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
click to enterContents
Foreword__________________________________________________________________ 3
Foreword
Introduction_______________________________________________________________ 4
Introduction
Background_______________________________________________________________ 4
Background
Structure of the Framework_
Framework ________________________________________________ 5
Benefits___________________________________________________________________ 7
Benefits
Aligning the Framework____________________________________________________
Framework 7
Terminology and Definition_________________________________________________
Definition 8
Frameworks
Level 5__________________________________________________________________ 9
Level 6_________________________________________________________________ 12
Level 7_________________________________________________________________ 16
Level 8_________________________________________________________________ 21
Level 9_________________________________________________________________ 27
Appendix_________________________________________________________________ 30
Appendix
References_______________________________________________________________ 30
References
© Crown copyright 2020 WG40105
Digital ISBN 978-1-80038-182-7
2Foreword
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
services.
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
3Introduction
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.
Background
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.
4Structure of the Framework
The Framework has two key parts Levels of Practice and Pillars of Practice.
Practice
1. Levels of Practice:
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.
Personal
Development
Clinical Practice
Management &
Development
Research &
Leadership
Education
5Each 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
Leadership
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.
6Benefits
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.
7Terminology 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
context.
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
8Career 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
safety
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
9Career 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
manner
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
individuals
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
10Career 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
assessment/teaching/facilitation
mentorship involvement in their care
techniques
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
enquiry
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
audit
organisational
leadership Demonstrates knowledge and
Demonstrates application application of curriculum requirements
of learning theories that are and learning outcomes
Supports learning
appropriate for adult
networks
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
outcomes
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
practice
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
research
11Career Framework Level 6
7
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
Health).
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
practice
12Career Framework Level 6
7
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
changes
Demonstrates active
engagement in developing
policy and procedure for
own area
13Career Framework Level 6
7
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
planning
• 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
colleagues
presentations and seminars
with colleagues for shared
development
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
modules
14Career Framework Level 6
7
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
15Career 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
solving
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
practice
16Career 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
judgements
necessary
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
team
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
improvement
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
policies
17Career 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
objectives
Demonstrates originality
Engages in supervision and in the application of
management of staff knowledge
Identifies and evaluates
areas for potential service
improvement
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
management
18Career 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
evaluation
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
experiences
to associated developments in
practice
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
19Career 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
research
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
20Career 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
doctorate
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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