Abraham J, Whiteman B, Coad J, Kneafsey R. Development and implementation of non-medical practitioners in acute care. Br J Nurs.. 2016; 25:(20)1129-1134

Association of Anaesthetists of Great Britain and Ireland. Physicians' Assistants (Anaesthesia) review. 2011. (accessed 10 July 2019)

A critical moment: NHS staffing trends, retention and attrition. 2019. (accessed 15 July 2019)

Cheang PP, Weller M, Hollis LJ. What is in a name—patients' view of the involvement of ‘care practitioners’ in their operations. Surgeon. 2009; 7:(6)340-344

De Cossart L, Biggins J, Thatcher J. The curriculum framework for the surgical care practitioner.London: National Practitioner Programme & Department of Health; 2006

The NHS plan: a plan for investment, a plan for reform.London: The Stationery Office; 2000

Department of Health. NHS Modernisation Agency and affiliated programmes (archived). 2003. (accessed 15 July 2019)

Department of Health. Major trauma centres to open across England. 2012. (accessed 10 July 2019)

Farah GA, Heaton P. Little public understanding of seniority of doctors according to job title. Arch Dis Child. 2013; 98:(12)1023-1023

Farmer J, Currie M, Hyman J, West C, Arnott N. Evaluation of physician assistants in National Health Service Scotland. Scott Med J.. 2011; 56:(3)130-134

Fotheringham D, Dickie S, Cooper M. The evolution of the role of the Emergency Nurse Practitioner in Scotland: a longitudinal study. J Clin Nurs.. 2011; 20:(19-20)2958-2967

The Mid Staffordshire NHS Foundation Trust Public Inquiry. Final report. 2013. (accessed 10 July 2019)

Gokani VJ, Peckham-Cooper A, Bunting D, Beamish AJ, Williams A, Harries RL The non-medical workforce and its role in surgical training: Consensus recommendations by the Association of Surgeons in Training. Int J Surg.. 2016; 36:S14-S19

Griffin N. How the lack of government is affecting healthcare in Northern Ireland. BMJ.. 2019; 364

Halliday S, Hunter DJ, McMillan L. Ward staff perceptions of the role of the advanced nurse practitioner in a ‘hospital at day’ setting. Br J Nurs.. 2018; 27:(2)92-97

Health Education East Midlands. East Midlands advanced clinical practice framework. 2014. (accessed 11 July 2019)

Health Education England. Facing the facts, shaping the future: a draft health and care workforce strategy for England to 2027. 2017a. (accessed 11 July 2019)

Health Education England. Multi-professional framework for advanced clinical practice in England. 2017b. (accessed 11 July 2019)

Health Education England. Medical associate professions. 2019. (accessed 11 July 2019)

Health Education England. Advanced clinical practice framework for the West Midlands. 2015. (accessed 11 July 2019)

Health Education Yorkshire and the Humber. HEYH Advance Practice Framework. 2015. (accessed 11 July 2019)

House of Commons Health Committee. Modernising medical careers (third report of session 2007–2008). 2008. (accessed 10 July 2019)

Reshaping the workforce to deliver the care the patients need. 2016. (accessed 10 July 2019)

Independent Working Time Regulations Taskforce. The implementation of the Working Time Directive, and its impact on the NHS and health professionals: report of the Independent Working Time Regulations Taskforce to the Department Of Health. 2014. (accessed 10 July 2019)

Kneebone R, Nestel D, Chrzanowska J The perioperative specialist practitioner: developing and evaluating a new surgical role. Qual Saf Health Care. 2006; 15:(5)354-358

Leary A, Maclaine K, Trevatt P, Radford M, Punshon G. Variation in job titles within the nursing workforce. J Clin Nurs.. 2017; 26:(23-24)4945-4950

Evaluation of the advanced practitioner roles. Report 465. 2009. (accessed 11 July 2019)

Mitchell G. Advanced nurse training set to be standardised. Nurs Times. 2018; 114:(12)6-7

Moorthy R, Grainger J, Scott A, Powles JW, Lattis SG. Surgical care practitioner – a confusing and misleading title. The Bulletin of the Royal College of Surgeons of England. 2006; 88:(3)98-100

The curriculum framework for the perioperative specialist practitioner.London: National Practitioner Programme & Department of Health; 2007

NHS Digital. Nurse and health visitor leavers by Health Education England (HEE) region September 2012 to 2017. 2018. (accessed 11 July 2019)

NHS Education for Scotland. Archived Copy of the Advanced Practice Toolkit at 2012. 2012. (accessed 11 July 2019)

NHS Education for Scotland. Advanced practice toolkit. 2018. (accessed 11 July 2019)

