Modernising Allied Health Professions' Careers in Wales - A post registration framework

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Modernising Allied Health Professions' Careers in Wales - A post registration framework
Modernising Allied Health
Professions’ Careers in Wales
A post registration framework

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    Foreword__________________________________________________________________ 3

    Introduction_______________________________________________________________ 4

    Background_______________________________________________________________ 4

    Structure of the Framework_
                     Framework ________________________________________________ 5

    Benefits___________________________________________________________________ 7

    Aligning the Framework____________________________________________________
                 Framework                                                     7

    Terminology and Definition_________________________________________________
                    Definition                                                  8

        Level 5__________________________________________________________________ 9

        Level 6_________________________________________________________________ 12

        Level 7_________________________________________________________________ 16

        Level 8_________________________________________________________________ 21

        Level 9_________________________________________________________________ 27

    Appendix_________________________________________________________________ 30
    References_______________________________________________________________ 30

              © Crown copyright 2020 WG40105
    Digital ISBN 978-1-80038-182-7

    In Wales we have ambitious plans for improvements to the health and well-being of the
    population. The Well-being of Future Generations Act vision is a society in which people’s
    physical and mental well-being is maximised and in which choices and behaviours that benefit
    future health are understood. Responding to this challenge will require a flexible and responsive
    healthcare workforce which is patient centred.

    The Allied Health Professions (AHP) have a vital role to play in the transformation of the health
    and social care that we wish to see for the public, patients, clients and their families. Children,
    older adults and people of all ages who experience illness, disease and disability or have special
    needs value the particular contribution that AHPs make to their treatment, recovery and quality
    of life. The skills, knowledge and expertise of AHPs are not only essential for the modernisation
    of services but are valuable resources for patients and the wider healthcare team. All the AHPs
    share a commitment to improving services for patients and developing a better evidence base
    to underpin their interventions. This Post Registration Framework is a major contribution to
    achieving that goal.

    The Post Registration Framework is not intended as a detailed blueprint for an individual’s
    future, but rather it sets our ambitions and expectations for the AHP workforce. Following
    the principles set out in this framework will deliver real benefits for the people of Wales by
    improving the outcomes, skills and working practices of the professionals delivering those

    I have great pleasure in endorsing this framework and I expect it to be a key reference
    document for AHPs. It contributes to what is already happening within the AHP workforce,
    describes both the development of AHPs and their increasing role at the centre of service
    delivery and change. This document supports and encourages their leadership in promoting
    aspirational thinking and challenging assumptions about how health care should be delivered.

                              Vaughan Gething AM
                              Cabinet Secretary for Health, Wellbeing and Sport

    The post registration framework has been developed to provide guidance for Allied Health
    Professionals (AHPs) working across the NHS in Wales. It will assist in meeting the career needs
    of AHPs and shaping future AHP careers in Wales, in order to maximise the impact of the AHP
    workforce in their delivery of health and care services. It will facilitate AHP professional, clinical
    and management development to ensure skills are maximised and services are effective.

    AHPs account for 25% of the clinical workforce of NHS Wales and make a valuable contribution
    to service delivery through the diversity of roles in which they are employed. This Framework
    relates to the following AHP groups:
    • Dietetics
    • Occupational Therapy
    • Physiotherapy
    • Podiatry
    • Prosthetics/Orthotics
    • Speech and Language Therapy
    • Orthoptics
    • Arts Therapies
    • Radiography
    • Operating Department Practitioners
    • Clinical Psychology
    • Paramedics
    The policy context over the past few years has highlighted that the NHS can no longer continue
    to deliver services in the same way. The skills and working practices of staff will need to evolve
    to support the aging population, changes in technology, increases in demand and changing
    context for care as it is increasingly provided in the community setting. This highlights the
    importance of creating a flexible and sustainable workforce that will be well educated and
    trained, thereby contributing to the health of the population and also the economic and social
    fabric of Welsh Society.

    Changes to how and where health and social care services are delivered in the future will mean
    that employers are increasingly developing their AHP workforce to meet current and future
    service, financial and workforce challenges. The role that AHPs have to play in service redesign,
    delivery, strategic planning and leadership is well recognised.

    Employees can frequently feel hindered and disengaged from an organisation when
    development opportunities seem limited. The solution is for organisations to put in place
    realistic development and career-advancement pathways that are actively managed, and offer
    clear and genuine development opportunities for the workforce whilst, at the same time,
    ensuring that the development undertaken meets the future service demands. This framework
    will work in alliance with existing processes e.g. Personal Appraisal Development Review (PADR)
    to ensure that Health Boards and Trusts can make more informed links between individual’s
    aspirations and developments and the organisational workforce plans.

Structure of the Framework
    The Framework has two key parts Levels of Practice and Pillars of Practice.

       1. Levels of Practice:

         This Career Development framework is based on levels 5-9 of the career framework
         for health (Skills for Health, 2006; Scottish Government, 2009). The purpose is to aid
         workforce flexibility, providing a common currency to map employees’ competence
         portfolios, and to identify areas of transferability to other job roles. This allows
         progression in directions which may not have been identified through traditional
         routes and may allow development into the next level prior to, or even without,
         attainment of higher Agenda for Change banding. The overview of each level
         provides a description of the attributes expected and suggests the qualifications levels
         that should be undertaken to support the development. Each level of practice builds
         on the one before so as to avoid repetition.

       2. Pillars of Practice:

         The four pillars of practice are:
         • Clinical Practice
         • Facilitation of Learning (Education)
         • Leadership
         • Evidence, research and development

         The proportion and expertise associated with each pillar will vary according to the
         role and level.

                                               Clinical Practice

                                                                   Management &

                                                                                   Research &

Each of the pillars of practice is divided into aspects of practice:

     Pillar of Practice                           Aspects of Practice

                                                  Safe, effective and person centred care
     Clinical Practice
                                                  Professional Judgement and Decision Making

                                                  Learning, teaching and assessment Creation
     Facilitation of Learning
                                                  of the learning environment

                                                  Team work and development Professional
                                                  and organisational leadership

     Evidence, research and development           Evidence into practice

    Within this Framework sphere of responsibility, key knowledge, skills and behaviours and
    opportunities for educational and professional development have been outlined for each
    aspect of practice.

