Exploring Advanced Clinical Practitioner's Experience Developing Clinical Competence and Opinions on Role Identity
Conditions: ACP, Nurse's Role, Development, Consensus
Sponsor: University of Sheffield

ACPComp_StudyProtocol: v4 (8th October 2019) 
 
 
 
 
 
 
 
Exploring Advanced Clinical Practitioner’s 
experience developing clinical competence and 
opinions on role identity 
 
 
STUDY PROTOCOL 
 
 

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Contents 
1. 
Project summary ......................................................................................................................... 3 
2. 
Background ................................................................................................................................. 4 
2.1. 
Health Education England definition of Advance Clinical Practice ..................................... 4 
2.2. 
Specific Specialty Curricula ................................................................................................. 4 
3. 
Research Objectives .................................................................................................................... 4 
4. 
Research Design and Methods ................................................................................................... 5 
4.1. 
Design and Setting .............................................................................................................. 5 
4.2. 
Eligibility Criteria and Sampling .......................................................................................... 5 
4.3. 
Recruitment ........................................................................................................................ 5 
4.4. 
Focus group schedule ......................................................................................................... 6 
4.5. 
Data collection .................................................................................................................... 6 
4.6. 
Analysis ............................................................................................................................... 6 
5. 
Ethical considerations ................................................................................................................. 7 
5.1. 
Recruitment ........................................................................................................................ 7 
5.2. 
Informed consent ................................................................................................................ 7 
5.3. 
Confidentiality and anonymity ............................................................................................ 7 
5.4. 
Potential risks and burdens to research participants ......................................................... 8 
5.5. 
Safety of research staff ....................................................................................................... 8 
5.6. 
Participant reimbursement ................................................................................................. 8 
6. 
Data handling .............................................................................................................................. 8 
7. 
Patient and public involvement .................................................................................................. 9 
8. 
Project timescales ....................................................................................................................... 9 
9. 
Publication and dissemination .................................................................................................... 9 
10. 
Project Management .............................................................................................................. 9 
11. 
Costing schedule ................................................................................................................... 11 
12. 
Future research ..................................................................................................................... 11 
13. 
References ............................................................................................................................ 11 
14. 
Appendix 1 ............................................................................................................................ 12 
 
 
 

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1. PROJECT SUMMARY 
There is an urgent need to reshape the NHS workforce to equip it to meet the changing demands of 
the population it serves and deliver the vision set out in the Next Steps on the NHS Five Year 
Forward View (2017)1 and recently published NHS Plan (2019)2.  One of the key elements to this is 
the continuing development, support and utilisation of Advanced Clinical Practice (ACP) roles.   
Advanced Clinical Practitioners are educated to Masters Level in clinical practice and assessed as 
competent in practice using their expert clinical knowledge and skills3.  They have the freedom and 
authority to act, making autonomous decisions in the assessment, diagnosis and treatment of 
patients3.   
Locally the development of ACP roles has been supported by funding from 2015 onwards from 
Health Education Yorkshire and the Humber.  Trainee Advanced Clinical Practitioner posts have been 
introduced across Barnsley, Doncaster, Rotherham and Sheffield in a wide range of clinical settings.  
These include Critical Care, Hospital Out of Hours, General Practise and Emergency Care.  
Although the level of education and assessment of competence are common for ACPs working in all 
areas, training and supervision varies between primary and secondary care, specialties and sites.  
Previous work by the authors used online questionnaires to ascertain how the ACPs felt about their 
education, supervision, confidence and competence when assessing and treating patients (appendix 
1).   This identified huge variability in their experience of training and supervision, with apparent lack 
of formal education supervision for those working in the Primary and Community Care settings.  
Knowledge gaps in assessing and treating patients with mental health problems were also identified.     
This project is a follow on from this work, using a qualitative study design to further explore the 
experience of ACPs, and specifically: 
● Factors that have influenced their clinical competency achievements. 
● Training experience, both in clinical practice and external education opportunities e.g. 
simulation. 
● Experience of educational and clinical supervision and its benefits. 
● Self-identified knowledge gaps, with a focus on managing patients with mental health 
conditions. 
● Their role identity as part of the NHS workforce going forwards. 
The study will be managed by the School of Health and Related Research (ScHARR), University of 
Sheffield in collaboration with the South Yorkshire and Bassetlaw Faculty for Advanced Clinical 
Practice (SYB-ACP) and Sheffield Teaching Hospitals NHS Foundation Trust (STH). 
Focus groups will be conducted with a sample of ACPs working in Primary or Secondary Care in the 
Yorkshire and Humber region.  All of the sessions will be video-recorded, transcribed verbatim and 
analysed thematically using NVivo.  
The findings of the study will be written up for review and used to inform improvements to 
supervision and training locally.  Findings will also be disseminated through peer-reviewed scientific 
journals and appropriate clinical and/or academic conferences.  

