As in the other home nations, health is devolved in Scotland. This means that the nations make their own decisions about healthcare investment, education and workforce plans through their own governments. This leads to differences in healthcare systems and implementation of FCP.
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Implementation of FCP
The 2018 General Medical Services Contract in Scotland, provided a refocusing of the GP role as expert medical generalists enabling roles historically carried out by GPs to be carried out by members of a wider primary care multidisciplinary team. As a result of this document, the implementation and spread of FCPs in Scotland was accelerated.
However, while the Scottish Government has outlined a commitment to maximising the contribution of the Nursing, Midwifery and Allied Health Professionals (NMAHP) workforce and pushing the traditional boundaries of professional roles. Progress for AHPs in this area has been slow and has not received the same level of investment as for our nursing colleagues.
As work restarts after being paused during the pandemic, the Scottish Government has committed to:
- Developing and transforming NMAHP roles to meet the current and future needs of Scotland’s health and care system.
- Ensuring nationally consistent, sustainable and progressive roles, education and career pathways.
Prior to the pandemic, work was undertaken within the Scottish Government's AHP Transforming Roles workstream. This work was paused as the focus shifted to the pandemic. The NHS Education for Scotland (NES) NMAHP directorate has now been given responsibility to refresh and complete this workstream, building on the work already done, and delivering a sustainable and appropriately governed educational pathway, not only for advanced practice but at all levels of the career framework.
While there is no consistent and standardised level of FCP practice in Scotland at present, we must acknowledge the significant differences in healthcare delivery and funding models, and the impact of these on service delivery and educational governance. Furthermore, Scotland does have many of the required building blocks already in place such as a robust Post Graduate Careers Framework which defines the progression through the different postgraduate levels of practice. This framework also has an established digital platform where e-portfolios will be housed.
Pre-Covid, the Transforming Roles workstream proposed that the nursing academies, set up to support advanced nursing practice, expand to include AHPs. The academy approach was intended to bring health boards across Scotland together to support the professional development of advanced practice. It aims to develop a cohesive, consistent approach to competence and capability and lead on new advanced role developments. At this time, these are virtual academies bringing together higher education institutes (HEIs), clinicians and leaders. It was therefore suggested that, with AHP representation, this could be the mechanism through which AHP advanced practice role Knowledge, Skills and Behaviours (KSBs) could be verified.
Requests for advanced practice roles would be taken to the AHP Directors Group in Scotland (ADSG). If approved by them, a group (including HEI reps, clinical experts and professional bodies) would work to define the KSBs for that role, which would then go to the academies for verification. All sign-off for individual clinicians would happen at board level but with standardised templates from the academies.
If you are an aspiring FCP in the Scotland, you may wish to align yourself with the Health Education England roadmap as this provides a clear framework for career development towards FCP and advanced practice in primary care, and includes details of a number of e-learning courses on primary care and personalised care that are relevant for all FCPs.
Find the latest version of the roadmap on the HEE website.
- National definitions for senior advanced and consultant practice were agreed.
- A set of national Knowledge, Skills and Behaviours (KSBs) for MSK FCP roles were developed.
- Basic service and educational needs analysis was undertaken.
- A process by which future roles would be developed was agreed.
- The need for sustainable education and career pathways for people in these roles was recognised.
The AHP Transforming Roles workstream will now sit with NES, and there will be a refresh to promote the need for, and benefits of, a consistent approach to AHP role development in Scotland. However, the previous work will be built on.
Key to this will be:
- The mapping of educational needs to current education provision.
- The development of educational pathways supported by accredited and non-accredited learning.
- The development of an e-portfolio to support practitioners to meet the KSBs.
Educational governance will be vital going forward, particularly in ‘signing-off’ levels of practice against educational frameworks. Whether the academy model discussed above can deliver on this will be explored and a consensus will be reached on the structures and processes required.
- Postgraduate education framework for nurses midwives and AHPs in Scotland – this provides an infrastructure to support the development needs at each level of the career framework. It demonstrates the progression required to move from being a newly qualified practitioner to an advanced level practitioner.
- The Advanced Practice Toolkit – this is a repository for credible and supportive resources relating to advanced practice. Its main focus is on advanced nursing practice, but the CSP hopes the content will evolve and what is there already may have relevance to other advanced practice roles.