    For AHPs working at any of the levels within the Framework it is important that their role
    contains an element of all of the Pillars of Practice. As an individual’s career progresses the
    proportion of their role for each Pillar will change. Some thought will therefore need to be
    given by organisations and managers as to how individuals can be developed across all 4
    pillars and so facilitate the development of career pathways away from the more traditional
    routes and towards future areas of practice that will meet the future healthcare needs.

    The Post Registration Career Framework for AHPs will benefit both the organisation and
    its employees. Evidence shows the link between staff engagement, including training and
    development and improved quality of care and outcomes. It must fit with the culture of the
    organisations; set realistic expectations for employees and help individuals develop their required
    competences for safe practice. The Framework will:

    • Support AHPs in developing and evidencing they have the necessary knowledge and skills to
      respond to peoples’ evolving healthcare needs
    • Outline professional development that provides assurance of up to date, effective and safe
      practice regardless of care setting
    • Supports the development of AHPs across all four pillars
    • Provide robust and consistent guidance for education and training to ensure future resources
      are targeted and utilised in line with the prudent healthcare agenda and meet future service
      needs more effectively.
    • Help organisations to understand where the workforce talent is concentrated: how prepared,
      or ill prepared, they are to meet future needs and challenges
    • Ensure talent management and succession planning is maximised.
    • Demonstrate how AHPs can be developed and retained while simultaneously improving the
      performance of the organisation.
    • Support managers as they seek to workforce plan to meet future service delivery
    • Better articulate the education requirements of individuals at a local level
    • Better articulate wholesale workforce development and changes that can both inform
      planning colleagues in relation to existing plans and help guide and underpin new service
      plans (i.e. ensure workforce plans are integrated)

    Aligning the Framework
    An AHP career should be seen as a continuum from the point of entering pre-registration
    education to the point the individual ceases being registered with the HCPC. Post registration
    AHP careers therefore build from the initial preparation that leads to registration and should not
    be seen in isolation from it.

    The Framework will continue to evolve and be influenced by changes in legislation, government
    policy and professional standards and codes of practice.

Terminology and Definition
    Practitioners working with a ‘Specialist’ title contribute in important ways to healthcare provision
    in NHS Wales. However, it is recognised that there is not a shared understanding of the
    ‘Specialist’ role amongst stakeholders, and this may reduce the impact and effectiveness of such
    roles. The terminology issues around ‘Specialist’ practice titles continue to create difficulties and
    confusion for the public, service leads and practitioners themselves.

    Considerable debate has focused on whether ‘Specialist’ practice is at a lower level than
    ‘Advanced’. It is increasingly widely accepted that ‘Specialist’ should be considered as one
    pole of the ‘Specialist - Generalist’ continuum (as illustrated in Figure 1) 1 rather than on the
    developmental continuum from novice to expert. This approach defines ‘Specialist’ practice as
    that which is particular to a specific context, be it a client group, a skill set or an organisational

    In this document ‘Advanced’ practice is a particular stage on a continuum between ‘Novice’ and
    ‘Expert’ practice. The ‘Advanced’ role profile is characterised by high levels of clinical and research
    skills, competence, autonomous decision-making alongside a leadership and educational element
    to the role and reflects a particular benchmark on the career development ladder as exemplified
    in the Career Framework for Health.

    The NHS Career Framework differentiates the level between practitioner level and advanced
    level using the term ‘Senior’. This helps remove the ambiguity over the specialist title. For this
    reason the terms ‘Senior’ and ‘Advanced’ will be used in this Framework when describing
    benchmarked developmental levels, and the term ‘Specialist’ will be used if required to define
    specific contextually-focused role types. This is not to devalue ‘Specialist’ knowledge or skills, but
    to recognise that such skills, in themselves, do not characterise an advanced level of practice.

    Figure 1

                                             Expert Practice

                                                                  Advanced Specialist

                    Specialist                                           Generalist
                     Practice                                             Practice

                         Junior Specialist

                                             Novice Practice

Career Framework Level 5

     Registered practitioners consolidating pre-registration experience and patient centred care and getting ready for a higher level of
     functioning. The Level 5 Practitioner is on a journey from novice, when initially registered, to practitioner.

     People at level 5 will have a comprehensive, specialised, factual and theoretical knowledge within a field of work and an awareness of
     the boundaries of that knowledge. They are able to use knowledge to solve problems creatively, make judgements which require analysis
     and interpretation, and actively contribute to service and self development. They may have responsibility for supervision of staff or training
     (©Skills for Health).

     Practitioners will have a broad knowledge base in a particular field of practice which enables them to work with a considerable degree
     of autonomy. They may have line management responsibilities but will not be responsible for service delivery. They actively use research
     findings to enhance and underpin their practice. A practitioner is competent in their area of practice and will seek opportunities to improve
     the service they offer (Skills for Health).

    Pillar of Practice       Characteristics                  Role Responsibility             Key Knowledge, Skills        Educational
                                                                                              and Behaviours               development
    Clinical Practice        Continues to develop             Effectively manages a           Demonstrates an              Blended learning
                             competence in meeting the        designated caseload for a       awareness of own values
    • Safe, Effective        holistic needs of patients/      delegated area of practice      and beliefs                  Will have completed
      and Person             clients and the wider public                                                                  accredited training
      Centred Care                                            Performs a broad range          Facilitates health           programme for student
    • Professional           Uses comprehensive               of clinical, technical,         enhancing and behaviour      supervision
      Judgement and          specialised factual and          managerial or scientific        change activities
      Decision Making        theoretical knowledge in         procedures                                                   Fully comply with all
                             order to solve problems, with                                    Facilitates shared           Mandatory Training
                             an awareness of limits of     Reviews and develops               ownership of decision        requirements
                             their knowledge base          performance of self and            making and supports the
                                                           others                             delivery of care             Meet professional
                             Evaluates own practice and                                                                    re-registration needs
                             identifies own development