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2. BACKGROUND 
Advance Clinical Practitioners (ACPs) are an increasingly important part of the NHS workforce.  
Coming from a range of professional backgrounds such as nursing, pharmacy, paramedics and 
occupational therapy, they have additional skills and knowledge to take on expanded roles and 
scope of practice. 
Their exact role varies according to the clinical setting, specialty and site, but all should be 
characterised by the following level of practice: 
● MSc level qualification 
● Autonomous decision making: an ability to work independently and as part of a clinical team 
● Ability to manage undifferentiated patients (discrete from Specialty Practitioner who 
manages a single condition/pathology e.g. asthma nurse) 
2.1. 
Health Education England definition of Advance Clinical Practice  
The following ACP definition which can be applied across professional boundaries and clinical 
settings, has been developed by Health Education England, in association with its multidisciplinary 
partners4.  This has been developed to provide clarity for employers, service leads, education 
providers and healthcare professionals, as well as potential ACPs practicing at an advanced level. The 
definition serves to support a consistent title and recognises the increasing use of such roles across 
the NHS. 
“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.” 
2.2. 
Specific Specialty Curricula 
Some clinical specialties have developed specific, bespoke curricula for ACP training.  For example, 
the Royal College of Emergency Medicine (RCEM) (2015) has developed a training programme for 
ACPs5, requiring them to demonstrate a wide range of competencies, which are assessed locally by a 
medical consultant supervisor, followed by a final external assessment.  
3. RESEARCH OBJECTIVES 
The principle research purpose is to: 
Explore ACPs’ experiences of how they develop clinical competence and their opinions on role 
identity. 

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The above encompasses the following objectives: 
● To gain insights into factors that have influenced their clinical competence achievements in 
the following areas: - 
o Training experience, both in clinical practice and external education opportunities 
e.g. simulation. 
o Experience of educational and clinical supervision and its benefits and 
disadvantages. 
o Self-identified knowledge gaps, with a focus on managing patients with mental 
health conditions. 
● To seek views on the role identity of ACPs as part of the multi-disciplinary team and NHS 
workforce going forwards. 
4. RESEARCH DESIGN AND METHODS 
4.1. 
Design and Setting 
A small-scale exploratory study using a qualitative design will be used to conduct four focus group 
sessions with ACPs who are currently working with in the South Yorkshire and Bassetlaw region..   
The focus groups will be undertaken at two locations, The University of Sheffield and the Hilton 
Garden Hotel Doncaster Racecourse, to maximise attendance and will commence in November 
2019. Each focus group will last two hours.   
The focus groups will be facilitated by two independent researchers, who have no previous 
connections with the participants, to encourage open discussion of issues. 
4.2. 
Eligibility Criteria and Sampling 
Those participating in the focus groups sessions must fit the following eligibility criteria: 
 
Qualified ACP or trainee ACP who has completed at least 1 years (FTE) of ACP clinical 
training  
 
Currently working in this role within either Primary or Secondary Care and based in South 
Yorkshire and Bassetlaw. 
4.3. 
Recruitment 
Ideally up to 32 ACPs will be recruited to participate in the 4 focus groups. South Yorkshire and 
Bassetlaw Faculty for Advanced Clinical Practice (SYB-ACP) will act as gatekeepers. Using ACP email 
distribution lists held by the SYB-ACP, an invitation to participate in the study will be sent to ACPs on 
behalf of the Study Team. The email will include: 
 
Invite to participate in the focus groups briefly outlining the study and details of  date, times 
and locations of the focus groups 
 
