Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012; 380:(9836)37-43

Benner P. From novice to expert: excellence and power in clinical nursing practice.Menlo Park (CA): Addison-Wesley; 1984

Benner P. From novice to expert. Am J Nurs. 1982; 82:(3)402-407

Bobay KL. Does experience really matter?. Nurs Sci Q. 2004; 17:(4)312-316

Brykczynski KA. Benner's philosophy in nursing practice, 4th edn. In: Alligood MR. St Louis (MO): Mosby Elsevier; 2010

A critical moment: NHS staffing trends, retention and attrition. 2019. (accessed 26 May 2021)

Castledine G. Will the nurse practitioner be a mini doctor or a maxi nurse?. Br J Nurs. 1995; 4:(16)938-939

Castledine G. Higher level practice is in fact advanced practice. Br J Nurs. 2002; 11:(17)

Christensen M, Hewitt-Taylor J. From expert to tasks, expert nursing practice redefined?. J Clin Nurs. 2006; 15:(12)1531-1539

College of Paramedics. Post-registration career framework. 2015. (accessed 26 May 2021)

Patricia Benner: novice to expert—a concept whose time has come (again). 2016. (accessed 26 May 2021)

Department of Health. Making a difference: strengthening the nursing, midwifery and health visiting contribution to health care. 1999. (accessed 26 May 2021)

Department of Health. Long term conditions compendium of information. 2012. (accessed 26 May 2021)

A five-stage model of the mental activities involved in directed skill acquisition. 1980. (accessed 26 May 2021)

Scoping the role of the nurse consultant. A report commissioned by HENCEL and produced on behalf of Middlesex University, School of Health and Education. 2014. (accessed 26 May 2021)

Ericsson KA, Whyte J, Ward P. Expert performance in nursing: reviewing research on expertise in nursing within the framework of the expert-performance approach. ANS Adv Nurs Sci. 2007; 30:(1)E58-71

Glendinning A, Walker D. Advanced nurse practitioners; what do the team think?. Future Healthc J. 2019; 6

Health and Care Professions Council. Standards of proficiency—physiotherapists. 2013. (accessed 26 May 2021)

Health and Care Professions Council. Standards of proficiency—paramedics. 2014. (accessed 26 May 2021)

Health Education England. Multi-professional framework for advanced clinical practice in England. 2017. (accessed 26 May 2021)

International Council of Nurses. Guidelines on advanced practice nursing. 2020. (accessed 26 May 2021)

Kennedy F, McDonnell A, Gerrish K, Howarth A, Pollard C, Redman J. Evaluation of the impact of nurse consultant roles in the United Kingdom: a mixed method systematic literature review. J Adv Nurs. 2012; 68:(4)721-742

Lambert LK, Housden LM. Nurse practitioner engagement in research. Can Oncol Nurs J. 2017; 27:(1)107-110

Lawler J, MacLaine K, Leary A. Workforce experience of the implementation of an advanced clinical practice framework in England: a mixed methods evaluation. Human Resources for Health. 2020; 18

Murphy K, Mortimore G. Overcoming the challenges of role transition for trainee advanced clinical practitioners. Gastrointestinal Nursing. 2020; 18:(5)35-41

NHS England. Five year forward view. 2014. (accessed 26 May 2021)

NHS England. Next steps on the five year forward view. 2017. (accessed 26 May 2021)

NHS England, NHS Improvement. The NHS long term plan. 2019. (accessed 26 May 2021)

NHS Improvement, Royal College of Emergency Medicine. Creating workforce stability in emergency care. 2018. (accessed 26 May 2021)

NHS Wales. Framework for the development of consultant practitioner posts. 2014. (accessed 26 May 2021)

Reynolds J, Mortimore G. Transitioning to an ACP: a challenging journey with tribulations and rewards. Br J. 2021; 30:(3)166-166

Royal Pharmaceutical Society. Advanced pharmacy framework (APF). 2013. (accessed 26 May 2021)

Ryder M, Jacob E, Hendricks J. An inductive qualitative approach to explore Nurse Practitioners views on leadership and research: An international perspective. J Clin Nurs. 2019; 28:(13-14)2644-2658

Titzer JL, Shirey MR, Hauck S. A nurse manager succession planning model with associated empirical outcomes. J Nurs Adm. 2014; 44:(1)37-46

United Kingdom Central Council. The scope of professional practice. 1992. (accessed 26 May 2021)

United Kingdom Central Council. Standards for specialist education and practice. 1994. (accessed 26 May 2021)

From expert to advanced clinical practitioner and beyond

10 June 2021
9 min read
Volume 30 · Issue 11
Figure 1. The Derby model: 7 levels of practice advancement
Figure 1. The Derby model: 7 levels of practice advancement


This article considers the potential development of advanced clinical practitioners (ACPs) and consultant practitioners, beyond the ‘expert’ status as defined by Pat Benner in 1984. The suggested Derby Model: 7 Levels of Practice Advancement, adapted from Benner's From Novice to Expert, recognises Health Education England's four pillars of advanced practice and how they can be implemented and enhanced within these senior roles, and what that means in a 21st century healthcare system.

As previously discussed in this series of articles on advanced practice, advanced clinical practitioners (ACPs) originate from a variety of health professional backgrounds. They may be nurses, paramedics or physiotherapists, to name a few, with many holding senior positions before becoming trainee ACPs (NHS Improvement and the Royal College of Emergency Medicine, 2018; Reynolds and Mortimore, 2021). According to Health Education England (HEE):

‘Health professionals working at the level of advanced clinical practice will exercise autonomy and decision making in a context of complexity, uncertainty and varying risk, holding accountability for decisions made.’

HEE, 2017:8

Therefore, having professional experience at senior level and being able to address the four pillars of advanced practice: clinical practice, leadership and management, education, and research (HEE, 2017) are prerequisites to becoming an ACP.

In 1984, Pat Benner devised a theoretical framework, based on the Dreyfus and Dreyfus (1980) model of stages of expertise, that assesses nursing competence and professional growth from novice, beginner, competent and proficient, through to expert status. Nearly 40 years on, Benner's From Novice to Expert model is still widely cited and utilised in current healthcare systems worldwide. It is commonly referred to during mentorship and leadership programmes and additionally employed as a teaching aid to student and registered nurses (Titzer et al, 2014; Davis and Maisano, 2016; Murphy and Mortimore, 2020). Incorporating the novice to expert model in health professionals' development, as recommended by Davis and Maisano (2016), allows:

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content