HEE ROADMAP

WHAT’S HAPPENING ON THE GROUND?

Pathway to primary care

HEE’s Roadmaps to Practice set out a development pathway for podiatrists looking to take up roles in primary care – as encouraged by the NHS Long Term Plan, which aims to provide more integrated and collaborative healthcare.

I n recent years, before the pandemic, there has been a signifi cant policy focus across all governments in the UK to shift the balance of care from secondary care to primary and communitybased care settings (NHS, 2019).

This shift has brought with it a signifi cant change in where and how resources are spent. Increased funding is now available to support the uptake of roles within primary care by health professionals who have previously worked in other sectors, following a change to the national GP Network Contract

Directed Enhanced Service (DES) 2020/21 (NHS England, 2020). Through the subsequent roll-out of the Additional

Roles Reimbursement Scheme (ARRS), podiatrists, paramedics, occupational therapists, dieticians and physiotherapists are funded by a national scheme to support the uptake and implementation of these allied health professional (AHP) roles into primary care, thereby meeting the workforce development set out in the DES at no additional local cost (BMA and NHS, 2019).

To support the introduction of new AHP roles into primary care, Health Education England (HEE) has launched a national multiprofessional training scheme (HEE, 2021a). The scheme, summarised in the Roadmaps to Practice series of documents, sets out a standardised training and development pathway, provides training resources, and signposts trainees to achieve role verifi cation and accreditation with the HEE Centre for Advancing Practice.

The podiatry profession has an unprecedented opportunity to use the national funding, infrastructure and training support available to engage in primary care and contribute our expertise, thereby positively impacting population health across health and care sectors (College of Podiatry [CoP], 2020). There has arguably never been a better opportunity to infl uence, integrate and impact foot health across the whole health and care system.

DR LINDSEY CHERRY is senior clinical academic at the University of Southampton and Solent NHS Trust. She is also HEE’s AHP adviser for the Hampshire and Isle of Wight Primary Care Training Hub

LAWRENCE AMBROSE

is head of policy and public aff airs at the College

The changing primary care landscape

Primary care networks (PCNs) have been developed in England to bring general practices together within a local area so they can work at scale (NHS England, 2021). The development of PCNs is a key part of the NHS Long Term Plan (NHS, 2019) and builds upon existing primary care services to enable greater provision of proactive, personalised, coordinated and more integrated health and social care that is also closer to home for patients. PCNs therefore enable GPs to provide a wider range of services to their communities and to integrate into the broader health and care system. There are 1250 PCNs in England, each with an average population size of 48,000 people. More than 99% of general practices are part of a PCN, which then signs up to the DES, detailing core requirements and system-wide entitlements (NHS, 2021).

The newly formed integrated care systems (ICS) offer a way to plan and organise the provision of health and care services in England at a larger scale than PCNs could (NHS England, 2018). Every ICS will ensure that PCNs work with other community staff and use multidisciplinary teams across primary and community care, feeding in and out of secondary care as appropriate. The overall aim is to provide a more integrated system, reduce competition within healthcare provision, and provide service users with a more navigable system than is currently in place (NHS England, 2018).

Private practice providers will continue to offer an additional

element of choice and diversity in the healthcare landscape, and PCN providers can direct service users toward provision within and outside the NHS (NHS England, 2021).

The Additional Roles Reimbursement Scheme

In podiatric practice, there is an important distinction to be made between those who work in private practice – for example, who undertake an important diagnostic role in terms of foot health as they may be a fi rst point of professional foot health advice – and those who will be entering into the new fi rst contact practitioner (FCP) or advanced practitioner (AP) roles within PCNs under the ARRS (CoP, 2020). Those in FCP or AP primary care roles have both a diagnostic and safety-netting responsibility, as set out in the DES, and are required to appreciate, use and connect the whole health and provide programmes of treatment, or to offer what may be considered ‘routine’ foot care. For PCNs to be eligible to receive ARRS funding, there is a need to ensure that the roles meet the specifi cation set out in the DES, and duplication or disruption of existing local services is to be avoided.

care landscape by signposting or forming onward referrals. Accordingly, they must have a minimum of master’s level clinical practice, as well as additional primary care-specifi c training (HEE, 2021a). The values and training ethos relevant to primary care are also strongly refl ected in the FCP/AP role descriptors, and there is strong emphasis on advanced communication skills, diagnostic skill, ICS awareness and appreciation of person-centred approaches to health and care.

