<p>The Role and Development of Advanced Clinical Practice Within Allied Health Professions: A Mixed Method Study</p>

Abstract

Objective: To investigate the profiles of advanced clinical practitioners (ACPs) in the allied health professions (AHPs) and their skills, attributes, experiences and involvement in new models of care. Methods: A 2 phase, cross sectional, mixed method survey of AHP ACPs across London was conducted in 2018-2019. Online questionnaires were completed by 127 AHP ACPs and then semi-structured interviews were conducted with 15 AHP ACPs. Results: The survey results gave a comprehensive overview of the attributes of AHPs in ACP roles across London. There was considerable variability between role titles, types and levels of qualification, and evolution of the roles. The respondents predominately worked in clinical practice, and less frequently in other ACP domains (research, leadership and management, education). The interview findings provided in-depth insights into the AHP ACP roles within four themes: being advanced, career pathways, outcomes of the advanced practitioner role and influencing and transforming. The "Being advanced" theme highlighted that expert practice comprised confident and autonomous practice, leadership, and applying specialist and expert decision-making skills. "Career pathways" highlighted the diversity within the participants' roles, titles, career opportunities and development. In the "Outcomes of the advanced clinical practitioner role" theme, the ACPs described their services as prompter, more accessible and providing an improved patient journey. The "Influencing and transforming" theme highlighted networking and dissemination and ideas for innovation, influencing and transforming services. Conclusion: This is the first comprehensive profile of ACP roles across AHPs and indicates that these roles are already having a positive impact on healthcare services and supporting new models of care. However, establishing the necessary infrastructure, standardization and governance for ACP roles across sectors, along with the career pathways, funding, sustainability and education, could increase impact in the future.

An examination of Advanced Clinical Practice: Qualitative insights from therapeutic radiography advanced and consultant practitioners based in England

“…Leadership is recognised as a key foundation of the advanced role with practitioners highlighting autonomous working and critical justification in their patient pathway decision making [25] . A very recent study [11] of advanced clinical practice amongst Allied Health Professionals supports the findings from this study and highlights disparity of working across the four domain areas of practice.…”

“…Moreover, it is their extensive involvement in cancer care delivery that makes a therapeutic radiographer an ideal candidate for role development [8] . New roles at advanced and consultant levels of practice have been highlighted as key to streamlining, focussing care and supporting patients across the radiotherapy pathway [9] , [10] , [11] , [12] .…”

The roles of physician associates and advanced nurse practitioners in the National Health Service in the UK: a scoping review and narrative synthesis

“…ANPs are required to master nursing skills, and four pillars of advanced practice, including clinical practice, leadership and management, education and research [22]. Skills for ANPs depend more on the specific specialities and the skill mix of ANPs varies across different healthcare contexts because ANPs are specifically recruited to and trained for locally defined roles [11,27]. PAs are all educated to a similar level, although their skills might vary due to differences in clinical specialities and placements and their skills may further develop depending on specific areas that they are working in [25,28].…”

“…2 PRISMA [20] diagram for ANPs both primary and secondary care [35][36][37]. Their jobs are largely context-dependent [35][36][37][38] and their job titles vary, including: ANP, lead nurse, matron, nurse practitioner, nurse specialist [11]. The scope of work and employment of ANPs are very much tailored to the needs of local employers [11,39,40].…”

“…The ANP role is firmly rooted in the philosophy of nursing practice and extends to include clinical competencies traditionally expected of doctors [9]. The Royal College of Nursing (RCN) recommended that ANPs are educated at a Masters level with expert clinical knowledge and skills [10], but in practice some ANPs do not have an advanced degree [8,11].…”