NHS Employers. Gender in the NHS infographic. 2018. (accessed 11 July 2019)

NHS England. Five year forward view. 2014. (accessed 11 July 2019)

NHS England. Leading change, adding Value: a framework for nursing, midwifery and care staff. 2016. (accessed 11 July 2019)

NHS Wales. Framework for Advanced Nursing, Midwifery and Allied Health Professional Practice in Wales. 2010. (accessed 11 July 2019)

Northern Ireland Practice and Education Council for Nursing and Midwifery. Advanced nursing practice framework: supporting advanced nursing practice in health and social care trusts. 2016. (accessed 10 July 2019)

Nursing and Midwifery Council. The NMC register. 2019. (accessed 15 July 2019)

Punshon G, Maclaine K, Trevatt P, Radford M, Shanley O, Leary A. Nursing Pay by gender distribution in the UK-does the Glass Escalator still exist?. Int J Nurs Stud.. 2019; 93:21-29

Quick J. The role of the surgical care practitioner within the surgical team. Br J Nurs.. 2013; 22:(13)759-765

Royal College of Anaesthetists. Curriculum framework for physician assistant in anaesthesia. Version 2. 2008. (accessed 15 July 2019)

Royal College of Anaesthetists. Anaesthesia associates. 2019. (accessed 11 July 2019)

Royal College of Physicians. Physician Assistant Managed Voluntary Register: Competence and curriculum framework for the physician assistant. 2012. (accessed 15 July 2019)

Royal College of Surgeons of England. Curriculum framework for the surgical care practitioner. 2014. (accessed 11 July 2019)

Royal College of Surgeons of England. A question of balance: the extended surgical team curriculum. 2016. (accessed 11 July 2019)

Smith A, Kane M, Milne R. Prospects for the introduction of non-physician anaesthetists in the United Kingdom: a qualitative analysis of interviews and case studies. Journal of Advanced Perioperative Care. 2006; 2:(3)123-130

Physician associates: Training for NI's first doctors' assistants. 2018. (accessed 10 July 2019)

Snaith B, Williams S, Taylor K, Tsange Y, Kelly J, Woznitzagh N. Is a nurse consultant impact toolkit relevant and transferrable to the radiography profession? An evaluation project. Radiography. 2018; 24:(3)257-261

White H, Round JE. Introducing physician assistants into an intensive care unit: process, problems, impact and recommendations. Clin Med (Northfield Ill). 2013; 13:(1)15-18

NHS increasingly desperate for nurses and midwives as applications continue to fall. 2018. (accessed 15 July 2019)

Non-medical practitioner roles in the UK: who, where, and what factors influence their development?

25 July 2019
Volume 28 · Issue 14



traditional health workforce roles are changing, with existing roles being extended and advanced, while new roles are being created, often undertaking duties previously completed by doctors, sometimes referred to as non-medical practitioners (NMPs).


to investigate which NMP roles exist within the UK, mapping distribution, and explore factors influencing their development and recruitment.


two descriptive, exploratory, online self-completed semi-structured questionnaires were used. One was sent to all NHS acute healthcare providers (n=156) and private/independent healthcare providers in England (n=90). A separate questionnaire collected data, using convenience and snowballing approaches, from NMPs across the UK. Quantitative data were analysed using descriptive and frequency statistics. Qualitative data derived from open questions and comments were analysed using content and thematic analysis.


healthcare organisations in England returned 23/246 useable questionnaires; 115 NMPs returned responses, 19 did not meet the criteria, leaving 96 useable responses.


seven NMP roles were identified, throughout the UK, with regional variation. Several factors influence the development and recruitment of NMP roles in England such as service delivery and national policies. Inconsistencies were noted in Agenda for Change pay banding. Many practitioners undertook NMP roles to progress their career clinically.

Healthcare reform was revolutionised by the NHS Plan (Department of Health (DH), 2000), with many drivers in the two decades since propelling the transformation (Box 1). Central to this transformation was the need to redesign the accessibility and delivery of clinical care to a 7-day service, while improving cost and patient experience. In addition, changes to doctor training (House of Commons Health Committee, 2008) and the reduction in doctor working hours to a 48-hour week (Independent Working Time Regulations Taskforce, 2014) have decreased the availability of doctors in clinical practice. Consequently, a radical reform of the healthcare workforce is being undertaken to extend and advance existing health professionals to undertake activities traditionally undertaken by doctors (Imison et al, 2016). Within England this has led to extensive consultation on developing a wider workforce strategy (Health Education England (HEE), 2017a). Similarly, Scotland, Wales and Northern Ireland have also developed and revised frameworks to support advancing practice in redesigning the wider healthcare workforce to ensure patient safety.

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