Participant information sheet 
 
Web link to a short online questionnaire and contact details form 

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ACPs that wish to participate will be directed to click on the web link which will take them to the 
online survey tool, Qualtrics (www.qualtrics.com). Participants will be asked to complete a short 
questionnaire to confirm eligibility and record basic details such as gender, age group, length of 
experience in ACP role, etc. Contact details and availability to attend the focus groups will also be 
requested. Participants that are not eligible to participate will be informed immediately after 
completing the questionnaire and no further information will be requested. 
The study will also be advertised on social media (Twitter, Facebook) and those expressing an 
interest will also be sent the study invitation email, participant information sheet and web link to the 
online questionnaire and contact details form. Participants not able to access the information online, 
will be sent a study pack (invitation letter, participant information sheet, questionnaire, contact 
details reply slip and stamp-address reply envelope) by post. 
Participants will be selected based on who responded to the study invitation first and who is 
available to attend the dates of the focus groups. Members of the study team will contact 
participants (telephone or e-mail) to confirm the date, time and location of the focus group. If there 
are more potential participants than slots available in the focus groups, a member of the study team 
will contact the participant (telephone or e-mail) to inform them of alternative focus group slots (if 
available). If these are not suitable, the participant will be thanked for their interest but informed 
that they will not be participating in the focus group sessions.  
Focus groups will take place as soon as sufficient numbers of participants are recruited. Due to the 
work schedules of participants being recruited, it is anticipated that focus groups may need to be 
held outside of normal working hours for convenience (for participants) and to maximise 
attendance. 
4.4. 
Focus group schedule 
A focus group schedule will be designed and agreed before the sessions for consistency between 
groups and to ensure that research objectives are achieved.  At the end of the focus group session, 
participants will be asked to provide feedback about how well they felt the process worked, in order 
to understand the focus groups from their perspectives and identify any strengths/limitations of the 
study. 
4.5. 
Data collection 
All of the focus group sessions will be recorded using a video camera to make it easier to identify 
participant voices during the transcribing process. Participants will be made aware of the video 
recording and the reason for it on the information sheet, during the first contact with the researcher 
and prior to the focus group commencing. . Written informed consent will be obtained for all 
research participants at the start of each focus group. Focus groups will be undertaken in a private 
room at The University of Sheffield or at the Hilton Garden Hotel, Doncaster RaceCourse. 
4.6. 
Analysis 
Data from the focus groups will be video-recorded, transcribed verbatim and analysed thematically. 
NVivo software will be used for data analysis, and development of themes to answer research 

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questions in understanding about the factors leading to the ACPs development of clinical 
competence and their role identity. 
Analysis will be on-going and iterative involving concurrent data collection and analysis, with 
systematic efforts to check and refine developing categories of data.  
Qualitative data will be interpreted using Thematic Framework Analysis. This will follow the five 
stages of Thematic Framework Analysis including familiarization, identifying a thematic framework, 
indexing, charting, mapping and interpretation. 
5. ETHICAL CONSIDERATIONS 
This study raises six key ethical considerations, namely: informed consent; confidentiality and 
anonymity; potential risks and burdens to research participants; safety of research staff; and 
participant reimbursement. 
5.1. 
Recruitment 
Participants will be contacted via email from the study team with the full relevant information 
regarding the study and details of their potential involvement.  Those responding to social media 
(Twitter) posts will be sent identical information. We will ensure the relationship between a 
potential participant and recruiter is free from undue influence. We will ensure that there is no 
coercion or unacceptable inducement to participate in our study. We will ensure that we collect the 
minimal amount of personal data before receiving consent.  
5.2. 
Informed consent 
All potential participants will be provided with full written information about the study and how any 
information collected will be used. They will be reminded that participation is entirely voluntary and 
that they can withdraw from the study at any time. However, due to the nature of conducting focus 
groups, it is not possible to delete any contributions that the participant makes during the course of 
the session should they wish to withdraw from the study part way through the focus group session. 
Participants will be made aware of this at the time of consent.  
Formal written consent will be obtained for all research participants. Before the focus group the 
researcher will complete the consent procedure, explaining the study and making sure each person 
fully understands what they are agreeing to.  
5.3. 
Confidentiality and anonymity 
Personal information (e.g. name, email and contact telephone number) will only be accessed by 
members of the study team as a means of contacting participants once the individual has agreed to 
find out more about participating in the study.  The study team will only have the contact details of 
those who have agreed to participate as the initial contact will be made by the SYB-ACP.  
Research participants will be given an explanation about how the data will be processed and an 
understanding that the data gathered in the study will not be reported, discussed or made available 
in such a way that will enable them to be identified.  Locations of work will not be attributed to 

