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How many levels of practice should there be for the TP role and what should they be termed as?

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Enhanced practice is a level of practice within the healthcare workforce. It covers the graduate professional workforce delivering the majority of clinical activity, those who have moved beyond novice/competent and who are not working at the level of advanced practice. This is a highly valued, broad and essential level of practice within the workforce for whom training and development to maximise their professional skills and capability is a vital aspect of building safe and effective services, workforce productivity and retaining our staff.

People working at enhanced level practice will use a wide variety of job titles and are experienced registered professionals (first level statutory registration or a managed voluntary registration) who undertake complex work and manage day to day risk, including risks on behalf of, or with people. Enhanced practice occurs in multiple settings including secondary, community, primary and social care.

The enhanced practice workforce have many job titles and roles across many different professions. They tend to have undertaken post registration education relevant to their profession, area of practice and role. They usually work in their professional role as part of a multidisciplinary team and apply their skills, knowledge, and experience to substantially contribute to patient care. Although they work across different settings, they will often have a skillset and depth of knowledge related to their professional background.

Those working at enhanced practice level, occupy a space before advanced practice in terms of the management of complexity and uncertainty with enhanced practice can be a precursor to advanced practice, or it can be a valued workplace destination in itself, offering services and patients a consistent level of expertise.

To support our work and growth in this area, we have developed two documents which are available to view.

- A workforce modelling project for Health Education England

- The Principles of Enhanced Level Practice

Speaking on this work, Alison Leary for the Enhanced Practice Steering Group said:

'Sustainable health and care requires a confident, capable, registered workforce able to fully realise their scope of practice at each level of practice from novice to expert. Developing as professionals means that clinical staff can effectively work with increasing levels of complexity and unpredictability.'

And Beverley Harden, AHP Lead Health Education England and Deputy Chief Allied Health Professions Officer noted:

'Each profession develops approaches and expertise to meet the needs of patients and populations and to develop a body of knowledge that they hold and apply. Enhanced level practice is very much rooted in that development of knowledge and expertise, therefore different professional different groups express what it looks like to work at this level of practice. This means there is no generic "enhanced clinical practitioner" role or training.'

Programme update

We're delighted to share some significant progress in our work to develop nationally recognised profession-specific training schema and model curricula for the enhanced level practice apprenticeship applicable to the individual Allied Health Professions (AHPs).

Following a positive procurement exercise, we have successfully awarded four contracts to the following organisations:

University of Salford

Coventry University

Sheffield Hallam University

and the Institute of Osteopathy.

This is an important step in the development of AHP profession specific clinical academic qualifications enhancing the options available across the breadth of the career framework. Working collaboratively within innovation partnerships alongside education providers, professional bodies, clinical experts and employers, we are pleased that 10 of the AHP professions will be covered* by this piece of work.

Working to a timeline of delivery by the end of June 2023 this work will bring a blueprint for the delivery of profession specific content within the enhanced practice apprenticeship framework, alongside examples of key model curricular for each of the awarded professions critical to the delivery of 21st century care. This work will then be made available by HEE to other education providers to enable their delivery of the enhanced practice apprenticeship to cohorts of AHP learners. These apprenticeships will provide an alternative education route to co-exist alongside traditional education for the enhanced workforce such as post qualification certificates, professional development courses, degree, or master's level qualifications.

The partnerships delivering this commission will incorporate a strong element of blended learning and technology enhanced learning (TEL), aiming to utilise the most up to date methods of education delivery.

Claire Arditto, Programme Lead and Regional Head of AHPs in the North East Yorkshire said:

'I am delighted that 10 of our AHP professions will have access to profession specific enhanced practice apprenticeships for those delivering patient care in environments that are complex and require highly specialist levels of clinical expertise and leadership. We will be working closely with our innovation partners to develop training and upskilling fit for the future.'

We intend to explore opportunities in the future for enhanced practice schema for those professions not covered in this current phase of work. We will maximise the learning opportunities from the current work to develop robust approaches with these professional groups.

More on our enhanced practice work

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Enhanced practice is a level of practice within the healthcare workforce. It covers the graduate professional workforce delivering the majority of clinical activity, those who have moved beyond novice/competent and who are not working at the level of advanced practice.

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New Practitioner- do you feel that this is the correct terminology. Please comment and suggest alternatives

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Practitioner- do you feel that this is the correct terminology. Please comment and suggest alternatives

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Enhanced Practitioner- do you feel that this is the correct terminology. Please comment and suggest alternatives

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Advanced Practitioner- do you feel that this is the correct terminology. Please comment and suggest alternatives

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Consultant Practitioner- do you feel that this is the correct terminology. Please comment and suggest alternatives

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What work-related qualities, principles, and standards are essential for a TP?