                             Has a comprehensive range        Shares information              Assesses situations          Professional Competency
                             of cognitive and practical       effectively and concisely for   and contributes to the       Frameworks
                             skills required to develop       a range of situations and       identification of the root
                             creative solutions to abstract   contexts to ensure patient      cause of a problem           Professional Codes of
                             problems                         safety and continuity of                                     Conduct
                                                              care                          Develops and implements
                             Makes judgements requiring                                     reflective skills and          Shadowing
                             analysis interpretation and      Develops effective            evidences changes to
                             comparison of options            relationships to gather       practice to improve
                                                              information and deliver care outcomes for clients,
                             Assesses risk and acts on        in partnership with patients, service, profession or
                             findings to ensure patient       clients and carers            organisation
                                                              Draws on a range of             Evidences the continued
                             Works autonomously               sources in making               use and development of
                             within scope of practice to      judgements guided               the skills and behaviours
                             exercise judgement about         as necessary by senior          of dignity, compassion and
                             actions while accepting          colleagues regarding            respect in all aspects of
                             professional accountability      management and                  care and interactions with
                             and responsibility               delegation to others            others
                             Consolidates own                                                 Uses critical thinking,
                             knowledge, skills and                                            analysis and evaluation
                             attitudes through mentoring                                      in making clinical
                             and reflective practice                                          judgements

Career Framework Level 5
     Pillar of Practice   Characteristics                  Role Responsibility            Key Knowledge, Skills          Educational
                                                                                          and Behaviours                 development
     Leadership/          Acts as a positive role model    Actively engage in the         Contributes to the             Management Certificate
     Management                                            clinical supervision and       improvement of services        as new graduates they
                          Promotes good health and         appraisal of self and others                                  should be involved in the
     • Team Work and      well being                       e.g. Healthcare Support        Understands own role in        training and assessing
       Development                                         Workers                        identifying and escalating     of Health Care Support
                          Works independently,                                            concerns re patient care
     • Professional and                                                                                                  Workers
       Organisational     planning organising and          Has a responsibility to        and dignity
       Leadership         prioritising own work,           contribute to administration
                          activities and more complex      and management of              Develops clinical
                          tasks                            processes and policies of      leadership behaviours and
                                                           work area or department        skills
                          Can work effectively in
                          teams and understands the        Understands the basic          Gives and receives
                          roles of other members of        concept of leadership and      feedback in an open,
                          the team                         followership                   honest and constructive
                          Can communicate clearly          Works independently
                          and effectively and translate    as well as in teams to         Develops skills in:
                          complex professional issues      coordinate, delegate           • Negotiation
                          in a lucid way.                  and supervise care for         • Influencing
                                                           a designated group of
                          Consolidates own                                                • Organisation
                          performance and contributes                                     • Problem solving
                          effectively to the delivery of   Works effectively across       • Resource management
                          the service                      professional and agency
                                                           boundaries, actively
                          Identifies priorities,                                          Consolidates:
                                                           involving and respecting the
                          manages time and resources                                      • Critical thinking skills
                                                           contribution of others
                          effectively to ensure that the
                                                                                          • Analytical skills
                          quality of care is maintained    Responsible for aspects of
                          or enhanced                                                     • Evaluation skills
                                                           clinical effectiveness and
                                                           management of resources        • Interpersonal skills

                          Recognises own                   Identifies unacceptable or     Blends personal objectives
                          accountability to act where      unfair treatment of self       with organisational
                          the performance and              or colleagues and acts to      objectives
                          practice of self and others      inform senior colleagues
                          should be improved                                              Understands the
                                                           Engages in any required        organisational
                          Develop and maintain             change management              employment policies
                          communication with people                                       in relation to team
                          about difficult matters and/     Participates in monitoring     performance at work
                          or in difficult situations       the effectiveness and
                                                           impacts of change              Demonstrates
                          Recognises early signs of                                       independent critical
                          poor performance and take        Builds professional            judgement and an ability
                          appropriate measures             networks, promoting            to take a leading role in
                                                           exchange of knowledge,         developing critical thinking
                          Contributes proactively to       skills and resources in        in others
                          the aims and organisation of     relation to work and health
                          a team
                                                           Works within Codes f
                          Responds autonomously            Practice and Professional
                          and confidently to complex       Guidelines
                          planned and uncertain
                          situations, managing self and    Alerts managers to
                          others confidently               resource issues which affect
                                                           learning, development and
                          Emotional resilience             performance

Career Framework Level 5
     Pillar of Practice   Characteristics            Role Responsibility              Key Knowledge, Skills and                   Educational
                                                                                      Behaviours                                  development
     Education            Participates and           Supports the training of         Presentation skilws                         Reading of
     (facilitation of     contributes to in-         others and contribute to                                                     Professional Journals
     learning)            service CPD                team performance                 Consolidates understanding of basic
                                                                                      learning principles                         Participating in
     • Learning,          Is responsible             Facilitates students and                                                     in-service training and
       Teaching and       and accountable            others to develop their          Learns from experience through              presentation
       Assessment         for keeping up             knowledge and competence,        supervision, feedback, reflective
     • Creation of        to date through            using a range of professional    practice techniques and evaluation
       the Learning       continuing personal        and personal development
                                                                                      Motivates, stimulates and encourages
       Environment        and professional           skills
                                                                                      others to facilitate the learning process
                          development and
                          engagement with            Provides education to clients
                                                                                      Applies core skills in practice
                          clinical supervision and   and families to ensure active
                          mentorship                 involvement in their care
                          Able to facilitate and     Conducts a fair, objective
                                                                                      Develops educational materials
                          evidence self-directed     and timely assessment of
                          learning and problem       learners.                        Understands improvement approaches
                          solving skills                                              such as learning audit and appreciative
                                                     Contributes to the creation
                          Can evidence               of an effective learning
                          understanding of           environment ensuring             Uses models of supervision/mentorship
                          theory and practical       facilitation opportunities for
                          application of team        students                         Collaboration with relevant Higher
                          working skills and                                          Education Institutes for student’s
                                                     Participates in educational      learning experience and assessment
                          professional and
                          leadership                                                  Demonstrates knowledge and
                                                     Demonstrates application         application of curriculum requirements
                                                     of learning theories that are    and learning outcomes
                          Supports learning
                                                     appropriate for adult

