Experienced advanced nurse practitioners (ANPs) are struggling to secure jobs in general practice because of an NHS accreditation scheme that has been described as ‘discriminatory’ and ‘deeply flawed’.
Some ANPs have been pushed to take sick leave over the situation, while others are forced to look for jobs elsewhere, according to our sister title Nursing in Practice.
The Queen’s Nursing Institute (QNI) has suggested the issue is ‘widespread’ and creating an ‘unequal playing field’, while ANPs themselves describe feeling ‘broken’ and undervalued.
The digital badge scheme was launched by NHS England (NHSE) in 2022 as a way of evidencing the ‘accredited education and training’ of ANPs. It is currently voluntary for all ANPs, apart from those seeking employment under the additional roles reimbursement scheme (ARRS) in general practice.
It can be obtained via two routes: from doing an accredited Masters programme or via an ePortfolio which includes a 5,000-word essay.
Concerns have been raised that as it is largely only courses post-2017 that are accredited – because they are matched to an ANP framework launched that year – ANPs who have completed their education before then have to undergo the extensive ePortfolio option if they want to obtain the badge (see box).
It is understood that there have been delays and several barriers to ANPs and advanced clinical practitioners (ACPs) accessing the digital badge, especially via the ePortfolio route.
Data from the QNI reveals 1,157 ACPs have been awarded the badge via the accredited programme route, typically for nurses completing their Master’s post 2017.
Meanwhile, 259 have secured it through the ePortfolio pathway – which is more likely to be completed by experienced ANPs.
And only 95 of those 259 ACPs are from a general practice or community background, meaning that of the 432 ANPs in general practice, fewer than 100 have obtained the badge via the ePortfolio route.
Furthermore, those who did have to go through the ePortfolio route have faced periods of waiting – further NHSE data showed there were 147 ePortfolios in the ‘post-submission quality and standardisation process’.
NHSE said it typically took between eight to 12 weeks from the time of submission to be notified of the outcome.
While figures on the number of ANPs in England are hard to pin down, a report from the Nuffield Trust last year suggested there were, as of May 2022, around 8,000 nurses with a job title either recorded as or suggested as an advanced practice role. And it stressed this was likely to be a ‘significant underestimate’.
The QNI said there had been several examples where experienced ANPs have been interviewed for jobs in general practice only to have their offer withdrawn because they don’t have the digital badge and therefore do not qualify for ARRS funding.
QNI chief executive Dr Crystal Oldman said: ‘We have been contacted by many ANPs over the last few months who have experienced the discriminatory impact of this requirement.
‘Nurses from outside primary care with the digital badge are able to apply for a role under the ARRS that an expert ANP without a digital badge but with an ANP Masters and more than 20 years of experience in primary care cannot.
‘This unintended discriminatory impact has got to be addressed urgently to not only win back the hearts and minds of the nurses working in primary care, but to retain our highly valued expert nurses working at an advanced level.’
The QNI is currently running a survey for ANPs in primary care, asking for their views and experiences.
Early findings suggest ‘that this is a widespread issue impacting on their opportunities for employment and an unequal playing field’, added Dr Oldman.
Sandra Dyer, who qualified as a nurse in 1990 and completed her advanced practice Masters in 2015, was told last year that her ARRS ANP role could no longer be funded as she did not have the digital badge.
Despite trying to secure a place on the ePortfolio route to obtain a digital badge since September 2023, she is still yet to be offered one and is therefore left struggling to find a job in primary care.
There was one instance where she was told she could have a job in general practice but would be paid around 16% less than an ANP rate.
The employer tried to justify this ‘by saying that I would need more supervision because I didn’t hold [the badge]’ she said.
‘This is a deeply flawed approach and a very worrying assumption that someone with a digital badge could, by the virtue of holding it, be competent for the job – they may or they may not depending on experience, knowledge and skills,’ said Ms Dyer.
She added: ‘Given I am unable currently find a clinical job it is going to be extremely difficult to complete the ePortfolio when a place becomes available.’
‘There is a shortage of nurses in primary care. It’s crazy I am not employable due to a voluntary badge.’
Community ANP Caroline Walker completed her Masters in advanced clinical practice in 2020 and was hoping to be given ‘legacy accreditation’ for the digital badge scheme, since her course was accredited by NHSE.
However, she said this has not been the case and that she has since submitted her expression of interest for the digital badge ePortfolio route.
It was her view that NHSE – then Health Education England – had commissioned a course for her that then ‘didn’t meet their own standards’ and that she had ‘been penalised for that’ as a result.
‘If the digital badge is seen as the current currency and experienced ACPs realise it has become compulsory for some roles, will they become demoralised to the point where they consider leaving the profession altogether?’ she said.
‘This would be a tragedy.’
Responding to the concerns raised, an NHS spokesperson said: ‘The NHS is working hard to ensure that anyone who has submitted an ePortfolio and is eligible for an advanced practitioner digital badge receives one as soon as possible, while new cohorts are set to start in the Autumn.’
A version of this story first appeared in our sister publication Nursing in Practice.
What is the digital badge?
The digital badge scheme, launched by NHSE in 2022, seeks to evidence the ‘accredited education and training’ of ANPs in a digital and secure format.
It is issued by the Centre of Advancing Practice in England – part of NHSE, formerly Health Education England – and can be used in email signatures as a portfolio of evidence for advanced practice.
It is mandatory for employment under the additional roles reimbursement scheme (ARRS) for ANPs in primary care, as per the GP contract, but voluntary for all other ANPs.
Those eligible can either access the badge by completing an advanced practice programme that is accredited by the NHSE post-2017 or via an ePortfolio supported route.
The ePortfolio requires advanced practitioners to evidence a series of capabilities, as well as their previous education and clinical skills training, and to complete up to a 5,000-word reflective critical essay to show they can write at level 7.
ANPs have reported ‘huge delays’ and several barriers in accessing the digital badge, especially via the ePortfolio route.
The situation is also understood to be particularly at the detriment of those who qualified in advanced practice before 2017, when a multiprofessional framework for advanced practice was launched and set the ‘minimum standard for the safe and effective requirements for clinicians working at this level’.
Work has since been undertaken to accredit advanced practice Masters courses so that ANPs can claim the badge without doing the ePortfolio route. However, it is understood there are issues with this, including that many will still have to do the ePortfolio route if their course started before full accreditation was given.
But largely, those who did their advanced practice education before 2017 and who are likely to be more experienced, have to do the ePortfolio route to obtain the badge.
While the badge scheme is open to advanced clinical practitioners (ACPs) more widely, including pharmacists and occupational therapists, it is only ANPs that must have it to secure an ARRS role.