The boxes display core values from other professions—do these align with the TP role? Share your thoughts by adding comments or suggesting additional values..

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If your TP team already has a purpose statement, feel free to share it! You can also react with a comment or emoji if you like or dislike a statement.

To suggest a new statement, click the "+" button next to 'Purpose Statement,' type your idea, and publish it."

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Our values are important to us. They guide the way we behave, individually and together, and give us a firm foundation to promote excellence in nursing and midwifery for the benefit of the public.

We've aligned these to our strategic aims.

Each value is crucial, but their real strength comes from how they work together.

We're fair

We treat everyone fairly. Fairness is at the heart of our role as a trusted, transparent regulator and employer.

We're kind

We act with kindness and in a way that values people, their insights, situations and experiences.

We're ambitious

We take pride in our work. We're open to new ways of working and always aim to do our best for the professionals on our register, the public we serve and each other.

We're collaborative

We value our relationships (both within and outside of the NMC) and recognise that we're at our best when we work well with others.

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Our values and behaviours will shape our culture, influencing the work we do and how we do it

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specialist role focusing on patient safety through best practice and appropriate use of blood and blood products. Much of the work of TPS centres on aligning practices with local, national, or international standards and guidelines

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Highlight risk & promote best practice. Lead investigation into transfusion inncidents

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Highlight risk & promote best practice. Lead investigation into transfusion inncidents

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facilitate safe, appropriate transfusion practice

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Advocate for patient safety & psyhological safety. Avoid blame. Engage at all levels   Evaluate risk and foresee potential risks

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Advocate for patient safety & psyhological safety. Avoid blame. Engage at all levels   Evaluate risk and foresee potential risks

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Advocating patient safety and choice in the context of blood component and product transfusion by ensuring patient blood management principles are embedded in the clinical setting and that proper attention is given to patient information giving and gaining consent. Being accountable for investigation of and sharing learning from errors will enhance knowledge amongst practitioners ensuring development towards better practice. Finally, consistent and high quality training will provide a safe workforce with enhanced skills.

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The Transfusion Practitioner is an experienced practitioner who acts as clinical lead for transfusion in collaboration with the Consultant Haematologist lead for transfusion and the laboratory lead for transfusion to provide effective clinical leadership with continuing responsibility for the co-ordination, management, organisation and provision of a safe and effective clinical transfusion service across the Trust and the local area.

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As an RN I follow the core values of the NMC

prioritise people, practice effectively, preserve safety, and promote professionalism and trust,

Behaviours to support this includes but is not restricted to:-

Honesty

Mindfulness and kindness.

A commitment to improving practice through effective change management and use of audit and research.

A curious enquiring mind

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I just wanted to say that seeing the presentations today, and how the group is developing the TP role has made me feel more enthusiastic about my own role and given me some hope for the future that our role will be a more recognised and structured one. I have not felt this positive about it for a while so thank you to everyone that is working hard to make this happen.

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Lynch pin to everything transfusion and patient blood management

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Putting the patient in the centre of everything we do

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Putting Transfusion safety at the heart of everything we do

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I do not like the idea of term "consultant" being used as many TPs from laboratory background do not have any clinical/medical training and I would feel uncomfortable being asked for specific clinical advise. I think terms to describe new and then experienced TPs are helpful e.g. emerging and advanced.

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Investigative - need to understand all aspects of transfusion, human behaviours, patient experiences, clinical pathways and all the pitfalls where errors may occur and how/why they have occurred.

Requires; honesty, conscientiousness, integrity, patience, inclusivity and desire for improvement/innovation

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On reflection from reading this report- Transfusion Practitioners are essential to patient safety. Working closest to the point of transfusion risk, they use critical thinking to identify potential hazards, support colleagues, and champion evidence-based practices. Their leadership is key to fostering a culture where safe transfusion is central to protecting patients and ensuring high-quality care

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These are the levels of nursing practice from the work led by Prof Alison Leary for NHS England which could be useful to align to. Allied Health Professions have similar.

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Levels of nursing | Royal College of Nursing

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A professional framework for nursing which encompasses the whole nursing workforce, from the nursing support worker through to the consultant nurse.

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Example of levels of practice for allied health professions

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Example of levels of practice for allied health professions

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AHPs also use enhanced, advanced and consultant and there are similarities across the nursing and AHP descriptions that could help us?

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Centre for advancing practice definitions of the levels of practice and the associated frameworks - Advanced and Consultant.

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The advanced clinical practice framework for midwifery uses the four pillars of practice

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Advanced Clinical Practice in Midwifery: Capability Framework - Advanced Practice

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Midwifery Capabilities Framework (The Centre for Advanced Practice) aims to help create the new midwifery roles.