     Research             Able to formulate          Evaluates equipment              Evidence of research activity               Contribute to service
                          research hypotheses        techniques and procedures                                                    evaluation (audit,
     • Evidence into                                 and make recommendations         Uses research findings to demonstrate       research, review)
       Practice           Assesses practice                                           the development of practice
                                                     Active involvement in clinical
                          Evaluates research         audit/surveys                    Maintains and develops research skills
                                                     Assists in the development       Ability to search databases and apply
                          Undertakes desktop         of clinical trials or R&D        information literacy skills
                          research                   projects
                                                                                      Accesses and applies research to
                          Analyses basic research    Accesses databases on            support practice
                          data                       research and evidence
                                                                                      Evidences the development and/or
                                                     and use to underpin own
                          Assesses own practice                                       maintenance of basic research skills by
                          and interventions                                           applying theory into practice
                          against                    Identifies ideas for research/
                          person-centred                                              Ability to demonstrate knowledge of:
                                                     development activity from
                          outcomes                   own practice                     • Local processes that contribute to
                                                                                        quality improvement
                          Consolidates               Contributes to data
                          understanding and                                           • Research governance – ethics, data
                                                     gathering activities such as       protection, confidentiality
                          application of different   audit and evaluations
                          research approaches
                                                                                      Consults with an experienced
                          Demonstrates a critical                                     researcher in relationship to research
                          awareness of the role                                       design and data analysis
                          of research and an
                          ability to describe and
                          comment on particular
                          aspects of current

Career Framework Level 6

      People at level 6 require a critical understanding of detailed theoretical and practical knowledge, are specialist and/or have management
      and leadership responsibilities. They demonstrate initiative and are creative in finding solutions to problems. They have some responsibility
      for team performance and service development and they consistently undertake self development (Skills for Health).

      Specialist practitioners have developed a high level of knowledge and skill in a specific area of practice. They have a depth of knowledge
      and understanding which enables them to perform at a high level of practice, take a leadership role, use and develop evidence to inform
      their practice, and deal with complex unpredictable environments. They will have their own caseload or work area responsibilities (Skills for

      Level 6 Practitioners have a higher degree of autonomy and responsibility than a Level 5 Practitioner in the clinical area. The focus of the
      role is on the development of the more specialised aspects of their profession, while starting to consider career choices and undertaking
      development opportunities to underpin those career aspirations.

     Pillar of Practice      Characteristics                  Role Responsibility                 Key Knowledge,                Educational
                                                                                                  Skills and Behaviours         development
     Clinical Practice       Further develops competence      Assumes accountability and          Uses detailed theoretical     Evidence of
                             and innovation in the            responsibility for specific         and practical knowledge       development that
     • Safe, Effective       management and delivery          elements of service delivery        of a work area involving a    includes advanced
       and Person            of care and interventions                                            critical understanding of     clinical reasoning and
       Centred Care          appropriate to client need       Works independently, leads          theories and concepts         decision making
     • Professional                                           work activities of a team or
       Judgement and         Demonstrates mastery and         others                              Evaluates own practice        Commences Level 7
       Decision Making       innovation in methods and                                            and identifies development    education
                             tools used in a complex and      Works autonomously with             needs within a complex
                             specialised work area.           freedom to exercise judgement       environment                   Basic level of skills
                                                              about actions guided by                                           evidenced in extended
                             Makes judgements involving       professional accountability and     Uses the ability to devise    scope practice and/or
                             a range of facts, options,       responsibility                      and sustain arguments         complex care
                             analysis and interpretation                                          to solve problems and
                                                              Provides specialist clinical,       implement solutions           Self and professional
                             Draws on a range of sources      technical, managerial or                                          development
                             in making judgements             scientific services and advice

                             Manages a team and               Implements policy and               Uses ability to conduct
                             resources in environments        guidance, proposes changes to       interventions, to discharge
                             that are unpredictable taking    working practices or procedures     and to refer on as
                             responsibility for decision                                          appropriate
                             making in unpredictable          Plans complex activities
                             work or study contexts.          involving liaison with others       Has understanding of and
                                                              and/or over a long time periods     can evidence partnership
                             Exhibits the skills of advanced                                      working
                             clinical decision making        Takes responsibility for the
                                                             purchasing/maintenance of            Applies specialist
                             Escalates concerns/clinical     assets, equipment and/or             knowledge, skills and
                             risk issues appropriately       resources                            behaviours appropriate to
                             (attribution of risk)                                                a specific area of practice
                                                             Understands the limits of their
                             Provides evidence that          professional practice                Contributes to the
                             specialist interventions are                                         development and review of
                             based on current research       Supports others to incorporate       policies and procedures for
                                                             quality improvement processes        own area
                             Manages complex ethical         into practice
                             issues, dilemmas and                                                 Appraises and identifies
                             conflicts                       Incorporates clinical governance     significant aspects in
                                                             into own practice and supports       conversations with others
                                                             others to do so                      and responds appropriately

                                                                                                  Reflects in practice on own
                                                                                                  values and beliefs and
                                                                                                  supports others in ethical
                                                                                                  decision making

                                                                                                  Uses critical thinking
                                                                                                  to explore and analyse
                                                                                                  evidence, cases and
                                                                                                  situations in clinical

Career Framework Level 6
     Pillar of Practice   Characteristics                  Role Responsibility                   Key Knowledge,               Educational
                                                                                                 Skills and Behaviours        development
     Leadership/          Demonstrates leadership          Manages others and/or                 Develops innovative          Understanding of
     Management           for a work area taking           elements of a service area            solutions to service         Management of
                          responsibility for managing                                            improvement imperatives      Change
     • Team Work and      professional development of      Able to develop and implement
       Development        individuals and groups           effective ways of working in          Takes initiative for         Understanding of
     • Professional and                                    networks across organisation          instituting small scale      Leadership skills
       Organisational     Leads work activities of a       and professional boundaries           service improvement
       Leadership         team or others                                                                                      All Wales Managers
                                                           Develops a wider understanding Ability to organise and             Passport
                          Promotes teamwork within a       of organisational and political  implement change
                          defined area of responsibility   issues and priorities                                         Development of team
                                                                                            Supports others to           members
                          Encourages staff to              Understands the wider            improve and enhance
                          contribute ideas and             hierarchy and organisation       practice
                          solutions for quality            structures affecting their
                          improvement and innovation       workplace                        Displays creativity and
                                                                                            innovation in exploring
                          Actively contributes to          Contributes to and manages       and implementing possible
                          a variety of professional        other members of a team          solutions to problems and
                          networks e.g. managed            by sharing information and       evaluate their effectiveness
                          knowledge networks,              expertise
                          professional learning                                             Leads, persuades
                                                           Engages in clinical supervision/ and influences others
                          Provides leadership, direction   preceptorship                    effectively
                          and motivation to achieve
                          the vision and objectives for    Brings team conflict out into         Contributes to effective
                          the area of responsibility       the open and encourages or            management of a budget
                                                           facilitates a beneficial resolution   in conjunction with others
                          Acts to promote a positive       by responding in a transparent
                          climate, good morale and         and structured way                    Ability to effectively
                          co-operation within the team                                           manage others