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comments and broad terms categorising individuals roles only will be used to describe staff 
participants to prevent the ability to identify participants.   
Research participants will never be named in any publications and thematic analysis of responses 
will be conducted at an aggregate level. Pseudonyms will be used in the focus group transcripts so as 
not to identify participants.  
5.4. 
Potential risks and burdens to research participants 
We do not envisage that the focus groups will cause any undue stress or embarrassment to the 
participants. Only experienced researchers will be used who have the skills and experience to 
conduct focus groups sensitively. In line with an approach of an on-going consenting process the 
focus group facilitators will be skilled at reading non-verbal and verbal communication to pick up 
quickly if a participant is becoming distressed.  
If a participant becomes upset, for example they have a poor experience of training or supervision, 
they will be asked if they are happy to continue and may take a break or leave the focus group 
session altogether.  Depending on the issue raised, they would be encouraged to contact their GP, 
occupational health department or supervisor.      
5.5. 
Safety of research staff 
A team approach to risk management will be adopted and any concerns will be communicated to 
the Chief Investigators in the first instance. Both focus group coordinators would have mobile 
phones and although focus groups may potentially be held outside of normal working hours, they 
will take place in pre-booked rooms within the University of Sheffield or the Hilton Garden Hotel, 
Doncaster Race course, both of which have 24-hour security. 
5.6. 
Participant reimbursement 
There is a risk that the research process may inconvenience participants. Therefore, participants will 
be offered refreshments at the session and a £40 high-street shopping voucher on completion of the 
focus group to compensate them for their time and effort and to thank them for their participation 
in the study.  
6. DATA HANDLING 
Personal data will include the contact details for ACPs who have expressed they wished to 
participate in the study.  
There will be a master file (Microsoft Excel Spreadsheet) located at The University of Sheffield that 
associates a named participant with a study ID (unique number). The master file will only contain 
contact details, confirmed eligibility and basic demographic data and the study ID. This study ID, 
rather than names/addresses will be used as the key on all other documents that associate data with 
an individual. In this way someone outside the study would not be able to identify an individual 
participant.  
The master file will be password protected and held in an access restricted project folder on The 
University of Sheffield secure shared networked filestore. The master file will be stored in a separate 

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location to the rest of the study documentation (e.g. focus group transcripts). Only named members 
of the study team will be able to access files containing the participant’s personal data. 
Following each focus group, the video recording will be uploaded straight on to a computer stored in 
a locked office located at The University of Sheffield. Once the video recording has been uploaded it 
will be deleted from the video recorder. Transcripts of the video recordings sent via e-mail will be 
encrypted and in the transcripts participants will be referred to using a study ID, not people’s names.  
The video recordings will be deleted after they have been transcribed by a transcriber (allocated 
member of the ScHARR Transcriber Team) and the transcripts quality checked by members of the 
study team.  
After the study has finished the anonymised transcripts will be kept for 5 years and then destroyed.  
7. PATIENT AND PUBLIC INVOLVEMENT 
The PPI group linked to the SYB-ACP will be approached to seek their advice on the recruitment 
materials that will be produced for this research project (e.g. patient information sheets), as well as 
their advice on the focus group schedule to gather their thoughts on the suggested questions and 
structure of the focus groups. 
8. PROJECT TIMESCALES  
We anticipate undertaking this study within 8 months commencing November 2019 as follows: 
● Months 0-2: Obtain ethical approval, study set up, focus group preparation 
● Months 1-4: Participant recruitment 
● Months 3-6: Undertake focus groups, commence data extraction and analysis 
● Months 7-8: Final write-up 
 
