ACCP Queries

Advanced Critical Care Practitioners (ACCPs) are clinical professionals responsible for patients' care during their critical care admission. They are highly experienced and educated practitioners who have developed their skills and theoretical knowledge to a very high standard. They are empowered to make high-level clinical decisions to ensure that patients receive timely, personal, and effective care.

Find out more on our ACCP webpages.

ICM doctors provide the definitive medical opinion and support for a critical care service in a hospital. GPICS (Guidelines for the Provision of Intensive Care Services) is clear that patient care is led by a consultant in Intensive Care Medicine. Members of the ICM Multidisciplinary Team (MDT) support the ICM consultant to deliver that care. Doctors working and training in ICM are doing so as irreplaceable members of the MDT, and with the understanding that the skills and knowledge they are developing in their training can equip them eventually to take on a medical consultant role in their chosen specialty.

ACCPs perform defined roles as members of the ICM MDT. Unlike for intensivists in training, there is no intention or expectation that they will ever lead patient care to satisfy the requirements of GPICS as a medically qualified ICM consultant does. All ACCPs holding FICM Membership are registered healthcare professionals, usually NMC or HCPC and have relevant critical care experience prior to entering their ACCP training. All FICM ACCPs are trained according to the knowledge, skills and capabilities of the FICM ACCP Curriculum, with clearly defined levels of supervision both in training and post qualification. FICM also has a Code of Conduct for its registered ACCPs in addition to any professional requirements of the ACCP’s base regulator.  

Ultimate decision making responsibility for patient care, and the supervision of intensivists in training, lies with the medically qualified consultant in Intensive Care Medicine (consultant in ICM).  Although the defined level of supervision for both ACCPs and intensivists in training will be determined locally, within these supervision models, intensivists in training should be appropriately recognised for both their extensive training and ongoing development into future medical consultant intensivists.  

Case-mix, availability of staff groups within the ICM MDT and local governance agreements play a major role in determining the scope of practice of any professional group in ICM at a local intensive care unit level. As an example, in many units across the UK doctors training in medicine of all backgrounds carry an on-call bleep/phone and see referrals whereas in some larger units this role is performed by much more senior intensivists in training. All critical care admissions should be discussed with a consultant in ICM as outlined in GPICS.

Rotas are determined by each unit using their local governance arrangements. Intensive care units should aim to meet the medical staffing requirements of GPICS as outlined. ACCPs also have a professional responsibility to work within their agreed scope of practice with clearly defined standard operating procedures and local governance arrangements. Any decision on rotas and scope of practice by staff groups is made locally as that is where the risk, as well as the knowledge, is held.

The Faculty’s position is informed by its strategic aims, and we set standards through GPICS. Patient care and supporting the workforce are basic requirements for any rota and slots should be occupied by individuals who are able to meet the basic clinical standards needed for that service.  ACCPs and intensivists in training have different clinical backgrounds, training frameworks, career pathways and the two roles are not exactly synonymous or interchangeable.  However, in the same way that pharmacists, physiotherapists, occupational therapists and dieticians all add to the multidisciplinary nature of Intensive Care Medicine, there is a degree of overlap in skill sets between all of these professionals to allow for timely, safe and appropriate care. 

Oversight and leadership of patient care rests with the ICM consultant regardless of rota configuration.

The title of ‘Consultant ACCP’ was not an invention of FICM, nor is it conferred by the Faculty. The use of the title is part of a career pathway for Advanced Practitioners and therefore pre-dates not only the FICM ACCP curriculum published in 2015 but also the 2010 founding of the Faculty itself.

 The title of consultant for Advanced Critical Care Practitioner (ACCP) for career progression was advised and adopted from the Skills for Health 2008 framework recommendations (updated in 2020 with the same nomenclature).  As per this framework, the title ‘consultant’ is recommended at practitioner Level 8 and relates to a level of practice accepted as completely outside medical practice. It formed part of the 2008 National Education and Competency Framework for ACCPs from the Department of Health on which the FICM ACCP curriculum was built. The FICM ACCP curriculum is clear throughout as to the appropriate levels of supervision where required. A FICM ACCP Member does not become a ‘consultant’ upon completing the FICM ACCP curriculum; the title relates to clinical expertise, and the Agenda for Change (AfC) pay banding, where it sits alongside other non-medical consultant roles which are also well established. The title ‘Consultant Practitioner’ fits into the Centre for Advanced Practice for NHSE in England and is replicated across the four nations. This relates to a level of practice around the four pillars of advanced practice [clinical, education, research and leadership] and is mirrored in other non-medical advanced practice roles.

The consultant ACCP title is therefore not intended to be viewed the same as a medical consultant title. To be appointed as a ‘Consultant ACCP’ requires attention to all four pillars at a higher level of advanced practice, with a priority on leadership and strategic development of services in the Health Board/Trust. GPICS is clear that decisions around patient admission, discharge and twice daily ward rounds deciding on and directing patient treatment and care are the ultimate responsibility of the medically qualified ICM consultant.