                                                           Engages in the recruitment of
                                                           professional staff and support        Is receptive to the
                                                           workers                               contribution of others

                                                           Engages in professional               Implements suggestions
                                                           supervision and reviews               for own improvement and
                                                           profession specific performance       that of others

                                                                                                 Demonstrates clear self-
                                                                                                 management strategies

                                                                                                 Supports others in
                                                                                                 understanding the need
                                                                                                 for and making agreed

                                                                                                 Demonstrates active
                                                                                                 engagement in developing
                                                                                                 policy and procedure for
                                                                                                 own area

Career Framework Level 6
     Pillar of Practice   Characteristics                Role Responsibility           Key Knowledge, Skills and         Educational
                                                                                       Behaviours                        development
     Education            Identifies and supports        Plans, organises and delivers Actively involved in action       Development of skills
     (facilitation of     the achievement of             learning events               learning/research and/or          in the facilitation of
     learning)            the learning needs of                                        academic research                 teaching and learning
                          individuals/team in            Facilitates workshops,
     • Learning,          response to service need       conferences, events           Involved in research papers,      Undertake appropriate
       Teaching and       and personal development                                     posters and publications          clinical education
       Assessment                                        Evaluates the effectiveness                                     training
     • Creation of                                       of educational interventions Consolidates skills to support
       the Learning       Consolidates own                                             workplace learning
                                                         Participates in uni/multi-
       Environment        assessment skills and
                                                         disciplinary teaching and     Reflects on practice and
                          supports others in making
                                                         student selection in HEIs     support reflection in others
                          assessment judgements
                                                         and/or other education
                                                         organisations                 Demonstrates a high level of
                          Creates an effective
                                                                                       skill in facilitation, support,
                          learning environment
                                                         Leads/participates in         supervision and developing
                          that ensures learning
                                                         educational audit and         learning needs analysis
                          opportunities for staff and
                                                         learning needs analysis
                          students                                                     Uses a range of information to
                                                         Develops and supports         review/evaluate the learning
                          Identifies personal learning
                                                         learning networks             environment
                          needs and articulates these
                          to ensure they are met         Facilitates learning and      Demonstrates development
                                                         assesses the practice of      and support of a learning
                          Understands the principles
                                                         students and mentors and      culture within the organisation
                          of professional education
                                                         supports students and/or
                          and development                                              Demonstrates involvement in
                                                                                       presentations and seminars
                                                                                       with colleagues for shared

                                                         Demonstrates active
                                                         involvement in training
                                                         programmes, personal
                                                         tutoring and assessment
                                                         of undergraduate students
                                                         and clinical supervision of
                                                         more junior staff

                                                         Evaluates the planning and
                                                         implementation of specific

Career Framework Level 6
     Pillar of Practice   Characteristics                Role Responsibility              Key Knowledge, Skills and         Educational
                                                                                          Behaviours                        development
     Research             Uses reflective practice       Undertakes clinical trials       Ability to understand different   Contribute to/lead
                                                         and research projects where      research approaches, methods      service evaluation (audit,
     • Evidence into      Identifies and uses skills     this activity is a significant   and analysis                      research, review)
       Practice           and knowledge of staff         part of the job description.
                          to support or undertake                                         Adheres to research
                          research related activity      Uses research related            governance for self and others
                          such as audit, evaluation      approaches to assess how
                          and wider research for the     evidence is being used to        Supports others to understand
                          benefit of the organisation    inform the quality of care       audit/evaluation and quality
                                                         of individuals by self and       improvement approaches
                          Contributes to the             others
                          development of guidelines                                       Assists others to access, use
                          and policy at a local and      Observes and records data        and apply evidence from
                          where appropriate at a         using appropriate methods,       databases relevant to area of
                          regional and national level    tools and technology for         practice
                                                         complex audits or clinical
                          Shares research activity                                        Demonstrates ability to
                                                         trials or projects
                          findings through local                                          critically appraise journal
                          bulletins, team meetings,      Participates in research         articles
                          professional journals          related activity including
                                                                                          Demonstrates an ability to
                                                         analysis of information
                          Develops a basic                                                submit an abstract/poster for
                          understanding of securing      Identifies and disseminates      local/national conference
                          grants and college awards      information on NHS Board/
                                                                                          Offer contribution to a peer
                                                         University programmes of
                          Provides evidence that                                          reviewed journal
                                                         research, forums, special
                          specialist interventions are   interest groups, networks        Applies ethical principles
                          based on current research      relevant to area of practice     in their own behaviour,
                                                                                          treatment of human subjects,
                                                                                          and in data reporting

                          Continues to develop own       Demonstrates involvement
                          skills by reading others’      in developing and
                          approach to critique/          implementing new methods
                          others’ research               of teaching to reflect
                                                         changes in research

Career Framework Level 7

      People at level 7 of the career framework will be experienced clinical practitioners with a high level of skill and theoretical knowledge, they
      will make high level clinical decisions and manage their own workload. They will be performing in a highly complex role and continuously
      developing their practice within a defined field and/or having management responsibilities for a section/small department (Skills for Health).

      They will have a critical awareness of knowledge issues in the field and at the interface between different fields. They are innovative, and
      have a responsibility for developing and changing practice and/or services in a complex and unpredictable environment (Skills for Health).

      Advanced practice should be viewed as a ‘level of practice’ rather than a specific role and it is not exclusively characterised by the clinical
      domain but may also include those working in research, education, management/leadership roles ( see Framework for Advanced Nursing,
      Midwifery and Allied Health Professional Practice in Wales for specific advice about the Advanced Practitioner role).