9. PUBLICATION AND DISSEMINATION 
The findings will be disseminated through peer-reviewed scientific journals and appropriate clinical 
and/or academic conferences.  
A final report will be prepared for the SYB-ACP. 
10. PROJECT MANAGEMENT  
The research is led by the School of Health and Related Research (ScHARR) based at The University 
of Sheffield, who have overall responsibility for project management. The project management 
group will meet once a month to oversee the project.  The following staff members comprise the 
project management group: 
● Julie Perrin, Joint Chief Investigator (Professional Lead Advanced Clinical Practice, South 
Yorkshire and Bassetlaw Faculty of Advanced Clinical Practice) 

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● Susan Croft, Joint Chief Investigator (Consultant Emergency Medicine, Sheffield Teaching 
Hospitals NHS Foundation Trust) 
● Maxine Kuczawski, Study Manager (Research Associate, ScHARR) 
● Sarah Hargreaves, Focus Group Lead (Research Associate, ScHARR) 
● Veronica Fibisan (Study Administrator, ScHARR)  
● Suzanne Mason (Professor of Emergency Medicine, ScHARR) 
● Kirsten Clinton (Nurse Consultant, Emergency Department, Sheffield Teaching Hospitals) 
All members of the study team will be involved in the study – developing the protocol, study 
documentation, analysis and report write-up.  Specifically:-  
● Susan Croft and Maxine Kuczawski will be responsible for the day to day running of the 
study. 
● Sarah Hargreaves and Maxine Kuczawski will manage the focus groups. 
● Julie Perrin and Kirsten Clinton will check and assess quality control of the focus group 
transcripts. 
● Sarah Hargreaves will undertake the analysis, with support from Julie, Perrin, Kirsten Clinton 
and Maxine Kuczawski. 
● The final stages of preparing and writing the final report will involve all members of the 
study team. 
The research sponsor is the University of Sheffield. 
 
 

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11. COSTING SCHEDULE 
(The following costing schedule excludes staff costs) 
Stage 
Item 
Detail 
Unit 
cost, £ 
Quantit
y 
Total 
cost, £ 
 
Focus groups  
Venue hire 
● University of Sheffield 
● Hilton Garden Hotel, 
Doncaster Race course 
 
- 
- 
0.00 
Staff travel 
Focus groups, Meetings, etc 
 
 
200.00 
Catering 
Refreshments and buffet 
food (£10.75 *10) 
107.50 
4 
430.00 
Participant 
incentive 
High street voucher 
40.00 
32 
1280.00 
Study 
documentation 
Participant Information 
sheet, Consent forms, etc 
0.2 
64 
12.80 
Dissemination 
Report printing 
- 
0.20 
50 
10.00 
 
Journal 
publication 
 
2800.00 
1 
2800.00 
TOTAL COST 
 
 
 
 
4732.80 
 
12. FUTURE RESEARCH 
It is anticipated that the findings from this research will be used to help prioritise areas of research 
for ACPs in the future. 
13. REFERENCES 
1. NHS England. Next steps on the NHS five year forward view, 2017. Available from: 
https://www.england.nhs.uk/wp-content/uploads/2017/03/NEXT-STEPS-ON-THE-NHS-FIVE-
YEAR-FORWARD-VIEW.pdf (Accessed 06/07/19) 
2. NHS England. The NHS Long Term Plan, 2019. Available from: 
https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan-june-
2019.pdf (Accessed 06/07/19) 
3. Royal College of Nursing.  Advanced Level Nursing Practice – Introduction, 2018.  Available from: 
https://www.rcn.org.uk/professional-development/publications/pub-006894 (Accessed 
06/07/19) 
4. NHS Health Education England, Advanced Clinical Practise.  Available from: 
https://www.hee.nhs.uk/our-work/advanced-clinical-practice (Accessed 25/08/19) 
5. Royal College of Emergency Medicine, Royal College of Nursing, NHS Health Education England. 
Emergency Care Advanced Clinical Practitioner Curriculum and Assessment, Version 1.0, April 
2015. 
 