Commissioning and standards documents for ICM services outline the importance of the role and responsibilities of the medically qualified consultant in ICM. GPICS V3 is currently being written and will be revised to ensure there is greater clarity around the wording of the significant role of medical consultants in Intensive Care Medicine, intensivists in training and ACCPs.

Consultant ACCPs are similar to other non-medical consultants who deliver a service in the NHS. Other professional groups in ICM, e.g. physiotherapists, already undertake ward rounds. Consultant ACCPs may lead a ward round to support the education of junior staff at the bedside – this would be in addition to the medical consultant ward rounds. Neither a consultant ACCP ward round nor other AHP ward rounds meet the GPICS standard of a twice daily medical consultant ward round and would not fulfil the intended purpose of the role.

Educational and clinical supervisors have always had a critical role in relation to the appraisal, assessment, and support of postgraduate medical doctors in training. These roles have been clearly described in the Gold Guide, which states: “Educational and named clinical supervisors should hold a licence to practise and are required to be recognised and/or approved in line with GMC Recognition and Approval of Trainers requirements.” Postgraduate Deans are responsible for ensuring those managing training have the required capabilities. FICM is clear that it wants the quality of educational supervision of intensivists in training to be the highest possible. This can only come from doctors who are familiar with the ICM training programme and therefore working in ICM. Clinical supervision is also provided by many excellent doctors who work in complementary specialties e.g. anaesthesia, medicine, emergency medicine.

 ICM professionals frequently work together as a team, and it is reasonable and appropriate for anyone to seek feedback on performance from other professionals in the team. In common with other Advanced Practice roles, ACCPs can sign off a variety of assessments for those skills which fall within their scope of practice according to the requirements of FICM and other medical royal colleges.  An individual doctor retains the ability to determine who they wish to approach for feedback and to sign off assessments.

Advanced airway management is a key part of ICM medical training, and all ICM doctors are expected to acquire and maintain advanced airway skills throughout their entire career.

There is no similar general expectation or requirement for ACCPs to lead the intubation of patients. Advanced airway management is not a core skill for FICM ACCP training. A small number of Optional Skills Frameworks have been developed where there is a clear, local need for an ACCP to develop an additional skill according to local  service need and appropriate governance arrangements. It is not the intention that an ACCP should develop all of these skills, even if they wished to do so, as the primary determinant is whether there is a local requirement.  The Faculty recommends that an impact assessment on the effects of advanced ACCP skill sets on the educational opportunities for intensivists in training, should be undertaken at a local level.

As such, only a very small number of ACCPs would be expected to develop an optional skill like intubation. In view of the recognised additional complexities of intubation in critically unwell patients on intensive care, we would encourage a 2 person approach to undertaking drug assisted intubation wherever possible.

As above, local governance processes determine members of the cardiac arrest team, which may include an ACCP. The optional skills frameworks do include interhospital transfers as a defined set of competencies, but an ACCP can only undertake an interhospital transfer if they have completed the appropriate training and the service requires them to do so within the appropriate governance framework. As is the case for intubation, interhospital transfer is a core capability for all intensivists in training, as opposed to an optional skill held by a small number of appropriately trained ACCPs.  As for intubation, the Faculty recommends that an impact assessment on the educational opportunities for intensivists in training, should be undertaken at a local level. 

Whilst the ‘consultant’ title is not legally protected, a number of medical titles are protected within the Medical Act 1983. Under section 49 of the Act, if an individual “wilfully and falsely pretends to be or takes or uses the name or title of physician, doctor of medicine, licentiate in medicine and surgery, bachelor of medicine, surgeon, general practitioner or apothecary” then this is unlawful.

Permanent medical consultant positions are advertised and appointed against strict criteria including the requirement to hold a primary medical degree. Consultant job descriptions are reviewed by FICM Regional Advisors to ensure they meet the criteria. One of the essential criteria for appointment to an ICM medical consultant post is that the individual must be GMC registered with a licence to practice and on the specialist register. ACCPs do not have a primary medical degree, are not registered with the GMC or on the specialist medical register so they are not eligible to be appointed to a medical consultant role. Also, it is important to note this has never been a consideration in the career pathway for ACCPs.

The Faculty cannot comment on the aims of any theoretical future government, but as a professional body we do not and would not support any development of the ACCP role to any level of seniority that would approach that of a medical consultant. There has never been a notion that a consultant ACCP would be a replacement for a physician consultant in ICM; neither the Faculty, nor the ACCP community, seek or would support this as appropriate for our patient group.

The Faculty does not comment on the terms and conditions of any individuals working in critical care as we do not have a role in negotiating the terms of service of any of our members. Our job is to set the professional standards for the specialty, ensure the voices of our members are heard and understood, and to support them at all stages of their career. We fully understand the frustration, and strength of feeling that doctors and others have regarding the profound NHS workforce shortages, their workload pressures, and other factors causing a steady erosion of morale and wellbeing. These include lack of postgraduate training places, rest facilities, access to hot food whilst working and inevitably, pay.