     Pillar of Practice          Characteristics                    Role Responsibility               Key Knowledge,                    Educational
                                                                                                      Skills and Behaviours             development
     Clinical Practice           Develops advanced                  Provides specialist clinical,     Uses highly specialised           Develops new skills in
                                 competence, innovation             technical, managerial and/        theoretical and practical         response to emerging
     • Safe, Effective           and leadership in the              or scientific services across a   knowledge some of which           knowledge and
       and Person Centred        management and delivery            work area involving complex       is at the forefront of            techniques
       Care                      of care interventions              judgements                        knowledge in the work
     • Professional              appropriate to client                                                area covering a range of          Evidences knowledge
       Judgement and                                                Takes responsibility for a        procedures and underpinned        to Masters Level
       Decision Making           Demonstrates critical              work area, specialist services    by relevant broad based           qualification in subject
                                 awareness of knowledge             or clinical pathways.             knowledge, experience and         area or is working
                                 issues in the work area and                                          competence. This knowledge        towards one
                                 at the interface between           Assesses, diagnoses, refers
                                                                                                      forms the basis for originality
                                 different work areas               and discharges                                                      Masters/ CQFW
                                                                                                      in development and/or
                                                                                                                                        level 7 education
                                                                    Assesses situations,              applying ideas.
                                 Demonstrates                                                                                           must underpin all
                                 independence in the                identifies the root causes                                          Advanced Practitioner
                                                                                                      Decision making/clinical
                                 direction of practice              of a complex problem                                                role developments in
                                                                                                      judgement and problem
                                 responding appropriately to        and takes a lead in clinical                                        Wales
                                 social, scientific, clinical and   governance in specific areas
                                 ethical issues encountered         of practice

                                 Clinical governance                Leads/participates in a wide      Quickly analyses complex          Achievement at
                                                                    range of effective healthcare     situations, identifying           this level may be
                                 Promotes respect and               interventions including           important aspects and taking      demonstrated either
                                 support others to consider         assessment and problem            appropriate action                by academic award,
                                 the dignity, wishes and            solving to manage actual or
                                 beliefs of all clients             potential risk                    Demonstrates independent          credit, or through
                                 involving them in shared                                             critical judgement and an         mapping portfolio
                                 decision making                    Promotes and influences           ability to take a leading role    outcomes against the
                                                                    others to incorporate values      in developing critical thinking   level
                                 Understands the structure          based care into practice          in others
                                 of health organisations and                                                                            Non-medical
                                 policy influencing health          Contributes to the                Uses information to take          prescribing
                                 and social care                    development of                    critical decisions
                                                                    organisational objectives                                           Evidences CPD in
                                 Practices autonomously             and create opportunities to       Manages complexity                Evidenced Based
                                 and as part of a team,             involve other practitioners                                         Learning
                                 using advanced knowledge,                                            Higher level communication
                                 skills, critical thinking and Identifies and shares more             skills
                                 evidence                      complex information
                                                                                                      High level influencing skills
                                                               effectively and concisely for
                                 Developing confidence         a range of situations and              Develops advanced
                                                               context to ensure patient              psychomotor skills
                                                               safety and continuity of care
                                                                                                      Utilises decision making
                                                                                                      mechanisms e.g. committees

                                                                                                      Involved in clinical networks,
                                                                                                      communities of practice

                                                                                                      Applies advanced skills,
                                                                                                      knowledge and behaviours
                                                                                                      relevant to specific area of

Career Framework Level 7
     Pillar of Practice     Characteristics                   Role Responsibility               Key Knowledge,                 Educational
                                                                                                Skills and Behaviours          development
     Clinical Practice      Demonstrates high levels          Works as part of a team           Assesses, diagnoses, plans,
                            of reflective and reflexive       with other services and           implements and directs
     • Safe, Effective      practice                          across multi-agency               care, interventions and
       and Person Centred                                     boundaries to access hard to      evaluates effectiveness
       Care                 Acts on feedback from             reach groups
     • Professional         patients, clients, the wider                                        Develops and supports the
       Judgement and        public to inform and improve      Identifies trends and             implementation of policies,
       Decision Making      practice                          changes in the needs              protocols and standard
                                                              of a population and the           operating procedures to
                            Supports and challenges           effectiveness of meeting          reflect national policy and
                            practitioners on specific         those needs                       legislation
                            aspects of their practice
                                                                                                Leads on implementation
                                                                                                of organisational clinical
                                                                                                governance framework in
                                                                                                own area of practice and
                                                                                                support others to use it
     Leadership/            Demonstrates leadership           Demonstrates experience of        Makes judgements based         Managing teams and
     Management             and innovation in work            managing change within a          on incomplete or limited       complex care
                            contexts that are complex         complex environment               information
     • Team Work and        and unpredictable and require                                                                      Can demonstrate
       Development          new strategic approaches          Proposes changes to               Negotiation and influencing    an understanding of
     • Professional and                                       practices or procedures           skills                         Health Economics
       Organisational       Solves problems by                which impact beyond own
       Leadership           integrating complex               work area                         Can demonstrate high levels Can demonstrate
                            knowledge sources that are                                          of skills in collaboration and an understanding of
                            sometimes incomplete and in       Manages staff and/or              communication in teams         Public Health issues.
                            new and unfamiliar contexts.      services ranging in size and
                                                              complexity, reviewing and         Applies models of team
                            They will make complex
                                                              prioritising work activities as   building and group working

                            Understanding of self and         Plans and/or organises a          Applies workforce and
                            others                            broad range of complex            workload assessment tools
                                                              activities or programmes          to build a business case and
                            Creates a culture of support      with formulation of               present evidence for team
                            and empowerment for the           strategies                        workforce development
                                                              Identifies the need for           Creativity and innovation in
                            Critically reviews team           change, leadinginnovation         exploring and implementing
                            performance and uses results      and managing change,              possible solutions
                            to enhance person centred         including service
                            care                              development and promoting         Management and
                                                              the involvement of others         leadership skills that
                            Leads and monitors clinical       and impact of the change          contribute to successful
                            effectiveness and efficiency to                                     change
                            enhance the management of         Monitors the delivery of
                            resources                         high quality person centred       Ability to demonstrate
                                                              care by the team and act on       partnership working
                            Identifies poor performance       the results
                            and takes responsibility                                            Shows awareness of the
                            for ensuring appropriate          Provides timely feedback to       effects of own behaviour on
                            development opportunities         the team that recognises          others
                            are available to address          good performance
                            concerns                                                            Develops and implements
                                                              and identifies areas for
                                                                                                operational plans for area
                            Ensures that organisational                                         of responsibility
                            goals are reflected in personal
                            and team objectives                                                 Present complex
                                                                                                information effectively in
                            Takes an active and                                                 written and oral reports
                            prominent role in providing
                            direction to staff and others                                       Assists the organisation to
                                                                                                develop and implement

