Over the past few years the Royal Pharmaceutical Society, the United Kingdom Clinical Pharmacy Association and other pharmacy specialist groups have worked together to develop curricula for advanced practice. Each specialist group has defined the knowledge, skills and experience needed to work as an advanced practitioner in its specialism. Ultimately, these curricula could be used as part of a process to support, develop and recognise advanced practice.
But what is advanced practice and how does it differ from specialist practice? The profession has struggled to clarify exactly what these terms mean; the fact that they are so often linked together as “advanced and specialist practice” adds to the confusion. This raises another question — do specialist practice and advanced practice always go hand in hand?
To provide clarity, I propose that pharmacy adopts the definitions used by the Nursing and Midwifery Council. It sets out that specialisation refers to the focus of practice and implies horizontal differentiation — that is distinguishing practice in one area (eg, oncology) from another (eg, critical care). In contrast, advancement refers to a level of practice and implies vertical differentiation — that is defining a set of competencies, and their application in practice, that exceed those associated with initial registration.
By unpicking the terminology you can see that advancement and specialisation do not always go together. A pharmacist could be, for example, an advanced specialist (eg, a consultant pharmacist in mental health) or a non-advanced specialist (eg, a newly qualified pharmacist working in mental health). Yet, specialisation arising from learning beyond registration almost by definition involves advanced learning and underpins a form of advanced practice. Practitioners undertaking advanced roles are unlikely to do so without specialist knowledge and skills — although I do acknowledge that it is possible to imagine an advanced generalist pharmacist.
So what differentiates an advanced practitioner from a non-advanced practitioner?
Minsky’s frame system theory was originally developed to explain the differences between how novice and expert medical practitioners made clinical diagnoses. The theory suggests that we acquire knowledge and experience and store these as data in a series of frames. When faced with a problem, we recall a frame that most closely matches the problem. If there is a close match between the problem and the data in the frame we can take the same course of action as before. Non-advanced practitioners have a limited number of frames containing a limited set of data and may not see all the possibilities when solving problems. Through experience, advanced practitioners have acquired more frames and their frames include more data. Therefore, they are more likely to find a frame to match the problem — or can draw on data from several other frames and use skills, such as analysis, interpretation, evaluation, reasoning and judgement, to solve it.
Although increased knowledge and experience are important, it is how this knowledge and experience is recalled and applied that enables advanced practitioners to handle increasingly complex situations, regardless of their specialism.