Factors influencing community-based advanced clinical practitioners maintaining their physical assessment skills: A qualitative study

Background: Numerous government White Papers have predicted significant health professional skills gaps in meeting patients’ needs within the National Health Service (NHS). Community advanced clinical practitioners (ACP) were identified as key skilled workers to support both patients and doctors. A wide range of physical assessment skills are essential to assess, diagnose and treat acutely unwell complex patients at home by providing safe, effective, timely care. Existing research is predominantly quantitative and focuses on the use of physical assessment skills; no studies have explored how these skills are maintained. Aim: This study explores the concept and application of community ACP roles, identifies practitioners’ understanding related to factors influencing maintaining their physical assessment skills, and generates a framework of how these skills can be optimised and supported in practice. Design and methods: A qualitative interpretivist single case study design using one-to-one semi-structured interviews with ACPs was conducted, and data generated analysed thematically. Findings: Community ACPs worked in highly autonomous roles assessing, diagnosing and managing acutely unwell patients with complex health needs, thus required wide ranging physical assessment skills. Accessing continued professional development (CPD) and clinical supervision were major contributing factors to difficulty maintaining some physical assessment skills, including those used less frequently. This reflected isolated working practices and the busyness of their environment, with reduced opportunities to rehearse skills. Clinical training gaps made it difficult for them to achieve their full potential. Innovative approaches for maintaining physical assessment skills were exposed, and multiple opportunities to gain practical experience, as opposed to one-off training courses, were seen as a necessity. Greater understanding on the part of employers would benefit skill maintenance. Recommendations: Advanced practice training needs to give more consideration to generic community roles to support practitioners in fully developing and maintaining their skills. Refresher courses incorporating opportunities for practical experience in varied clinical settings, regular clinical supervision and more opportunities for collaborative learning between doctors and this group of professionals are recommended. Contribution of knowledge: This study makes a unique contribution to understanding factors influencing community based ACPs maintaining their physical assessment skills. The findings supported the development of an innovative framework to promote CPD in this area of practice and demonstrate how skills can be optimised and supported in these highly autonomous roles