Advanced clinical practitioners in emergency care: past, present and future.

Developing a consistent and skilled workforce is critical to the sustainability of any clinical service. Nurses and paramedics have formed part of the emergency care workforce for many years and the extended role of these staff groups has supported patient care as the demand has risen and outstripped the capacity of the medical staff. In many hospitals and health-care systems, these extended roles have developed in response to local demand and case mix, resulting in inconsistent role descriptions and lack of transportable qualifications. Even for established roles such as emergency nurse practitioners, there is no UK-wide defined scope of practice or curriculum to support the role. In 2014 a joint working group of the Royal College of Emergency Medicine and Health Education England agreed a programme of work to support a sustainable emergency care workforce. One stream of that work focused on developing non-medical roles within emergency care and in particular the role of the advanced clinical practitioner in emergency medicine. Advanced practice has developed in the UK in many specialties and the new advanced practice framework from Health Education England (2017) allows a cross-discipline understanding of the principles and key aspects of advanced practice. However, this framework is naturally generic and does not focus on what a practitioner is capable of within a specific clinical area, but more on the core capabilities. This article outlines the development of a UK-wide curriculum and credentialing process for emergency care advanced clinical practitioners and reports on progress to date.