Implications for practice and research

• Workforce planning needs focus on the level of practice required for service demand and not ‘what role is needed’. Planners must appreciate the contributions and limitations of practice different advanced clinical practitioners (ACPs) bring.

• Research is needed to move beyond capturing the advancement of roles to exploring changes, in practice and education, and evaluating the improvements made, particularly with advanced practice (AP) regulation being reviewed by the Nursing and Midwifery Council (NMC).

Context

Advanced Practice (AP) is a phenomenon which in the last century may be traced back to the post second world war era. During the 1960s, countries such as the USA and Canada led the way with the UK following with seminal developments in the 1980s. The nursing profession has dominated, demonstrating many added benefits both for the profession as well as patients. However, recent policy and political developments in the UK have borne the expansion to other professional health workforces culminating in the 'ACP'. Despite this progress, disparity exists between the four UK nations both in terms of policy, standards and in appreciating the mechanisms which support this level of practice.

Findings

The research team presented the three broad themes, such as the ACP role, barriers and facilitators to the ACP role and contribution of these roles to health services. The findings highlighted a variance in reported levels of practice including understanding and acceptance for the role. Similarly, added a challenge to those who educate ACPs with learners and roles are different, parallels are not always possible between services and practitioners. The research established the contribution of ACPs to health services and the wider body of ACPs supporting change in the way care and workforce engage. Educational pathways, supervision in practice and organisational support are key for ACP success during and once competent/qualified.

Commentary

AP for nurses, midwives and allied health professionals continues to develop and this research along with others,2 3 reaffirms the rapid development. Yet, significant challenges remain and are not being adequately addressed both in education as well as by governance mechanisms across the health service and regulatory bodies.^{2 3}

In the UK, the pandemic and recent strike action by healthcare professionals has exposed services chronically struggling, confounded by recruitment and retention concerns. AP has proven to be an important feature to mitigate these factors. However, there remains a disconnect between understanding and meaningfully acting on the experiences of those working at this level against the need to sustain, progress or change services. Equally, there is an absence of the service users voice and their relationship with these developments, both at a local and national level.

Healthcare in the UK is a devolved matter and while progress in relation to educational standards for ACPs across all professions has been made by bodies such as NHS England (formerly Health Education England), the other three devolved nations have adopted differing approaches. This could complicate attempts to pursue regulation.

The Royal Colleges and regulatory bodies who are involved in supporting the professions must collaborate, examining the strengths and limitations which come with standardisation and regulation, including the costs involved, both financial and non-financial.

The inclusion of both qualified and trainees from differing professional groups within the data set is important as AP as a level of practice covers many registered professionals, not just nursing. Higher Education Institutions (HEIs) and stakeholders must work together so that masters pathways support the differing learning needs of the professions and services. Similarly, the competitive UK education sector needs to have the courage to do things differently. For example, accepting not every programme can facilitate every ACPs learning needs nor service needs. The specialist needs of some populations and services likely requires a shift to investing in specific UK hubs of AP education, ensuring programmes attract the right expertise to sustain long-term delivery.