 The terms and conditions of service for ACCPs are consistent with Agenda for Change that includes contracted hours of work and overtime. Under the requirements of the Centre for Advanced Practice, the banding structure under Agenda for Change dictates the pay level. Qualified ACCPs may hold the band of 8A in line with the Centre for Advanced Practice, with a similar structure in the devolved nations. Locum rates for additional shift cover are negotiated locally and broadly fall under the arrangements of the AfC framework.

There is no link between ACCP numbers and ICM NTNs. There is no national recruitment process for ACCPs and therefore no allocation of National Training Numbers (NTN). The decision to recruit a trainee or trained ACCP is entirely decided based on local service need and unit workforce planning.

Medical ICM recruitment is UK-wide and delivered by the ICM National Recruitment Office, supported by FICM. For 2023 there were 178 ICM training numbers offered. Currently (as of March 2024) there are 1,087 FICM registered doctors in ICM training. In 2012 when ICM national recruitment first started there were 72 posts offered for ICM training.

FICM plays no part in recruitment to ACCP training which is managed locally. Upon successful completion of the FICM curriculum ACCPs can apply for membership of the Faculty as an ACCP. All applications undergo a robust review process. Given the potential for variation in academic delivery by Higher Educational Institutions [HEIs] i.e. the universities delivering the MSc level programme, FICM is currently leading a process of accrediting HEIs offering ACCP training that facilitates a clear pathway to FICM ACCP membership.Currently there are 202 ACCP members in training registered with FICM, although such registration is encouraged, it is voluntary. 

This is entirely a matter between individual ACCPs and their employers; FICM has no role in this process.

Progression to consultant ACCP is not time-based but determined by demonstration of the relevant attributes for the banding as an 8b /c under the Agenda for Change. It would not be expected that every ACCP would be able to progress to a Band 8b/ c role, nor for every critical care unit to employ an ACCP in that capacity. Such roles within an organisation are usually occupied by healthcare professionals who have a significant senior leadership role.

Doctors are registered medical professionals. Any UK registered healthcare professional can train as an ACCP. The majority of registered ACCPs are nurses but other Allied Health Professionals (AHPs) such physiotherapists and paramedics have also successfully trained as ACCPs. The responsibilities for an ACCP are different than for senior medical staff.

A doctor who did not wish to continue training in ICM but still wanted to continue working in ICM would be better advised to seek an alternative medical career pathway e.g. as an SAS doctor in ICM, as this offers much better long term career options for holders of a medical degree than retraining in a different healthcare professional role. If you left medicine to retrain in another profession, you would lose your GMC licence to practice unless you were able to continue to revalidate and pay for it. 

The roles, responsibilities, examinations, career progression and training are not the same. Possession of a primary medical qualification and appropriate postgraduate training in ICM leading to entry onto the GMC’s specialist register will always be the ‘gold standard’ in terms of leadership and responsibility in ICM. The options available within the ICM medical career pathway will always be greater.

ACCPs are a different professional group, and their career progression is not the same as medical professionals. It is ultimately more limited than for medically qualified ICM professionals.

ACCPs were involved in the early discussions around the Medical Associate Professionals (MAPs) programme.

In December 2021, FICM polled the ACCP community (fully trained and FICM registered ACCPs, ACCPs in training, as well as the wider community via the National Association of ACCPs) around the future direction for the role. 77% of respondents clearly supported the view that active involvement in the MAP agenda had become increasingly less applicable for ACCPs. This tallied with the views of the FICM ACCP Sub-Committee and the MAP Oversight Board. As such, ACCPs are not part of any MAP work-stream, although the Faculty has retained a corresponding membership of the Oversight Board so that we can be contacted regarding any future critical care related queries. MAP roles are currently pursuing GMC regulation as they are currently without professional regulation.

ACCPs retain their base professional regulator (NMC or HCPC) and with that, the code of conduct required of them. ACCP career progression is tied to the Skills for Health NHS framework and the centre for advanced practice. This remains important for employers as it relates not only to a job title but also to the level of practice on which this is based. ACCPs are aligned to the Centre for Advancing Practice for HEE (now NHSE) and should not be conflated with the MAP group which have a different scope of practice, freedom to act and supervision.

FICM supports ACCPs holding FICM ACCP Membership as a high-calibre professional group who possess an existing professional registration and relevant clinical experience that adds to the ICM MDT. We do not support any widespread UK development in ICM of other roles with alternative titles that may be suggested e.g. Advanced Practice in Critical Care roles, AA (Anaesthesia Associate) or PA (Physician Associate) roles with direct entry into critical care. The rationale for this is that there has not been a demonstrated national need for these roles in ICM and the standards of entry and training are lower than that of ACCPs. AAs and PAs currently would not meet the entry requirement for ACCP training. FICM does not maintain curricula for any non-ACCP practitioner roles.