 
 
 
 

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14. APPENDIX 1 
Title:  An evaluation of competence and confidence of Trainee Advanced Clinical 
Practitioners 
Reference no - 8249 
Authors:  
Julie Perrin, Professional Lead Advanced Clinical Practice, South Yorkshire and Bassetlaw 
Faculty of Advanced Clinical Practice 
Susan Croft, Emergency Medicine Consultant, Northern General Hospital 
Richard Campbell, Research Support Officer ScHARR 
Background 
There is an urgent need to reshape the NHS workforce to equip it to meet the changing demand 
from the population it serves and deliver the vision set out in the Five Year Forward View 
(Nuffield Trust 2016) and recently published NHS Plan (2019). Advanced Practice roles can 
deliver benefits for patients through more patient focussed care whilst benefits for staff are 
related to more rewarding roles and enhanced career pathways. 
Opportunities to develop the current workforce to meet the needs of the future health service by 
developing new roles have been supported regionally by funding in 2015 onwards from Health 
Education Yorkshire and the Humber. Trainee Advanced Clinical Practitioner posts across 
Barnsley, Doncaster, Rotherham and Sheffield in a wide range of settings including Critical 
Care, Hospital Out of Hours, General Practise and Emergency Care have been introduced. 
Within the training posts, there have been different approaches to training were taken including 
time given for training/education and differences in clinical specialty exposure. McDonnell et al 
(2013) identified in a small cohort study that supernumerary education for ACPs resulted in 
increased confidence and preparedness for practice.  
The study aimed to use a questionnaire to ascertain how the ACPs felt about their education, 
supervision, confidence and competence when assessing and treating patients. 
Methods 
 A validated electronic questionnaire, based on EDit 1 was distributed via e mail in 2017/2108 to 
110 Advanced Clinical Practitioners both in training and one year post qualification working 
across the South Yorkshire and Bassetlaw region. The questionnaire used both multi-choice 
questions and free text to collect the following information: 
 
Demographics – age, gender, duration of training 
 
Confidence managing different patient groups according to presenting complaints (scale 
from 1-9 where 1 is least confident and 9 is most confident) 
 
Confidence performing clinical skills (scale 1-9) 
 
The impact certain factors would have had on improving their confidence (e.g. clearer 
guidelines, improved teaching etc.) 
 
Supervision – supervisor contact 
 
Teaching/training/feedback 

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The ACPs were identified by clinical leads in the four local NHS Trusts. Responses were 
submitted anonymously via an electronic link. 
The questionnaire was redistributed a further 2 times via e mail with a supporting letter from the 
Medical Lead of the South Yorkshire and Bassetlaw Faculty of Advanced Clinical Practice 
requesting support for the completion. 
Responses were collated and themes identified. 
Results 
There were 24 respondents, a response rate of 21.8%.  The sample size was too small to 
undertake any formal statistical analysis.  The mean age of respondents was 36.3 years (range 
25-57 years) and the majority (70.8%) were female. Their working hours were between 22.5 and 
40 hours per week (mean 31.3 hours) and the length of their training varied between 6 months 
and 2 years.  
The ACPS had undertaken placements in a variety of settings – General Practice, Radiology, 
Hospital Medicine, Paediatrics, Orthopaedics, Hospital Surgery and Emergency Medicine.  
Presenting complaints and clinical skills 
The ACPs were most confident managing general medical conditions (e.g. diarrhoea and 
vomiting, cellulitis, shortness of breath).  They were least confident managing acute mental 
health problems (see figure 1). 
With regard to clinical skills – they were most confident performing a clinical assessment and 
phlebotomy related tasks.  They were less confident interpreting results (ECG and x-ray 
interpretation), see figure 2.   
Figure 1: Trainee ACPs subjective confidence managing patient groups according to presenting 
complaint 
 
 
 

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Figure 2: Trainee ACPS subjective confidence in performing clinical skills 
 
Improving confidence 
The factor they felt would most improve their confidence was more supervision.  Clearer 
guidelines, better teaching and increased experience managing the condition were also felt by 
the majority to have improved their skills.   
The majority of ACPs felt they had sufficient time and time to make the appropriate decisions 
about patient care.  
Supervision 
4 ACPs (16.7%) stated that they did not have a clinical supervisor.  The 2 ACPs who had 
undertaken placements in General Practice (100% of those with placements in GP) stated they 
had no supervisor.   
The time spent with clinical supervisors or in direct contact with a senior medic varied 
substantially between ACPs.  Those that had supervisors had one to one contact with them 
between 0 and 20 hours/month (mean 2.75 hours/month), with direct contact with a senior 
medic between 0 and 108 hours/month (mean 6 hours/month).  
Teaching /training/feedback 
Most ACPs identified having “just a little amount” of formal teaching sessions and training in the 
last 6 months, but felt that they had a “moderate amount” of feedback about their quality of 
work. 
 
