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Assessing the benefits of advanced clinical practice for key stakeholders

21 March 2024
Volume 33 · Issue 6



Advanced clinical practice roles, usually filled by nurses, have had positive effects on clinical effectiveness, including in patient satisfaction, but their benefits for other stakeholders (such as employers, health professionals, education providers and commissioners and professional/regulatory bodies) are less clear.


This study aimed to identify UK research on the potential benefits of advanced clinical practice and evaluate the evidence base for key stakeholders in this field.


A mixed-methods systematic literature review was carried out to inform a narrative interpretive synthesis.


44 articles of mixed quality were identified. Consensus was found regarding the definition of and barriers and facilitators to advanced clinical practice. This role is split into substitution (eg, of doctors) and supplementation (eg, adding value) aspects, and the clinical practice element dominates. Training for the role varies, as do scope of practice and regulation.


There are several barriers to the implementation of advanced clinical practice and therefore the realisation of its benefits for key stakeholders. Areas requiring attention include training, support from others for role expansion and organisational issues.

Anumber of professional bodies collaborated with Health Education England (HEE) (2017) 7 years ago to create the Multi-Professional Framework for Advanced Clinical Practice in England. Drawing on research and related policy documents and collaboration with key stakeholders, this sets out the definition of advanced clinical practice, the scope of practice and practitioners this applies to and the standards and capabilities that are expected of health professionals in these roles. The introduction of this framework, along with additional funding released specifically for the support of advanced clinical practitioner (ACP) training, the development of the NHS People Plan and the approval of an apprenticeship route, have led to increased activity around advanced clinical practice.

In 2020, a study by Lawler et al exposed the workforce experience of advanced clinical practice since the introduction of the multiprofessional framework. The COVID-19 pandemic and recent industrial action have also sharply bought into focus the demands on health services and those who work within them, including ACPs, the largest number of whom are nurses, who have often had to step up, be redeployed or work in different ways from before (HEE, 2020). This provides the context in which advanced clinical practice has become an increasingly hot topic in healthcare career development and, potentially, a hot potato when it comes to decisions on regulation as well as access to and provision of advanced clinical practice education, support, and development.

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