The advanced practitioner and accreditation

Twenty years have now passed since the concept of advanced practice in the UK was formally introduced through the Department of Health’s 2003 Radiography Skills Mix report¹. 

Since then, the evolution of advanced practice has been relatively organic – being reactive to local service needs and with no set standard – resulting in inconsistency regarding the expectations for education, job titles and levels of practice². For radiographers in the UK, the devolved nations have different healthcare structures, commissioning processes and governing legislation, which also add to the challenges of equity of opportunity and the growth of the radiography workforce into advanced-level practice. 

The Society and College of Radiographers is in a unique position – as the professional body and trade union across all four nations, it can help to influence and guide the nations through its professional policies and guidance documents. One such document is the revised College of Radiographers Education and Career Framework (ECF) for the Radiography Workforce (fourth edition)³. The revised ECF was launched in November 2022 with the overall goal of improving outcomes for patients through the education and training of the radiography workforce. 

The ECF details the educational and qualification expectations across all four core levels of practice and wider domains, including those for the advanced practitioner. In doing so, the ECF has drawn upon the various national frameworks^4-8 in existence across the four nations, aligning its vision with government policy and wider allied health professional development and workforce strategy. Each of the advanced practice frameworks across all four nations^4-8 carries a multi-professional focus that supports collaborative working and collegiate development of roles – something the College of Radiographers (CoR) supports through its engagement in projects with various AHP professional bodies and relevant stakeholders. 

The ECF provides clear guidance that, in order to support radiographer-led service transformation both now and in the future, advanced practitioners must have the appropriate underpinning education. Possessing a full master’s degree relevant to their area of advanced clinical practice, advanced practitioners will meet the four pillars of advanced clinical practice (clinical practice, education, leadership and management, and research and development). This will show them as having advanced clinical competence in their specialist area or across a broad range of practice. 

Drawing on their underpinning education, training and clinical experience, and employing the available evidence base, advanced practitioners will have significant clinical and leadership responsibilities and will display a high degree of autonomy and complex decision-making skills. They will use critical thinking and problem solving to research and analyse complex situations throughout their practice to deliver safe and effective patient-centred care. 

Having leadership responsibilities, advanced practitioners will often need to respond to local and national developments, which will see them engaging across professional boundaries. Some may work within advanced clinical practice multi-professional roles and within advanced uni-professional clinical roles in imaging and radiotherapy. They will input into the education of a wide range of others and will be actively involved in research, service development, improvement and innovation. 

The ECF contains case studies from a number of advanced practitioners across various domains of practice, highlighting the reach and impact advanced practitioners are currently making on improving services and outcomes for patients. As services move forward, it is vital the workforce is supported in facing the great and many challenges that lie ahead and is able to adapt and respond at pace. Advanced practitioners have a key leading and supporting role in this, through their provision of strong clinical leadership, supervision and mentoring. It is fundamental, therefore, that role development into advanced practice continues to be supported and embedded into practice. 

How can this be achieved? When we consider radiography role development at practitioner level, one of the positive drivers for change was statutory regulation⁹. This paved the way for the increasing standards of proficiency and widening scope of practice that the radiography workforce is familiar with today¹⁰, which helped to underpin radiography role development and the formation of the four core levels of practice in 2003¹. With the title “advanced practitioner” remaining unregulated, holding accreditation as an advanced practitioner can be a way of outwardly demonstrating to patients, colleagues and employers that you meet the professional and educational expectations associated with this level of practice. 

Both the CoR and Health Education England’s Centre for Advancing Practice offer accreditation for those currently working in advanced practice in radiography. Both schemes work to standardise advanced-level practice, to support patient safety and accountability, promote public and peer confidence, and enhance workforce transformation¹¹.

The CoR Advanced Practitioner Accreditation Scheme 

The CoR is long established in offering accreditation for a range of levels of practice and roles within the radiography workforce through its CPD Now platform. The College sees its accreditation schemes as a way of outwardly recognising the contribution of its members to service delivery, promoting and maintaining continuity in education and training as well as good practice and quality of care. 

The CoR offers five accreditation schemes, which are being revised to align with the educational expectations and the knowledge, skills and attributes associated with each relevant level of practice or role as detailed within the ECF. The College launched its Practice Educator Accreditation Scheme (PEAS) in July last year and, more recently, launched its Assistant Practitioner and Mammography Associate Schemes in February. Work is nearing completion on its revised Advanced Practitioner and Consultant Practitioner Accreditation Schemes. 

