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<!-- Pillars of Practice The four pillars of practice are part of the NHS Career Framework. The four pillars of practice divide professional development within the NHS Career Framework into 4 domains: clinical practice, leadership, facilitating learning and education, development and research. They are a means of ensuring high quality, individualised service and care for patients. They also encourage continued development which improves adaptability and acquisition of. This will improve the Advanced Clinical Practitioners (ACPs) ability and confidence to problem solve complicated or ambiguous situations. APCs have a higher education and training to equip them with the required skills and knowledge, allowing them to provide and deliver evidence-based care and service to patients. APCs are registered health practitioners with a high level of autonomy, accountability and clinical reasoning for complex decisions.

There are five levels for each of the four pillars of practice. Depending on the individual’s scope of practice, their role and professional background, the level of each pillar of practice will vary. These differences may be inter-professional, such as nursing and physiotherapy, but also within professions. As an individual’s career progresses, the role may require additional and more complex competencies and abilities. Therefore, it may be required to further develop specific pillars in order to take on further responsibilities and develop new areas of skills, for example, teaching or lead departments. https://www.hee.nhs.uk/our-work/advanced-clinical-practice https://www.lasepharmacy.hee.nhs.uk/dyn/_assets/_folder4/advanced-practice/multi-professionalframeworkforadvancedclinicalpracticeinengland.pdf https://www.nes.scot.nhs.uk/media/1355082/ahp_career_development_march12.pdf

Clinical Practice Clinical Practice is the use of professional expertise and knowledge to provide care in your particular field in the appropriate manor. Clinical practice is the amalgamation of professional knowledge, evidence based practice and patient input. Combined, these guide safe and effective physiotherapy care within the clinicians scope of practice. The clinical practice pillar is split into two themes: "Safe, Effective and Person Centred Care" and "Professional Judgement and Decision Making". There are different levels in the clinical practice pillar that can be used to guide an individual with their professional learning. They correspond to the different bandings associated with NHS jobs. This system can be used as a tool to understand and guide what would be expected of someone within a particular band. Therefore, this could determine whether an individual is meeting their job requirements or could guide someone looking for a promotion. The first level, level 5, focuses on developing professional skills in order to provide an effective and holistic patient centred focus to clinical practice. There is a focus on building and improving communication skills- linking closely to the Key Skills Framework (KSF). Levels 6 and 7 see a continuation of knowledge and skills development, with a key role change into taking on more responsibility in helping and guiding others in their clinical practice journey. Level 8 and 9 see a reduction in a clinical practice in terms of patient contact, and a more prominent role in service improvement, mentoring and leadership and influencing the NHS as a whole.

Leadership When a newly qualified physiotherapist enters their profession they are expected to have some basic leadership skills. This includes identifying priorities, acting as a positive role model, ability to work in a team and the competency to receive and deliver constructive feedback. In addition, it is expected that the practitioner helps to achieve the goals of the organisation, seeking opportunity for growth of service teams. To move up to a senior practitioner (level 6) the use and knowledge from NHS Knowledge and Skills Framework (KSF) guidance should be considered. The practitioner should be contributing to their immediate team and help achieve the groups goals. In this manner, they act as an agent of change recognising poor performance and encouraging a positive working environment in which everyone feels they are part of the team. Furthermore, they are expected to actively contribute to professional networks while advancing their clinical reasoning. To satisfy the competencies of an advanced practitioner (level 7) the individual must apply, create and critically review the team and organisation’s performance. This can also be described as a managerial position as they are able to co-ordinate on budgets, comment on colleges performance, provide support and lead initiatives for the organisation and their team. They are also responsible for dealing with complex issues through written and oral reports. In order to be deemed as a consultant (level 8), one must be able to influence policies and strategic direction of the company, act as coach and mentor. They oversee the development plan of the company, respond to national and local requests for document review. This could be for example, strategy, policy guidelines, leading and managing change at local and national levels and acting as an expert resource for patient care and decision making. Finally, at level 9, more senior staff take on the role of maximising the potential of the team with recognised workforce planning methodologies and skill mix. They can operate independently, manage departments, develop and interpret organisational policies. They thus, have a positive impact on team performance using workforce intelligence.

Facilitation of learning Learning, teaching and assessment and creation of the learning environment. Practitioners are responsible for keeping their knowledge upto date through CPD tasks, professional development and engagement with clinical mentors. This is in an attempt to learn from the reflection of these experiences. Furthermore, practitioners should facilitate students to develop their knowledge and understanding of the profession; facilitate learning in clients and their families to allow them to engage more during their rehabilitation. This outcome can be achieved by stimulation, motivation and encouragement of others through this process. Creation of the learning environment can include participation in an educational audit or facilitate learning opportunities for students. This process will work on the self-development of both the practitioner and the student, with the practitioner developing learning materials and using mentor models to aid in the supervision of students. For level 6, 7, 8 and 9 these skills are developed further, moving more towards leadership roles in teaching, education and facilitation of learning. Level 8 also includes evaluating the findings of interventions to assess how best to develop teaching and leaning models in the future; and also to work collaboratively with stakeholders and other education providers. Level 9 moves more towards providing strategic guidance to support organisational learning and are responsible for ensuring organisations are adhering to the applied standards and guidelines. This is in an attempt to ensure a high-quality educational experience; develop teaching models to ensure evidence-based practice and upto date health care is delivered. Regarding the creation of learning, level 9 practitioners are expected to create an ethos within the organisation that creates a positive learning environment.

Evidence research and development, a pillar of practice, sets out a series of career development goals generic to nurses, midwifes and other allied healthcare professionals. The four pillars of practice provide practitioners with a structure which facilitates professional development that reflects the changing needs of their profession and the levels through which they can progress (levels 5-9). In respect to research, among the similarities across the levels of practice are the opportunities for educational and professional development. Each level has access to and facilitates research skills through a multitude of online platforms and paper resources. This includes resources, such as the Cochrane Collaboration Library, The Framework for Measuring Impact and the Institute for Health Improvement: Open School Resources. Firstly, regarding the responsibilities and roles, the level 5 practitioner is expected to be searching databases and exploring evidence to help inform their own practice. They should aim to understand, but not necessarily participate, in conducting research and should be aware of gaps in current evidence. The level 5 practitioner should be comfortable in collecting data for audits and service evaluations. Most importantly, they should be able to evaluate their own practice and interventions. Secondly, regarding demonstrable knowledge, the level 5 practitioner should contribute to quality improvement. This includes initiatives such as Time for Care (a programme which helps teams to manage workloads, leading to increased clinical time for care) and person-centred initiatives such as Talking Points (a quarterly update on patients experiences and outcomes). The practitioner must always work in line with their profession’s governing body and its policies, ensuring ethical, data protection and confidentiality standards are maintained and adhered to. Continuing along the levels of practice from 5 to 9 there are subtle changes. The practitioner becomes more involved in research, interprets results and can implement the findings at the organisational level rather than for the practitioner’s own clinical practice. Furthermore, the advanced practitioner (level 7 onwards) begins to provide support to other practitioners’ development of research skills. At the other end of the continuum, level 9 of the Pillars of Practice focuses more on the practitioner’s responsibility and role in contributing to national research strategies. For example, they could contribute to research carried out by the Nursing, Midwife and Allied Health Profession Research Unit (NMAHP-RU) professions.

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