Some aspects of advanced practice are within scope (such as prescribing) and some are not (such as regional nerve blocks) but are within the individual’s scope or capability. Registered professionals can develop skills outside the scope of their primary registration to meet clinical service needs in the NHS.
Advanced practice is a level of practice that registered healthcare professionals from a range of backgrounds and areas can achieve. In recent years, it has evolved considerably resulting in many members asking the CSP's professional advice team what is in scope and what advanced practice is covered by our professional liability insurance (PLI) scheme.
- Advanced practice physiotherapists (APP) incorporate advanced-level skills and knowledge into their physiotherapy practice, such as the skills to address complex decision-making processes and manage risk in unpredictable contexts.
- Advanced clinical practitioners (ACP) come from a range of professional backgrounds, such as nursing, paramedics or physiotherapy. They complete a defined training programme that enable them to work outside of the scope of their primary profession to address local need. They are however still regulated by their primary profession.
Some additional tasks advanced practitioners are trained to do may not be physiotherapy. While you are able to train in these because you are a physiotherapist, some advanced practice roles involve tasks or assessments that do not fall within the four pillars of physiotherapy practice and are therefore not in the scope of the profession. Such tasks are not covered by the CSP PLI scheme.
In many contexts, these additional tasks allow physiotherapists to personally practice skills and capabilities outside the scope of practice of their primary profession. The Health and Care Professions Council (HCPC) understands this, and at this time there is no annotation or recognition of the level of practice on its register. However, HCPC standards must still be adhered to, including the need for you to be educated, trained and competent in all activities undertaken outside the scope of your primary registered profession. If the task an employer is asking you to do is outside of the scope of the profession, you will require additional insurance which is usually offered by your employer.
Prescribing as an ACP
The scope of practice for prescribing is limited by the Human Medicines Regulations 2012. Prescribing rights are connected to your relevant protected title in the legislation. As such your prescribing activity must be within the generally accepted scope of practice of your base profession and connected to activities covered by your indemnity insurance.
The role in which you are prescribing must require you to be registered with the HCPC and must draw on the knowledge, skills and experience of your base profession.
What falls within scope?
Considering each of the four cornerstones of physiotherapy practice in turn will enable you to decide whether your practice sits within the scope of the profession.
Further information about scope of practice
- Download the presentation about understanding scope (see slide 8 for advanced practice)
- HCPC standards of proficiency for physiotherapists
- HCPC standards of performance, conduct and ethics