Specialist Semantics

In the last few months since I have been concentrating on surfing, “Zooming” and making video calls in different time-zones; all in earnest for my upcoming Winston Churchill Fellowship travels. The aim is to gain an understanding about the complex topic of Advanced Practice from an international perspective.

This blog will demonstrate some of the fruits of my labor. This is a complex area with a few traps and pit falls in cultural context and language. I hope you will help me to continue my learning by offering your thoughts in the comments section below, especially from those I have spoken with as it is important these words are representative of our conversations.

In the Oxford English Dictionary there are two definitions offered of the word “Advanced”:

” Far on or ahead in development or progress. “

” New and not yet generally accepted. “

Advanced Practice is consistently far ahead and occasionally new and not yet generally accepted. Elements of what we see as advanced practice can be accepted practice in one country but disputed in others. For example, in some areas injection therapy may be seen as “far on or ahead” when discussing physiotherapy practice, in some areas it is well embedded and accepted while in others it is new and not yet widely practiced or governed for.

As an international term I have come to think of “Advanced Practice” as any level of practice above that which can be expected of an experienced clinician. After this the term “Advanced” becomes confused depending on the context its used in. Other such terms include “Specialist”, “Extended”, “Enhanced” and these all have different educational attainment levels, different levels of experience and different responsibilities.

Advanced Practice also seems to have a different flavour in each place I have looked, this could be due to the drivers of healthcare which exist in each country and the way this shapes practice.

I would like to outline below my current grip on the situation of Advanced Practice internationally. Through the very nature of my Fellowship I hope this view will grow and expand to add more clarity and nuance.

The UK Perspective: I am very grateful to Richard Collier for spending the time with me to understand more about the current understanding of Advanced Practice in the UK. Other contributors have been Neil Langridge, Amanda Hensman-Crook, Beverley Harden and many more. The information below is England- centric and I still have some work to do to understand the perspectives of the devolved nations.

As well as the insight of those great minds I have also drawn on the following documents: Multi-professional framework for advanced clinical practice in England, Musculoskeletal Core Capabilities Framework.

There are many conversations happening regarding Advanced Practice in the UK at moment, some of these conversations have been bought to light thanks to the spotlight on First Contact Practitioner services currently so I will make my thoughts as succinct as possible.

Advanced Practice in the UK is currently (Nov-2019) unregulated and is not a protected title. There are many job roles in use to describe Advanced Practice.

The Multi-professional framework discussed above provides an overarching framework for competencies of Advanced Clinical Practice. Advanced Clinical Practice is a level of practice which covers 4 specific pillars of practice; clinical expertise, research, education and leadership. Advanced Clinical Practice is not the same as being advanced in your clinical practice…this is because of the importance of the 4 pillar, you can be advanced in your clinical practice, your clinical reasoning even in clinical skills which are at top of license or beyond physiotherapy scope of practice but this may not be Advanced Clinical Practice unless there is evidence of leadership, education and research at a Masters Level (7). At present Advanced Clinical Practice is not a regulated level of practice or protected title but there is work within Health Education England to change that.

The Australian and New Zealand perspective to follow…




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