Career Framework Level 7
     Pillar of Practice   Characteristics                Role Responsibility            Key Knowledge,                  Educational
                                                                                        Skills and Behaviours           development
     Leadership/          Is proactive and uses          Participates and influences    Provides direction to
     Management           initiative when problems       local (and where               people to enable, inspire,
                          arise or progress is slow      appropriate national) policy   motivate and support
     • Team Work and                                     and strategy development       them to achieve what the
       Development        Demonstrates provision of      by supporting and              organisation has set out to
     • Professional and   opportunities for staff to     developing lateral thinking    do and apply different styles
       Organisational     extend and develop their       in self and others             of leadership appropriate
       Leadership         management skills and                                         to different people and
                          to undertake appropriate       Involvement in                 situations
                          professional development       developments in
                                                         professional practice,         Facilitates discussions
                          Identifies patterns between    and transforming service       effectively to achieve clear
                          current and past situations,   delivery                       outcomes
                          points out patterns, trends
                          or missing information to      Provides leadership for a      Shows resilience under
                          others                         multi professional team        pressure and does not let
                                                         providing direction,           setbacks affect performance
                                                         motivation and co-
                                                         ordination to support          Evidences the appraisal of
                                                         members to achieve both        or manages the appraisal of
                                                         team and personal work         staff performance
                                                                                        Demonstrates originality
                                                         Engages in supervision and     in the application of
                                                         management of staff            knowledge

                                                         Identifies and evaluates
                                                         areas for potential service

                                                         Appraises draft policies and   Demonstrates an
                                                         strategies for their effect    ability to develop and
                                                         on users and the public and    implement effective ways
                                                         makes recommendations          of working in networks
                                                         for improvement                across organisation and
                                                                                        professional boundaries
                                                         Demonstrates capability in
                                                         financial and equipment

Career Framework Level 7
     Pillar of Practice   Characteristics                     Role Responsibility           Key Knowledge, Skills and         Educational
                                                                                            Behaviours                        development
     Education            Principles of teaching and          Designs, plans, implements Acts as an experienced mentor,       Facilitating staff
     (facilitation of     learning                            and evaluates learning and clinical coach, supervisor           development and
     learning)                                                development programmes                                          promotion of the
                          Develops service user/carer                                     Role model, encourages and          student learning
     • Learning,          education materials                 Provides advice and         supports teaching, supervision      environment
       Teaching and                                           support to other            and mentorship skills in others
       Assessment         Builds capability and capacity      practitioners to develop
     • Creation of        to support learning in              knowledge and skills        Acts on intelligence from
       the Learning       practice settings                                               educational audits to
       Environment                                            Coaching                    strengthen the workplace as a
                          Creates a positive learning                                     positive learning environment
                          culture through assuring            Engages with education
                          and improving the quality           providers to contribute to  Understands principles of the
                          of educational opportunities        curriculum development      learning environment and
                          within the work environment         and delivery and            complex organisations
                          Demonstrates active                                             Acts as an experienced work
                          involvement in training             Takes a lead role in        based learning educator/
                          programmes for specialist           ensuring the application of assessor
                          area                                standards and guidelines
                                                              that underpin a quality     Develops and facilitates the use
                          Demonstrates active                 learning experience         of educational materials for
                          involvement in personal                                         students, staff and service users
                          tutoring of undergraduate           Analyses the range of
                          and postgraduate students           factors which influence     Role model skills in assessment
                                                              learning and take account of competence
                                                              of these when planning
                                                                                          Demonstrates continued
                                                              and managing learning
                                                                                          involvement and contributions
                                                                                          to associated developments in

                          Contributes and assists in          Advises service/education     Demonstrates collaborative
                          curriculum development and          providers on capability       links outside the university
                          in reviewing and reforming          and capacity for student      with industrial, commercial and
                          modules, subjects and               experience in placements      public organisations
                          programmes at university
                          department and cross                Contributes to the            Demonstrates advanced
                          university department level         development of                knowledge and application of
                                                              postgraduate and CPD          curriculum requirements and
                          Demonstrates development            provision                     learning objectives
                          of assessment to meet the
                          level of requirement and            Demonstrates awareness        Evidences provision of
                          effectively utilising theories of   of current educational and    academic support to students
                          teaching and learning               social issues                 both informally and formally
                                                                                            through the system of progress
                          Evidence of effective use of     Design programmes to             reviews and the provision
                          marking strategies at all levels meet training needs of           of appropriate and timely
                          of undergraduate study           staff                            feedback on assessments

                          Demonstrates active                 Enables others to develop     Actively promotes the
                          involvement in developing           and apply their knowledge     workplace as a learning
                          others and enables others           and skills                    environment encouraging
                          to develop and apply their                                        everyone to learn from each
                          knowledge and skills in             Gives specific feedback,      other and from external good
                          practice                            positive and corrective,      practice
                                                              and assesses competency
                                                              of others so as to delegate   Encourages others to make
                                                              full responsibility when      realistic self-assessments of
                                                              they are ready                their application of knowledge
                                                                                            and skills, challenging
                                                                                            complacency and actions which
                                                                                            are not in the interest of the
                                                                                            public and/or users of services