The ARRS roles are an important addition to the PCN workforce, providing a unique diagnostic and fi rst-contact contribution that complements the work of the traditional GP and nurse colleague roles. The podiatrist FCP would not, therefore, be expected to

PCNs in England 1250

PCNs in England

48,000

Average population size > 99%

of general practices are part of a PCN

Definitions of FCP and AP in primary care

First contact practitioner

A diagnostic clinician working in primary care at the top of their clinical scope of practice, at Agenda for Change Band 7 or equivalent and above (HEE, 2021a). Able to assess and manage undifferentiated and undiagnosed lower limb presentations within primary care.

Minimum threshold for working as a fi rst point of contact within a PCN environment with people who have undifferentiated undiagnosed conditions. Must be working at master’s level (academic level 7) or above in their clinical pillar of practice, but may not yet have attained that level of mastery in their research, management or leadership, and education pillars.

Advanced practitioner

Working in primary care, will hold all the attributes described above for an FCP role, but will be demonstrably working at master’s level across all pillars of practice. The role descriptors and levels of practice set out by HEE in the Roadmaps to Practice are similar for all the AHP professions entering PCNs.

‘There has arguably never been a better opportunity to influence, integrate and impact foot health across the whole health and care system’

The HEE Roadmaps to Practice

HEE has worked with the College of Podiatry and its special advisory groups to develop the podiatry-specifi c Roadmap to Practice in Primary Care.

The roadmap sets out the expected podiatrist FCP and AP capabilities, and describes the range of knowledge, skills and attributes (KSA) expected of post-holders. The KSA elements are cross-referenced to existing national standards and frameworks for podiatrists to ensure consistency across sectors of working.

Roadmap supervision

The roadmaps provide guidance on the training required to work in FCP or AP roles in primary care. Supporting resources and signposting to additional sources of training, such as e-Learning for Healthcare online modules, are also included.

Supervision and supervisor verifi cation of a portfolio of evidence demonstrating FCP/AP level of practice is an important element of the pathway to role verifi cation with the Centre for Advancing Practice (HEE, 2021b).

‘Supervision’ has many defi nitions across healthcare, and there may be variation between professions or regulators in what is meant by the term. To support FCP or AP roles in primary care, supervision is considered in terms of clinical supervision (for example, regular or daily supervision in practice), continued professional development supervision (for example, monthly supervision, and contributing to the requirements for maintaining professional registration) and educational supervision (for example, that related to taught courses) (HEE, 2021a).

The amount of clinical supervision recommended for those transitioning to FCP or AP roles within primary care is considerably higher than that traditionally offered to podiatrists of increasing clinical experience, or who are already working at level 7. HEE recommends the high level of supervision during the training and verifi cation process as part of the podiatrist’s transition into the primary care environment, and in recognition of the unique challenge that working in primary care with people who have undiagnosed/ undifferentiated disease can bring.

Commensurate with this, HEE-verifi ed supervisors must themselves hold a master’s or equivalent and above qualifi cation, be practising as an AP in primary care or a consultant in any healthcare setting, or be a GP, and must have completed a HEE supervisor training course. Supervisor training courses are typically advertised regionally on PCNs’ training hub websites (HEE, 2021c). Supervision is multidisciplinary, and podiatrists can supervise and be supervised by professionals from different disciplines.

Supporting FCP and AP podiatrists in primary care

The College is funding an ongoing project to evaluate FCP and AP podiatry roles. To find out more about this project or FCP/AP primary care roles, please contact

lawrence.ambrose@cop.org.uk

To read about one podiatrist’s experience of working in an FCP role, go to page 30.

References are available to view online: membersarea.cop.org.uk/ the-podiatrist