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Case Study – Betsi Cadwaladr University Health Board

Developing the role of Acute Coronary Syndrome Nurses using Skills for Health Competences improves Coronary Heart Disease services in Wales, support senior clinical workforce teams, and improves patient care

Wrexham Maelor Hospital, within the Betsi Cadwaladr University Health Board, developed an Acute Coronary Syndrome Nurse with the support of Consultant Cardiologists and other senior colleagues, the Cardiac Services Manager at Wrexham Maelor Hospital to put in place plans for a non-physician led Rapid Access Chest Pain Clinic. The key to its success would be a new role, at the advanced practitioner level, of Acute Coronary Syndrome (ACS) Nurse.

Using the Skills for Health framework for Coronary Heart Disease to provide a structure and define specific competences, the patient’s journey through the clinic was mapped out from the point of GP referral to a treatment and management plan. The competences which would be required on the part of the nurse to meet the patient’s requirements were identified for each stage of the journey. Mapping the process in this way the Manager and Nurse were able to select the competences needed to build a profile for the role of ACS Nurse.

Using the agreed profile the nurse was able to work under the supervision of an Associate Specialist in Cardiology to concentrate on gaining experience in specific areas. In this particular case, the nurse was already highly experienced requiring only a 5 month supervision period. As the Associate Specialist assessed that each of the required standards had been met, they could be ‘signed off’ to show that the Nurse had achieved the required level of competence.

“To ensure safety for both patients and the nurse we determined that a structured, competency-based approach was required. This is where the CHD Competence Framework was so valuable. It enabled us to focus on exactly what we required, what were the appropriate levels of competence for the nurse to practice at to deliver the service, and also for her clinical supervisor to ensure he was clear about her training and development needs.”

Karen Keating Cardiac Services Manager, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board


  • Two non-physician run clinics each week
  • Introduction of a ‘post-intervention clinic’
  • Alternative management pathway reducing patient waiting times
  • Career enhancement opportunity for an experienced nurse
  • Reduced pressure on Consultant clinics

The Cardiac Services Manager has also used the Skills for Health framework to introduce a trust-wide protocol for the non-physician led RACP clinic, to support process mapping and in the development of cardiac rehabilitation team roles.

As Sector Skills Council for the UK health sector, we support the NHS, independent healthcare providers, and voluntary organisations across Wales, England, Northern Ireland, and Scotland. Our purpose is to help develop solutions that can deliver a skilled and flexible workforce to improve health and healthcare A key aim of our workforce development experts is to develop and manage a bank of national workforce competences which describe the performance criteria, knowledge, and understanding required to carry out a work activity effectively. Because competences describe what individuals need to know and to do, regardless of who is performing the activity, they can be used in many different ways.