Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review

Abstract

ObjectivesIn response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK.DesignA scoping review was undertaken following JBI methodological guidance.Methods13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative.Results191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England definition of ACP). Most papers were small-scale descriptive studies, service evaluations or audits. The papers reported mainly on clinical aspects of the ACP role. Most papers related to nursing, pharmacy, physiotherapy and radiography roles and these were referred to by a plethora of different titles. ACP roles were reported to be achieving beneficial impacts across a range of clinical and health system outcomes. They were highly acceptable to patients and staff. No significant adverse events were reported. There was a lack of cost-effectiveness evidence. Implementation challenges included a lack of role clarity and an ambivalent role identity, lack of mentorship, lack of continuing professional development and an unclear career pathway.ConclusionThis review suggests a need for educational and role standardisation and a supported career pathway for advanced clinical practitioners (ACPs) in the UK. Future research should: (i) adopt more robust study designs, (ii) investigate the full scope of the ACP role and (iii) include a wider range of professions and sectors.

Competency Gradients in Advanced Practice Nurses, Specialist Nurses, and Registered Nurses: A Multicentre Cross-Sectional Study

“…Some countries such as the UK have already implemented these roles with a positive impact in terms of patient and family clinical outcomes, quality of care, use of the healthcare system and its costs, as well as some aspects related to the work environment. In a scoping review carried out in the English context, it emerged that the factors that facilitate the implementation of these roles are those related to the standardisation of the education and training of these professionals, knowledge, and clarity of the functions they perform, encouraging the continuous evaluation of these functions and establishing a structured and clear professional career path [ 42 ].…”

Nationwide evaluation of the advanced clinical practitioner role in England: a cross-sectional survey

“… 1 2 In response to these challenges, NHS policies such as the NHS Long Term Plan (2019) have focused on transforming the workforce to enhance service provision and optimise standards of care. 3 4 To meet growing service demand, NHS policies highlight the increasing need to establish innovative care models and develop advanced roles to contribute to the workforce transformation agenda. 4 One strategy of importance is the introduction and formalisation of advanced clinical practice (ACP).…”

Exploring the role of advanced clinical practitioners (ACPs) and their contribution to health services in England: A qualitative exploratory study

“…A seminal systematic review of the changing skill mix conducted in 2004 highlights the beginning of a fundamental shift in roles, predominantly led by nurses, but with support from AHPs from across different clinical settings ( Sibbald et al, 2004 ). A more recent systematic review of the ACP role ( Evans et al, 2021 ) highlights the extent of the development of the ACP role across professions in the UK and provides a useful backdrop to this empirical work undertaken in 2020. By contrast a limited number of studies were identified examining a multi-professional ACP role within the global context ( Cardwell and Smith, 2018 , Cohen et al, 2009 ).…”