The revised Advanced Practitioner Accreditation Scheme will reflect the education expectations detailed in the revised ECF, while also acknowledging the need for the CoR to be supportive of those who may not yet fulfil the College’s educational expectations for this level of practice. Therefore, initial advanced practitioner accreditation will be open to those who hold a minimum of a postgraduate diploma relevant to the area(s) of expertise for which they are seeking accreditation, but they must currently be enrolled on a master’s programme of study and be able to demonstrate fulfilment of the four pillars of advanced clinical practice through their supporting CPD evidence and critical narrative. 

The scheme is also aligned to the College’s own programme-approval process, so applicants who have completed a CoR-approved master’s programme of study relevant to their area of advanced clinical practice will be eligible to apply via a fast-track route. 

All successful applicants under the CoR accreditation schemes are expected to undertake re-accreditation. Under the revised scheme, the re-accreditation period for advanced and consultant practitioners has been extended to five years. This is in recognition of the challenges faced in clinical practice, allowing more time to build substantial pieces of CPD to demonstrate their fulfilment of the advanced practitioner outcomes across the four pillars of advanced practice and for completion of their enrolled master’s programme of study. Re-accreditation helps to encourage continued engagement in CPD at this level of practice, and offers a longer-term reassurance that the advanced practitioner is maintaining their knowledge and skills at this level. Successful applications are awarded a certificate with an interactive QR code, which provides portability of the award between employers.

The Health Education England Centre for Advancing Practice 

Complementary to the CoR’s Advanced Practitioner Accreditation Scheme, the Health Education England (HEE) Centre for Advancing Practice offers advanced clinical practitioners the opportunity to have their educational and experiential equivalence in Advanced Practice Training formally recognised through the Centre’s ePortfolio (supported) route.  Reporting radiographer Gavin Cain shares his experience of achieving recognition through the centre’s ePortfolio (supported) route.

“Back in July 2021, the head of clinical education and workforce at our trust notified all practitioners working in advanced roles about the launch of HEE’s Centre for Advancing Practice website. Following this initial communication, there was a flurry of activity in all things advanced practice within our trust,” says Gavin. 

“I subsequently learned that the Centre for Advancing Practice (the Centre) was to provide a scheme of certification and education equivalency for individuals who met the necessary requirements for advanced practice, either through the successful completion of an accredited programme of study or an ePortfolio (supported) route. The latter route was designed for existing, experienced advanced practitioners, who regularly work in advanced practitioner roles but who have not completed a Centre-accredited programme at a higher education institution. The justification provided for individuals to seek recognition with the Centre was the need to standardise advanced-level practice to support patient safety and accountability, promote public and peer confidence, and enhance workforce transformation¹¹.

“The ePortfolio supported route was interesting to me as an advanced practitioner in clinical reporting (musculoskeletal plain film). I was already accredited and re-accredited with the CoR as an advanced practitioner and had just submitted my dissertation to complete my master’s degree in clinical reporting. The principal motivator for upgrading my postgraduate diploma was that to maintain my accreditation with the CoR beyond 2021, I would need a full master’s degree, an expectation reiterated by the College. I decided to apply for the ePortfolio route as a way to additionally confirm with my employer my educational equivalence and experience as an advanced clinical practitioner and, more broadly, to help raise awareness and understanding of advanced practitioner roles in radiographer reporting within my trust.    

“Fast forward to today and I have just received notification that my application with the Centre via the ePortfolio route has been successful, and I have been issued a ‘digital badge’ as a verified indicator of recognition of educational and experiential equivalence in Advanced Practice Training. I am in the first multi-professional cohort and am the first radiographer in England to have my advanced practitioner status formally recognised in this way. 

“The process started with an initial application on the Centre’s website. I was then allocated to an education provider, who would support me through the process. There was some trepidation regarding who this might be so I was delighted when I was allocated to Professor Beverly Snaith at Bradford University. With Bev’s expert supervision and support, I developed an ePortfolio of evidence derived from my previous formal and informal learning and experience. The evidence was mapped against 38 capabilities across the four pillars of advanced practice, as outlined in HEE’s Multi-Professional Framework for Advanced Clinical Practice⁴. A requirement of the final submission was a critical narrative or reflective commentary showing how I met the framework capabilities in all four pillars and how the supporting evidence substantiated this.

“Applying for accreditation with the Centre was a significant and rewarding endeavour. It has helped me to critically appraise my practice and address gaps in my knowledge and skills, such as formal leadership training and my role in health promotion. Reflecting on my advanced-level practice and my professional and academic achievements has given me the confidence to consider doctoral-level study to support my progress to consultant practitioner level. For practitioners already working in advanced practice roles, and for those needing to top up their education, I would recommend the ePortfolio route to recognition with the Centre.”