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The Education Framework for Infection Control Practitioners lists Introduction to Advance. Introduction level aimed at staff are taking on the role in addition to their main role

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NHS England » Education framework for the infection prevention and control practitioner (IPC) workforce

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The framework sets standards and identifies learning outcomes for the professional development and growth of the IPC practitioner workforce, promoting confidence and leadership skills to ensure practitioners can lead, challenge, and implement safe standards of IPC practice.

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I feel Practitioner can be misleading. In the rest of my trust, the term practitioner means hands on with the patient.

It has been complicated in the past, to convey to staff that I would not be involved in a transfusion. As my role is very much advisory, I use the term Transfusion Specialist locally. This seems to have worked better.

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Ensuring our Trusts understand the role and support us in where we sit in the Trust and know the impact and how far we reach across the organisation

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Julie gave me this idea. The below is from our band 6 TP job description and sums it up I think. But essentially, at Southampton if it's got to do with transfusion in this trust, then a TP is very likely to be involved in some way. It's that central lynch pin type role as someone else said.

The main purpose of this role is to work as part of the Transfusion Practitioner team, often making autonomous decisions, to promote and facilitate safe and effective transfusion practice throughout UHS in line with national guidance and regulations.

This includes daily operational duties, including responding to phone and email queries, undertaking audit, investigating adverse reactions and events and investigating failures in the traceability of blood components and products.  In addition, there will be management of longer-term projects and developments with support and guidance from the Lead Transfusion Practitioner.

The role encompasses aspects of education, audit and management but is firmly grounded in appropriate care provision and work to promote high clinical standards in line with current evidence-based practice. This is intended to promote the safe and efficient use of blood components through education, training, audit, and incident review in clinical practice as per Patient Blood Management guidance.

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Not sure if this is what you wanted but these are our job titles at UHS. They're largely designed to fit in with the BMS staff and others across the trust.

Lead Transfusion Practitioner

Specialist Transfusion Practitioner

Transfusion Practitioner

Associate Transfusion Practitioner

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TP’s facilitate and promote the safe practices of the transfusion process from sample to transfusion. This can be complex and varied depending on the practitioner’s role and experience and background. Having this forum to exchange and build more unison for our role is amazing. From investigation, policy writing, training for sampling, collecting, prescribing and administering blood and its components.

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"Practitioner" is a very generic term and we find that the Trust teams do not understand the that practitioner is used for a variety of different staff, and think often that you are nurses and link our Trust training patient facing nurses, we have both BMS and nurses in our team we used to have ODP as well - which was great so we have a specialist from lab, ward and theatres. The name was specialist practitioner of transfusion way back when I started but this gives the acronym "SPOT" which is not very nice so we no longer use it. I have great sympathy for those who are on their own - how they manage everything my team do I have no idea.

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A Transfusion Practitioner (TP) is a highly specialised multi faceted role with a primary patient focus relating to all aspects of blood transfusion. TP activities aim to increase awareness and knowledge to improve clinical decision making and enhance transfusion practice. Safe transfusion requires a multidisciplinary approach and TPs are seen as the link between different health professionals and departments, such as clinical and laboratory colleagues, as well as patients.

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Patient focus

Expert (including finding information if not known)

Leadership

Multi professional - (an understanding of all TP legacy professions)

Forward thinking & flexible to change

Ability to be both macro & micro when considering complex transfusion issues

Collaborative

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Transfusion Practitioners are in post to find the best the collaborative approach, for their organisation and nationally, to enhance patient safety in Transfusion Medicine. This is undertaken through the use of evidenced based practice to raise awareness of effective, appropriate and safe standards in patient care.

(from the TP Team at York & Scarborough discussions)

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What work-related qualities are required

Honesty/transparency

Openness

Kindness

Attention to detail/planning

Inclusive

Assertive

Curious

Flexibility

Time Management

What Principles are required

Risk Assessor

Forward facing/ Innovative

Patient Centred

Responsibility to remain up to date with knowledge and guidance

Empathy to understand position of others

Advance the programme for patient blood management and Transfusion Medicine

Integrity in Information management

Leadership Skills

What Standards are essential for a TP?

Quality in Educational Role

Voice in patient safety agendas

Accurate documentation

Ability to lead investigations

Sustainability-work based i.e blood stocks, not tested samples

Self-based resilience/ workload planner

Compliance with/or consideration of national regulation/standards/guidance- BSQR, NICE, BSH

Professionalism and accountability

Subject matter lead

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Feels that

1)      Associate Transfusion Practitioner

2)      Transfusion Practitioner

3)      Specialist Transfusion Practitioner

4)      Senior/Lead Transfusion Practitioner

are sensible options from our point of view-

although colleagues may not be aware of what we actually do the term has been around 20+ years so perhaps now becoming a recognized term........