Career Framework Level 7
     Pillar of Practice   Characteristics               Role Responsibility              Key Knowledge, Skills and          Educational
                                                                                         Behaviours                         development
     Research             Ability to access research/   Horizon scanning                 Demonstrates understanding         Conference
                          use information systems                                        of research proposal               presentations
     • Evidence into                                   Building of the evidence          application development,
       Practice           Be a role model for the      base                              ethical approval process and       Publications
                          wider team by promoting a                                      funding sources
                          positive research culture    Contributes to the wider                                             Collaborate with HE
                                                       research agenda through           Use of understanding of            on research
                          Identifies, promotes and     initiating or supporting          research and information
                          embeds evidence and          research activity                 governance to support others
                          identifies impact measures,                                    in the research processes
                          using findings to enhance    Collates evidence based
                          future activity              reports to inform service         Critically evaluate data and
                                                       improvement                       information with accuracy
                          Educates others re. critical                                   and perception, and is able to
                          appraisal to reinforce/      Uses the specialised
                                                                                         synthesise and use data drawn
                          clarify own skills           problem solving skills
                                                                                         from a variety of different
                                                       required in research and/or
                                                                                         methods appropriately
                          Communicates own             innovation to develop new
                          viewpoint succinctly and     knowledge and procedures          Ability to implement
                          defends it appropriately     and to integrate knowledge        research findings into
                                                       from different fields             practice - including use of
                          Demonstrates active
                                                                                         and development of policies/
                          involvement in supervision Design audit in a specialist
                                                                                         protocols and guidelines
                          of undergraduate research field
                          activity                                                       Further enhance knowledge of
                                                       Undertakes ethically
                                                                                         research approaches including
                          Provides evidence of         approved research
                                                                                         advanced evaluation methods
                          peer reviewed published
                          research and participation
                          at professional conferences
                          and seminars

                                                        Seeks/increases                  Demonstrates a
                                                        collaboration with other         comprehensive understanding
                                                        researchers, both within         of techniques applicable to
                                                        and beyond own area of           own research
                                                        research interest, in UK and
                                                        beyond                           Demonstrates successful
                                                                                         contribution to a peer
                                                        Writes research proposals        reviewed journal
                                                        directed at small funding
                                                        resources                        Demonstrates successful
                                                                                         submission of an abstract/
                                                        Identifies trends and            poster for local/national
                                                        changes in the needs             conference
                                                        of a population and the
                                                        effectiveness of meeting         Demonstrates knowledge of
                                                        those needs                      the major codes, statements
                                                                                         of ethical principles, and laws/
                                                        Provides mentorship for          regulations that prescribe
                                                        novice researchers               responsible conduct in
                                                        Teaches or guides others
                                                        about the implications of        Offers contribution to a peer
                                                        research for practice            reviewed journal

                                                        Undertakes personal              Presents research-based
                                                        research projects and            reports or summaries at
                                                        actively contributes to the      regional and national
                                                        institution’s research profile   conferences

Career Framework Level 8

      People at level 8 of the career framework require highly specialised knowledge, some of which is at the forefront of knowledge in a field
      of work, which they use as the basis for original thinking and/or research. They are leaders with considerable responsibility, and the ability
      to research and analyse complex processes. They have responsibility for service improvement or development. They may have considerable
      management responsibilities and be accountable for service delivery or have a leading education of commissioning role (Skills for Health).

      The Consultant practitioner is an expert practitioner with a high level of responsibility and delivery of services. There is a strong element of
      research within the role. They will carry out research, and may have overall responsibility for the coordination of R&D programmes as well
      as ensuring that current research findings are used by all staff to inform their practice. The consultant practitioners will lead by example in
      developing highly innovative solutions to problems based on original research and inquiry. They will apply a highly developed theoretical
      and practical knowledge over a side range of clinical, scientific, technical and/or management functions (Skills for Health).

      The Consultant Practitioner is an expert in clinical practice, bringing innovation and influence to clinical leadership as well as strategic
      direction in a particular field for the benefit of patients/clients. The Consultant Practitioner would not normally be undertaking day to day
      operational management of services. A Consultant Practitioner will exercise the highest degree of professional autonomy and decision
      making and will work beyond the level of practice of Clinical Specialists and others with extended or enhanced roles.

      The Consultant Practitioner will play a pivotal role in the integration of research evidence into clinical practice. Exceptional skills and
      advanced levels of clinical judgment, knowledge and experience will underpin their expertise and ability to promote delivery of the clinical
      governance agenda. They will do so by enhancing quality in all areas of assessment, diagnosis, management and evaluation, delivering
      improved outcomes for patients/clients and extending the parameters of their field of practice.

      Consultant Practitioners will work strategically across a range of models of service delivery and are expected to influence policy and
      decision making where the impact is on patient/client outcomes.

      While Consultant Practitioners are autonomous professionals, they must work within ethical, legal and professional frameworks and
      remain liable for their actions and omissions as registered practitioners. It is vital that the boundaries of responsibility, autonomy, authority
      and accountability of the post are clearly defined in any submission for approval (All Wales Guidance for the development of Consultant
      Practitioner roles).

      Staff working at a very high level of expertise and/or have responsibility for planning services.

     Pillar of Practice          Characteristics                  Role Responsibility          Key Knowledge,                    Educational
                                                                                               Skills and Behaviours             development
     Clinical Practice           Communicates with                Be expert in one or more    Uses specialised knowledge         The nature of a
                                 authority through engaging       service areas               to critically analyse, evaluate    Consultant Practitioner
     • Safe, Effective           in critical dialogue with                                    and synthesise new and             post requires a portfolio
       and Person Centred        peers in a specialist            Responsibility for          complex ideas at the most          of career long learning
       Care                      community                        management of a complex advanced frontier of their             and development. A
     • Professional                                               caseload that must include work area                           Consultant Practitioner
       Judgement and             Extends and redefines            providing and managing                                         must have a minimum
       Decision Making           knowledge and/or                 an expert clinical advisory Depth and breadth of               of a Masters Degree.
                                 professional practice within     service                     knowledge, skills and              In addition they should
                                 a work area or at the                                        expertise within their sphere      either have published
                                 interface between work           Responsibility for          of practice                        research or have, or
                                 areas                            delivering a whole
                                                                                                                                 be working towards a
                                                                  system patient/client       Promotes and demonstrates
                                 The primary function of          focused approach that       best practice
                                 expert advanced practice         incorporates the principles
                                 will be central to the role of   of co-production and        Facilitates integration of
                                 the Consultant Practitioner      shared decision-making.     research evidence into
                                 and should involve a                                         practice
                                 minimum of 50% of the            Responsibility for ensuring
                                                                  there is adherence to       Understands and applies new
                                 Consultant’s time focused
                                                                  the ethical and moral       and emerging guidance and
                                 on provision of direct care
                                                                  dimensions of practice      legislation

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