Executive summary
The review panel would like to thank the Trust for participating in this senior leadership conversation which was convened to discuss the clinical learning environment and governance for Advanced Practice (AP) learners in Emergency Medicine at the Trust. The panel met with senior members of the Trust Executive team, Emergency Medicine team, including the Chief Executive, Chief Nurse, Chief of Service (Divisional Medical Director), Deputy Medical Director, Clinical Director for Emergency Medicine, Deputy Chief nurse, Deputy Director of Operations, Divisional Director of Nursing and Quality for Medicine and Emergency Care, Trust Head of Medical Education and Advanced Practice Trust Lead.
The panel heard that following recent changes in the AP education leadership and supervisory, team in Emergency Medicine, an interim governance structure has been put in place to ensure AP learners are supported to continue acquiring the teaching and learning experience to qualify. Overall, the review panel were pleased with the progress made and processes that have been and will be put in place to ensure this.
The panel advised that the department implement systems to record AP learner teaching attendance, and the time educational and clinical supervisors use to support AP learners.
In conclusion, the review panel issued one mandatory requirement, gave two recommendations, and would like to arrange a Trainee Focus Group later in the year to meet with AP learners in Emergency Medicine at the Trust.
Review overview
Background to the review
This Senior Leader Conversation (SLC) was arranged in response to concerns escalated to the South East faculty of Advancing Practice relating to the support for Advanced Practice trainees in Emergency Medicine at the Trust. In June 2024, an SLC in Medicine took place but the scope did not include Advanced Practice or Emergency Medicine learning environments.
Who we met with
- Clinical Director for Emergency Medicine
- Divisional Director for Nursing and Quality for Medicine and Emergency Care
- Deputy Director of Operations for Medicine and Emergency Care
- Deputy Medical Director
- Chief Nurse
- Deputy Chief Nurse
- Chief Executive
- Trust Lead for Advanced Practice
- Trust Head of Medical Education
Review panel
Education Quality Review Lead
- Sarah Goodhew, SE Advancing Practice Faculty Lead, Southeast Region
Specialty Expert
- Karen Swift, SE Advanced Practice Faculty Supervision & Assessment Lead
NHSE Education Quality Representative(s)
- Debbie Roberston, Head of Education Quality for KSS
- Alex Bamford-Blake, Education Quality Project Officer
Supporting roles
- Jacqueline Codrington, Lay Representative
Review findings
Quality Domain 1: Learning environment and culture
The panel heard that since the specific trigger issue, it was noted that some learners feel anxious about speaking up without fear of negative consequences. The panel asked what options were available for practitioners to raise concerns or provide feedback during the recent departmental changes. The Trust reported that they had held focus groups for learners to help alleviate any uncertainty and that building open communication channels with learners is ongoing. The Trust emphasised that practitioners can speak to their line manager, the Freedom to Speak Up (FTSU) guardian, and patient safety teams. There is a weekly directorate patient safety meeting which AP leads attend, and any concerns can be raised. The review panel advised that the Trust consider including a practitioner learner representative at the Advanced Practice Advisory Group (APAG), and identify methods to collect practitioner learner feedback, including representation at the Emergency Medicine Local Faculty Group (LFG) going forward. Please see Recommendations R-EM-01 & R-EM-02.
The panel asked if AP learners lack clarity on their scope of practice. The Trust reported that trainee Advanced Practitioners in the emergency department follow the Royal College of Emergency Medicine’s (RCEM) Emergency Medicine Advanced Clinical Practitioners (ACP) Curriculum and are working towards credentialing with RCEM.
Quality Domain 2: Educational governance and commitment to quality
The panel heard that the Advanced Practice Advisory Group (APAG) is a part of the Advanced Practice (AP) governance structure that provides oversight and support for the expanded AP workforce across the Trust. The group is made up of the Chief nurse, Deputy Chief Nurse and Chief of Service/ Divisional Director of Nursing & Quality/ Divisional Director of Operations, Clinical Director, and Local AP Leads who meet every two months to provide consistency across the different divisions around expectations for APs.
Additionally, the leadership structure within Emergency Medicine that has been in place since February 2025 includes the head of nursing, clinical director, general manager, and interim leads for the Trust’s sites including the newly acquired urgent treatment centre (UTC). The Emergency Medicine triumvirate and the interim leadership team structure provides the necessary day-to-day resources and leadership that supports AP learners to perform their roles effectively in Emergency Medicine. These two groups meet monthly to review progress, to provide additional support, and address any issues that arise.
The panel heard the Trust’s development plan for AP learners within the emergency department will include monitoring supervision and implementing an internal Annual Review of Competence Progression (ARCP). Both will help to ensure APs are receiving the guidance they require to succeed and assessing their progress.
Quality Domain 3: Developing and supporting learners
This requirement was not specifically discussed as part of the review, however themes in other sections may link to this domain.
Quality Domain 4: Developing and supporting educators
The panel heard that those supervising AP learners are supported by the interim leads
The trust reported that a big challenge was finding the time required for consultants to provide adequate supervision for AP learners. The department is ensuring that educational supervisors meet with learners at least one hour per month, and 3 hours per month with clinical supervisors. However, the panel heard there is currently no system in place to record how this time allocation is evidenced. Please see Mandatory Requirement MR-AP-01.
Quality Domain 5: Delivering programmes and curricula
The panel heard that AP learners in the Emergency Department participate in fortnightly half day teaching sessions. These sessions are coordinated by the APs themselves and include input from various departments within the trust so as to cover a multiprofessional range of learner interests. The Trust also coordinates simulation teaching, mid-grade teaching days, to which AP learners are invited, and multi-professional half day events with Kent and Medway. When asked, the Trust reported that there is not currently a system in place to monitor AP learner teaching attendance.
The Trust reported that all AP learners work on a tier-1 rota which does not include night shifts, and trainees have the same level of supervision of any tier-1 learner. Once ACPs are qualified they are eligible and assessed for tier-2.
Quality Domain 6: Developing a sustainable workforce
When asked about the Trust’s plan for the growing AP workforce, the panel heard that the new self-assessment process will help to inform strategic business and workforce decisions. The panel heard that there is currently a pause in AP learner recruitment in emergency medicine whilst a robust governance structure is being built to support them. The panel heard that the trust is committed to their learners and there will be available AP posts for those who finish their training at the Trust. However, this is subject to workforce transformation changes made in response to NHS Egland directives regarding cost savings.
Requirements
Mandatory requirements
| Review findings | Required action, timeline and evidence | Reference number and or domain(s) and standard(s) |
|---|---|---|
| When asked, the Trust reported that there is not currently a system in place to monitor AP learner teaching attendance. | To provide evidence that consultants in the Emergency Department provide educational supervision for Advanced Practice learners and have protected time in their job plans for educational responsibilities. This should include supervision for all four pillars for Advancing Practice (Clinical Practice, Leadership and Management, Education and Research). Evidence to be submitted by 3 October 2025. | MR-AP-01 |
Recommendations
| Recommendation | Reference number and or domain(s) and standard(s) |
|---|---|
| The Trust should consider an Advanced Practice learner representative be included in the Advanced Practice Assurance Group membership and invited to the meetings going forward. | R-EM-01 |
| Advanced Practice representative to be included in the Emergency Department Local Faculty Group or equivalent governance meeting. | R-EM-02 |
Report approval
Report completed by: Alex Bamford-Blake, Education Quality Project Officer
Review lead: Sarah Goodhew, SE Advancing Practice Faculty Lead, Southeast Region
Date approved by review lead: 25 June 2025
NHS England authorised signature: Jo Szram, Postgraduate Dean for Kent, Surrey & Sussex
Date authorised: 25 June 2025
Final report submitted to organisation: 16 July 2025