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Case Study – Royal Berkshire NHS Foundation Trust

Advanced Level Practitioner role created using competences to support hospital night shifts and improve NHS workforce utilisation

The Royal Berkshire NHS Foundation Trust provides care for the population across Berkshire, including support for people with mental health problems and those with learning disabilities. Services are provided for children and young people, adults, and older people as well as specialist substance misuse services.

Following analysis of Junior Doctors’ workload out of hours, Trust managers realised that services could be more provided in a more cost-effective and enhanced way. They addressed this by exploring the requirement for more practitioner-grade staff in line with the nursing strategy and clinical governance.

A new role of Advanced Level Practitioner (AP) was part of the solution. The AP role took on many functions traditionally the domain of other professional groups, for example carrying out routine tests and simplifying patient pathways.

Managers at the Trust scoped the requirements and competences needed for an AP to work safely and effectively. These were then matched, where possible, against National Occupational Standards. Managers searched the Skills for Health competences database and identified those required for the role. Competences were divided into the foundation (those required of any employee), core (those for any qualified member of staff such as recognising the presentations of mental illness) and role-specific (those needed for an Advanced Practitioner Level).

After being invited to host a National Demonstrator Site (NDS), managers at Royal Berkshire NHS Foundation Trust saw an opportunity to use a competence-based approach to role design in support of its Hospitals at Night programme.

“The competences framework was extremely helpful for this programme. With the backing of Skills for Health, we have been able to take this role from a concept and turn it into a reality, with positive benefits for our service users and our staff who have greater opportunities to develop professionally.”

Alyson Hill, Deputy Director of Nursing, Hospitals at Night Demonstration Site,
Royal Berkshire NHS Foundation Trust


  • Improved patient safety Greater opportunities for career progression
  • Better recognition of role holders’ skills
  • Cost savings through more flexible workforce
  • Better allocation of resources without compromise to service delivery

Due to the way the role was created, there is a great opportunity for health professionals to progress into the role – for example, nurses, occupational therapists, psychologists, and social workers have the potential to progress.

The training would need to be tailored for each of these groups, to plug any skills gaps and complement existing knowledge.

A competence-based assessment manual was produced, which was well-received to provide a career path for clinical staff which prior to the project had not existed.

The Trust saw the impact of the new role as being pivotal for future service provision and there is widespread support for its implementation. Our expert workforce development team welcomed the success, underpinned by tangible benefits to patients of competence-based approaches to the design and re-design of roles and services.

We develop and manage a national bank of national workforce competences which describe the skills and knowledge required to carry out a task or function effectively. They are designed to underpin and be integral to accredited and non-accredited education and training programmes. Since competencies describe what individuals need to know and do, whoever is performing the task, they can be used in many different ways.

As the Sector Skills Council for the UK health sector, we support the NHS, independent healthcare providers and voluntary organisations. Our purpose is to help develop solutions that can deliver a skilled and flexible workforce to improve health and healthcare.