 

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Themes identified from free text responses 
Discussion 
The response rate to our questionnaire survey was disappointing.  Despite our efforts to explain 
the questionnaires importance and engage staff, less than a quarter of ACPs 
responded.  Perhaps in future, incentivising staff to complete questionnaire or including as a 
compulsory part of their appraisal process may improve response rates. 
The ACPs who responded had undertaken placements in a variety of areas, in both Hospital 
and Community settings. Their roles and therefore training, experience and supervision in these 
settings obviously differed, but we were unable to fully analyse this as the sample size was 
insufficient.  Instead, patterns, themes and trends were identified.   
There was a huge variation in the amount of supervision the ACPs received both from a senior 
clinician or educational supervisor.  Worryingly, four trainees identified that they had no 
identified educational supervisor.  These included the two trainees who had community 
placements in General Practice.  This apparent isolation is a worrying feature particularly as the 
ACPs identified that greater supervision was the factor that impacts most on their confidence.  
Subsequent information gathered by the Medical Lead and Professional Lead for Advanced 
Practice support this concern by highlighting that in general ACPs receive less support and 
supervision within the Primary and Community care setting. As a direct result of this, HEE have 
funded a 2 year project to develop and provide a support programme for practitioners in these 
areas in addition to placements and development of Mental Health services as  identified within 
the NHS Long Term Plan (2019) 
 
Variability (mostly lack) of training, supernumerary time, placements 
and supervision 
“I have not had any supernumerary time at all and no clinical supervision” 
“Supernumerary periods disorganised and disjointed” 
“Have to use my own initiative to learn” 
“Training has made me more confident taking a history and clerking” 
“My ACP supervision was excellent” 
 
 
Extended responsibilities in their roles that they feel 
unqualified/untrained for 
“Asked to cover FY1 bleeps overnight, with no formal training in the 
specialties being covered, this is a particularly concerning trend” 
“Addition of site responsibilities…..is frankly the most stressful part of my job.  
Lack of training in this area is concerning”   
 
 
Lack of formal feedback mechanisms 
“Lack of feedback from parent teams means you only become aware of 
mistakes you’ve made” 
 
 
Disparity within workforce 
“Disparity of pay between us and other ANPs within the Trust is concerning” 

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Most ACPs felt more confident managing medical presenting complaints/conditions than 
psychiatric presentations.  The experience and knowledge required for assessing different 
presenting complaints/conditions obviously relates to the area in which the ACP works, but 
some psychiatric experience is increasingly necessary when working in GP, ED and inpatient 
areas.  Perhaps this is an area where additional training should be focused. 
In the free text sections, there was obvious variability in the training/supervision 
highlighted.  ACPs also felt that they were on occasions, asked to take on additional roles such 
as site responsibility for which they had not formal training.  Most ACPs felt that they received a 
moderate amount of feedback, but others felt that this could be improved if it was formalised.  It 
would be interesting to see if these experiences and opinions were shared by the junior doctor 
workforce. 
Recommendations 
1. A formal clinical supervisor for each ACP should be mandatory. 
2. Inclusion of mental health education within the training programme. 
3. Use focus groups to further explore variability in time and requirements to gain clinical 
competence. 
References: 
 
DoH (2019) The NHS Long Term Plan https://www.longtermplan.nhs.uk/wp-
content/uploads/2019/01/nhs-long-term-plan.pdf Last accessed 14.2.19 
 
Mason S, O’Keefe C, Carter A, O’Hara R, Stride C. (2012) An evaluation of Foundation 
Doctor training: The impact on workforce well being and patient care (The EDit study) NIHR 
https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/081819221/#/ Last accessed 
14.2.19 
 
Nuffield Trust (2016)