Consultant Practitioner Trainee Programme
In 1999 the then Prime Minister Tony Blair, announced the introduction of the Nurse Consultant role. These posts were announced with the dual purpose of enhancing the quality of nursing care and providing new career opportunities for experienced and expert nurses, midwives and health visitors who wished to remain in clinical practice. The role centred on the four domains of advanced practice, including clinical practice, leadership, education and service development. At that time there were no formal educational programmes to support the role or its development.
In 2004 Health Education Wessex and Thames Valley established a Nurse Consultant Development Programme for Emergency Care. Following its success the programme was opened up to other specialties: midwifery, neurology, mental health and learning disabilities. It was also open to professions other than nursing. In 2014, the political drive to increase clinical leadership within the “Older Persons” agenda necessitated the introduction of the Consultant Practitioner Trainee (CPT) programme specialising in frailty.
This is the first programme within the United Kingdom that supports senior practitioners, from a range of professional backgrounds, to develop skills that exemplify the required expertise of clinical excellence and academic proficiency to support individuals living with frailty. Entry into the CPT programme requires the individual to be an experienced senior clinician of any profession, working with older adults. The applicant should hold or be working towards a master’s degree and needs to have experience in quality improvement diagnostics and application. The programme is centred on the four domains of advanced practice and is unique, in that it allows the CPT to identify areas for their clinical and academic development, rather than a perspective pathway.
The first cohort of four CPTs specialising in frailty, started the programme in January 2015, mentored by Dr Gwyn Grout, a Consultant Nurse appointed to post in 2001 and a founder member of the BGS Nurse and AHP Council (and its former iterations). Since then, a further two trainees have commenced the programme. The trainees bring a wealth of experience and knowledge from a range of professional backgrounds which include: advanced nurse practitioners, specialist general and mental health practitioners and physiotherapists. At present, two CPTs are based in the Thames Valley area and a further three are in the Wessex region.
In the first two years the CPT involves four six-month clinical placements in areas that support their identified learning objectives and fulfil the programme learning outcomes.
In the final year the CPT returns to their sponsoring Trust to undertake a twelve-month clinical placement. Within each placement the Trainee has an allocated clinical supervisor and receives one-to-one coaching by quality improvement specialists to support their service development projects. During the programme the CPTs are supported and funded to undertake academic study, each of the CPTs are currently either undertaking a Doctorate in Clinical Practice (DClinP) or a PhD – focused on the concept of Frailty.
The evaluation process is an Annual Review against the programme learning outcomes; each year there is a different set of outcomes to be achieved. The review includes the submission of a portfolio of evidence, a presentation and a panel interview.
I commenced a Consultant Practitioner Trainee Programme sponsored by Health Education Thames Valley (HETV) in 2015. I am an active member of the BGS Nurses and AHP Council and represent the Council on the BGS Policy and Communications Board. My sponsoring Trust is Berkshire Healthcare NHS Foundation Trust.
The Consultant Practitioner role is the pinnacle of the clinical career framework and the CPT programme has provided me with the necessary knowledge, skills and experiences required to undertake this role in practice.
Within the first two years of the programme I have taken the opportunity to work clinically in a variety of settings which included; community, secondary and primary care; social services and the independent and voluntary sectors. The experience of working in different settings has increased my knowledge and understanding of how other services operate and the support they offer to individuals living with frailty. It also highlighted the challenges they face, particularly related to individuals living with multiple long-term conditions. I am now mid-way through my final placement within my sponsoring Trust, BHFT. A typical week on placement is based on the working pattern of a Consultant Practitioner This includes 50 per cent of my time in clinical practice, where I am currently leading and delivering comprehensive geriatric assessments within the community hospital, working with a multi-disciplinary team.
The remaining 50 per cent of my time is shared between, education of self and others; service development through research and evaluation; and seeking opportunities for professional leadership. As part of my academic programme I am undertaking a doctorate through Southampton University; my research thesis is focused on resilience in the context of older adults living with frailty. While doing this programme, I have had the opportunity to deliver lectures on the concept of frailty at Southampton University, to students reading for a master’s degree in the complex care of the older person.
My service development project this year is focused on the concept, identification and management of frailty, working with the local Clinical Commissioning Groups and across the Sustainability and Transformational footprint. The findings from the project are being shared nationally and internationally, influencing commissioning, future care models and workforce development.
The knowledge, insight and confidence I have gained while undertaking this programme has enabled me to influence practice at a local, regional, national and international level.
Claire Barker, RGN, MSc, ANP, NMP
Esther Clift (Twitter @EstherClift), Consultant Practitioner Trainee in Frailty with Health Education England (Wessex) holds a BSc (Hons) Physiotherapy and MSc in Gerontology and is a Non-Medical Prescriber. She has worked with older people for 15 years. She is currently reading a Doctorate in Clinical practice at University of Southampton. Her thesis explores the reversibility of frailty with exercise, using critical ethnographic methodology.
In addition, she has developed competence in the theory and practice of Quality Improvement tools for service development, and implemented some significant service changes in complex situations, which have had lasting benefit, such as prescribing antipsychotics in Care Homes.
Aileen Murray-Gane (Twitter: @MURRAY2812), (RMN, BSc, MSc, NMP) is studying on the Trainee Consultant Practitioner Programme through Health Education England, specialising in Older Persons Mental Health. Areas of interest include all aspects of dementia care, the psychiatry and frailty interface, dignity, personhood and recovery within older adult’s mental health, and self-identity in dementia. She is currently reading for a Professional Doctorate in Nursing through the University of Portsmouth.
Spencer Winch: I am a specialist paramedic in urgent care for South Central Ambulance Service, and a trainee advanced clinical practitioner in urgent and emergency care working in Royal Berkshire Hospital (ED) as part of a Health Education England Thames Valley fellowship (HEE TV).
I have a B.Sc in Paramedic Science and am currently three-quarters of the way through a master’s degree in advanced practice at Oxford Brookes. My transition to advanced practitioner in emergency care also requires the completion of a Royal College of Emergency Medicine (RCEM) portfolio under the guidance of and ED consultant and as such I am also an associate member of RCEM. I have a special interest in the emergency care of the older adult with frailty, in particular falls and reducing long lies, and as part of the HEE TV fellowship I was supported in initiating a quality improvement project (QIP) within the ambulance service whereby a bespoke response of specialist paramedic and occupational therapist was dispatched to patients over the age of 65 who had fallen at home. This was a proactive response in place of a normal ambulance with aims to provide clinical and therapeutic assessments on scene attempting to prevent acute admission, and with the provision of treatment, equipment and care packages, reduce the risk of further falls and subsequent admission. This was initially a pilot study for one day a week but after providing positive data, has just been re-commissioned and funded by the Berkshire West CCG’s for another year running three days a week.
Spencer/Falls and Frailty Project online: