of commissioning and delivery of physiotherapy within community learning disability teams; misunderstanding within the multi-disciplinary team about the role of physiotherapy; and most importantly result in poor understanding of the role by service users and the public. 

2. Supporting the development of the framework into a unit of assessed learning:

Two universities, Edge Hill and Cumbria have been successful in the tendering to develop the first units of assessed learning. These are due to start in March 2021 and November 2021 respectively. Both universities are delivering a post graduate certificate (60 credits) which will run over a year. They will have a multidisciplinary content; will be delivered through distance learning; and will be a combination of 50% theory and 50% practice based learning. The finer details of the course content are being finalised. Further details about the courses can be found by watching the below webinar:

https://www.youtube.com/watch?v=rM-pJznH-Bc

HEE are funding 40 places for the course (20 at each university). They are funding the post graduate certificate not the full advanced clinical practice course. Places will be equally allocated around the different regions and professional groups. Therefore, there will be limited places for physiotherapists to apply for in the New Year. These will be only be available for members based in England. If anyone is considering becoming an Advance Clinical Practitioner and is interested in applying for the course we would be very keen to hear from you.

We are currently on the steering and reference groups for the developing the courses. The steering group aims to ensure that the project is meeting its aims and running to the proposed timeframes. The reference group works more closely with the higher education institutions to ensure the course content, delivery and assessment accurately represents the physiotherapy needs of adults with a learning disability and the role of the specialist learning disability physiotherapist.

3. Workforce development:

HEE are working with health and social care providers to develop the Advance Clinical Practitioner role into practice. This is clearly an important step as roles need to be developed for newly qualified Advance Clinical Practitioners to move into following completing their training. This may be an extension of their current roles or newly developed posts. This a new and emerging role in the field of learning disability, therefore it is likely to take some time to fully understand its place and benefit within learning disability services. There are currently more questions than answers about how the role will impact of the delivery of healthcare to adults with a learning disability and whether it will impact on the specialist roles within learning disability services. Certainly, from the work I have completed with the HEE, it is not meant to replace the different specialisms. But to develop more holistic and rounded professionals who can identify; provide generic assessment and treatment; and then make appropriate onwards referrals for specialty intervention. This work is currently being developed and we have meetings with HEE workforce development team in the New Year.

4. Exploring how advanced clinical practice is being implemented into physiotherapist practice:

Deepak Agnihotri (Lead Physiotherapist, Eastway Community Services) is currently completing his Advanced Clinical Practitioner course. He is really excited about the opportunity to develop his new role into practice and can see the value his training can bring to the health of adults with a learning disability he works with locally. Obviously as his job expands, the challenge will be ensuring that it does not take him away from his physiotherapy role. The learning disability and/or autism credential was not available to him at the time so he took a different route to becoming an advanced clinical practitioner. However, he would be happy to talk to members who are considering becoming an Advanced Clinical Practitioner.

In summary,

This is an emerging role with learning disability services. Personally, I can see the value of Advanced Clinical Practitioners to improve the holistic management of the health needs of this vulnerable population and reduce health inequalities. I feel that advanced clinical practitioners could have an important role in the proactive identification, assessment and multidisciplinary management of health problems, as well as improving appropriate onward referrals to specialist professions. Indeed, it would be beneficial if professionals working with people with a learning disability had knowledge of the physiotherapy needs of the group; where able to implement some strategies to minimise risk; and then make onward referrals to the appropriate physiotherapy service.

Furthermore, there are very few specific courses available and appropriate to learning disability physiotherapists. Therefore, if the post graduate certificate becomes a standalone unit, it could become an important programme in developing the knowledge and skills of the learning disability workforce. In addition, the advanced clinical practitioner route will hopefully attract physiotherapists and professionals into the specialism as well as help with retention through opportunities for career progression.

The framework on which advance clinical practitioners and educational courses are developed must accurately represent the needs of the people with a learning disability and/or autism, and describe the skills of the learning disability workforce. Therefore, we will continue to work with HEE to represent physiotherapy, and we will feedback where appropriate.  

Please let me know if you have any questions.

Happy New Year and stay safe.

David Standley, Research and Education Officer, david.standley@gstt.nhs.uk

Number of subscribers: 3

Log in to comment and read comments that have been added