BGS Nurse and AHP Council: position on the professionals’ workforce development and educational requirements of those supporting the health and care of older people

The BGS Nurse and Allied Health Professional Council believe that all health and care staff and professionals require knowledge and skills to enable them to work effectively with older people.

This assertion is in line with recent position papers from the British Geriatric Society (2018) on Primary Care for Older People which calls for training, and Our priorities for the NHS Long Term plan, which calls for increased education and training.

We have identified five levels of health and care staff in the workforce where specific knowledge and skills pertaining to working with older people, who may be living or dying with frailty, requires a tailored educational and practice development response. These levels are:

  1. Early apprenticeships and the pre-registration workforce
  2. The undergraduate workforce
  3. Post-registration practice education – preceptorship and beyond
  4. Advanced practice
  5. Consultant level practice

The Nurse and AHP Council states below its position for each of these five levels:

Apprenticeships are training programmes to help create a skilled workforce, linked to recognised standards or qualifications. City & Guilds provides a range of health and social care early carer apprenticeships defined as: Intermediate (level 2), Advanced (level 3) and Higher (level 4) equivalent to a foundation degree. Across sectors the knowledge and skill development of this workforce cannot be underestimated especially in how it is required to respond to the growing needs of the population living with frailty. The Council believes older person / frailty focused apprenticeships that are responsive to this growing need, are essential to develop across this pre-registration level workforce.

Across the whole workforce, Skills for Health’s Core Capabilities for Person Centred Care, Frailty, End of Life Care and Dementia Frameworks together with  Adult Safeguarding awareness (RCN 2018) must be embedded into all education, training and development programmes. For the early career and pre registration workforce development must embrace tier 1 (awareness for everyone) and tier 2 (for staff with regular contact with older people).

Providers of early career apprenticeships and those educating and training this workforce, who support registered practitioners, are duty bound to equip them with the the knowledge and skills of these core capabilities to to be responsive to current and future care needs of older people.

The BGS Nurse and AHP Council advocates for the investment in progressive pathways for this workforce from apprenticeships into undergraduate programmes.

All health and social care focused undergraduate curricula, where graduates will work with older people, focus on the older population must be recognised as the golden thread that runs throughout each programme. Education curricula regulators need to respond to this call as do Higher Education Institutes who must make it a priority to review their course content to reflect this new horizon of population demand and long-term supply need. The BGS cannot reinforce enough the urgency for providers to respond now and ensure a fit for the future undergraduate curricula are in place.

In recognition that all registered health professionals will work with older people and those with health complexity, the BGS reinforces here the need for the Core Capabilities in Person Centred Care, Dementia, End of Life and Frailty Frameworks to be embedded into preceptorship and post graduate programmes as well as education, training and development programmes for all registered practitioners – across its three tiers:

· Tier 1 (awareness for everyone)

· Tier 2 (for staff with regular contact with older people)

· Tier 3 (for experts working with older people)

The multi-professional aspects of care for the older people should be developed through educational opportunities including simulation

The Council promotes the programmes such as Health Education England and National Institute for Healthcare Research’s Integrated Clinical Academic Programme for non-medical healthcare, recognising the advancement of practice is driven from high quality research.

Advanced clinical practice is delivered by experienced, registered health and care practitioners. It is a level of practice characterised by a high degree of autonomy and complex decision making. This is underpinned by a master’s level achievement that encompasses the four pillars of clinical practice, leadership and management, education and research, with demonstration of core capabilities and area specific clinical competence.

Advanced clinical practice embodies the ability to manage clinical care in partnership with individuals, families and carers. It includes the analysis and synthesis of complex problems across a range of settings, enabling innovative solutions to enhance people’s experience and improve outcomes. (HEE 2017)

Professionals working at advanced practice level, where the majority of the patient group are older people and/or people living with frailty, must evidence their level of practice against the HEE Multi-professional Framework for Advanced Practice, Tier 3 of the Person Centred Care, Dementia, End of Life and Frailty Core Capabilities Framework plus additional evidence of capability specific to their workplace speciality. Education and Development at Advanced level is a combination of academic achievement at Masters level and work based assessed capability by a supervisor in practice.  Nurses may choose to credential through the Royal College of Nursing.

Consultant practice is first defined as ‘the pinnacle of the clinical career ladder for all health care disciplines in the United Kingdom. Consultant nurse, midwife and AHP roles build on the clinical credibility and expertise characteristic of advanced level practice, but also possess expertise in: clinical systems leadership and the facilitation of culture change, learning and development; advanced consultancy approaches, and research and evaluation to prioritise person-centred, safe and effective care across patient pathways’. (Adapted from Manley & Titchen 2017)

The BGS Nurse and AHP Council is clear that recognition of this established professional position is beneficial to older people, the wider public as well as the professionals they lead.  A Consultant Practitioner is one who works at Knowledge and Skills Framework level four. The Consultant extends existing Advanced Clinical expertise to provide system leadership across the four domains of practice at local, regional and national level:

  1. Clinical Practice
  2. Leadership and Management
  3. Education
  4. Research

Education and Development towards such roles is through HEI supported clinical research, Educational Supervision within a range of service settings and facilitated opportunity to lead across service and organisational boundaries.