In England, the NHS workforce transformation agenda is being supported by a national non-departmental public body, ‘Health Education England’ (HEE). 61 This variability and lack of consistency gives rise to concerns for patient safety and impedes workforce planning at scale. 58–60 Moreover, the definition and understanding of advanced roles have differed both within as well as between professions. 58 59 As a result, there has been a proliferation of roles with different titles, different job descriptions, different scope of practice and different educational requirements (particular confusion relates to roles with titles such as ‘extended’ or ‘specialist’ practitioner vis a vis ‘advanced’ practice roles). 20 56–58 In contrast, in the UK, advanced roles have evolved more organically in response to local need, local health service commissioning decisions and profession-specific imperatives rather than as part of an overarching national health workforce plan. 27–55 In many countries, ACP roles are separately regulated and are underpinned by standardised training programmes. These developments mirror policy initiatives and debates on ‘task shifting’ and optimal workforce skill mix in many other countries, 20–26 and are supported by international systematic review evidence that advanced practice roles are safe, effective, have high levels of patient satisfaction and produce a range of benefits for service accessibility and efficiency. 4 8–13 In order to support service development, there is considerable attention being given to the potential for non-medical advanced clinical practice (ACP) roles to contribute to the transformation agenda. 1–3 NHS policies such as the NHS Long Term Plan (2019), 4 5 the NHS People Plan (2020) 6 7 and the General Practice Forward View (2016) 8 set out a vision for significant change in future service delivery with a concomitant need to develop models of care that cross traditional sectors and professional boundaries. Like countries all over the world, the National Health Service (NHS) in England and across the UK is facing unprecedented pressures associated with ageing populations, rising demand, rising costs, increasing health inequalities, workforce shortages and, more recently, the coronavirus pandemic. Ongoing ambiguity and variability of advanced clinical practice roles and titles within the UK means that some relevant studies may nonetheless have been missed or misclassified. This was an extremely wide ranging and comprehensive review that was underpinned by a careful, comprehensive and systematic search strategy. The use of an internationally recognised framework (PEPPA-Plus) to map the outcomes, impacts and implementation challenges of advanced practice roles boosts the international relevance of the findings. The review covers ACP roles in all health professions, hence, has a broad relevance and applicability. This is the first attempt to comprehensively map the evidence on advanced clinical practice roles across all sectors, professions and settings in the UK, highlighting clear implications for national health workforce policy development.
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