Article

Advanced practice

Learn how to use advanced practitioner roles to support workforce planning and enable career progression

6 April 2026

Advanced practice is a key workforce lever for delivering the ambitions of the NHS 10 Year Health Plan. When designed and governed well, these roles can support workforce supply, improve access to care and enable multidisciplinary teams to deliver safe and sustainable services.

This guidance sets out the advanced practitioner education and career development pathways, how employers can embed advanced practice within workforce planning and service design to deliver practical benefits, and includes examples of good practice.

Why advanced practice matters

Advanced practice is a defined level of practice characterised by a high degree of autonomy, complex decision‑making and accountability. Advanced practitioners work across a wide range of professions and settings, with roles aligning to the multi‑professional framework for advanced practice in England. When introduced with clear purpose and appropriate support, advanced practice can help employers to:

increase workforce capacity and flexibility
support service redesign and pathway transformation
improve continuity and quality of care for patients
strengthen multidisciplinary working and clinical leadership
provide progression and retention opportunities for experienced staff

These benefits are most likely to be realised where advanced practice is planned as part of a wider workforce approach, with clear role design, governance and ongoing evaluation, rather than introduced in response to short‑term pressure or vacancies.

The four pillars of advanced practice

While job titles and professional backgrounds vary, employers should expect consistency in the level of practice not just the tasks undertaken. The four pillars provide a shared framework to support role design, development and assurance.

Clinical practice

Advanced practitioners demonstrate a high level of autonomy and complex decision‑making in clinical care, working within their defined scope of practice. This can be developed by undertaking an NHS England accredited Level 7 advanced practice masters, and by gaining practical experience through supervision, mentoring, and peer review.

Leadership and management

Advanced practitioners contribute to service leadership, influencing care delivery, managing complex situations, and effective multidisciplinary working. The NHS Leadership Academy provides resources to further develop this pillar.

Education

Advanced practitioners support the learning needs of others, and maintain their own professional development through self-directed learning and reflection, supporting workforce capability and sustainability.

Research, evidence and improvement

Advanced practitioners use evidence-based strategies to improve patient care, contributing to quality improvement, service evaluation and innovation.

Planning and designing advanced practice roles

Early engagement with clinical leaders, workforce teams and education partners can help ensure roles are sustainable and deliverable. Before creating or expanding advanced practice roles, employers should consider:

- What problem is the role intended to address?
- How does it support wider service priorities and patient pathways?
- How will the role complement existing roles within the multidisciplinary team?
- How does it support safe skill mix and clinical leadership?
- A clearly defined scope of practice.
- Alignment with national frameworks and local expectations.
- Clear distinction between role purpose and job title.

National frameworks and pathways for advancing practice

Advanced practice in England is underpinned by a national, multi‑professional framework, which sets shared expectations for the level of practice, career development and governance of advanced roles across health and care.

This section summarises the national frameworks and pathways and highlights what employers need to consider when planning, developing and supporting advanced practice roles.

The multi‑professional framework for advanced practice

NHS England introduced the multi‑professional framework for advanced practice to create greater consistency and clarity across advanced practice roles, regardless of profession or setting.

The framework supports employers by:

providing a shared definition of advanced practice
setting expectations for education, capability and scope of practice
supporting consistent role design across professions
enabling clearer career pathways into and within advanced practice

For employers, the framework offers a common reference point to support workforce planning, role assurance and governance, while allowing flexibility to meet local service and population needs.

What the framework includes

The framework sets out:

a national definition of advanced practice
entry requirements and expectations for development
principles and guidance to support safe and effective practice
a clear career pathway across professions and settings

Advanced practitioners are expected to demonstrate capability across four pillars of practice: clinical practice; leadership and management; education; and research, evidence and improvement.

The way these capabilities are demonstrated will vary depending on the service, setting and role. This flexibility enables employers to tailor advanced practice roles to local priorities while maintaining consistency of level of practice.

The Health and Care Professions Council (HCPC) has published a suite of resources to support practitioners working at advanced levels of practice, as well as their managers and employers. Commissioned by NHS England, the resources provide practical guidance on regulatory expectations, scope of practice, supervision and delegation, and are designed to support safe, effective and confident practice across professions and settings.

For employers and managers, the resources can help inform role design, strengthen governance and supervision arrangements, and support staff development in line with national regulatory standards. Explore the full range of resources, including downloadable guidance and recorded webinars, on the HCPC website.

Credentials and defined scopes of advanced practice

Building on the framework, NHS England has developed advanced practice credentials. These define the purpose, learning outcomes and training requirements for specific, clearly described scopes of advanced practice.

Credentials are designed to:

develop advanced capability in priority clinical and service areas
support sustainable workforce development and deployment
improve consistency and efficiency in education and training
support local governance and workforce deployment and mobility.

Credentials help employers align advanced practice development with population need, service priorities and workforce strategy, rather than relying on bespoke local approaches.

Employers can access published credentials via NHS England’s Centre for Advancing Practice.

Governance, supervision and employer assurance

Employers are responsible for ensuring that advanced practice roles are safe, effective and appropriately governed.

Credible governance includes:

clear scope of practice and accountability
appropriate supervision and support
consistency with professional regulation
alignment with service need and workforce planning

NHS England’s Advanced Practice Governance Maturity Matrix supports organisations to assess and strengthen governance arrangements across advanced practice roles.

For trainees and developing practitioners, NHS England has published guidance on workplace supervision for advanced practice, setting out minimum standards and an integrated, multi‑professional approach to supervision and assessment.

Education, training and development

Advanced practice requires structured development alongside workplace support.
Employers should ensure:

access to appropriate education and development pathways
protected learning time and supervision
opportunities to develop across all four pillars of practice, not only clinical activity
clarity about progression, competence and expectations

Education and training should be built into workforce planning and job design, rather than treated as an individual responsibility.

Master’s‑level programmes

Advanced practice programmes accredited by the NHS England Centre for Advancing Practice are typically delivered in partnership with employers and support development across all four pillars of practice.

Recognising existing advanced practitioners: the ePortfolio (supported) route

The ePortfolio (supported) route, developed by NHS England’s Centre for Advancing Practice, enables the recognition of experienced practitioners already working at an advanced level.

This route:

supports practitioners to evidence equivalence to current framework requirements
recognises prior learning and experience
avoids unnecessary duplication of education.

For employers, the ePortfolio route:

supports workforce assurance
helps retain experienced staff
provides clarity where roles pre‑date current frameworks.

Information on eligibility, application processes and cohorts is available via NHS England’s ePortfolio guidance and the advanced practitioner applicants’ guide.

Advanced clinical practitioner degree apprenticeship

The advanced clinical practitioner (ACP) degree apprenticeship remains an established route for developing advanced practitioners. However, changes to level 7 apprenticeship funding from January 2026 mean that access to government apprenticeship funding is now subject to specific eligibility criteria and national funding arrangements.

In response, NHS England has confirmed targeted mitigation funding for priority NHS roles, including advanced clinical practitioners, to support workforce development where this aligns with national and local priorities.

Apprenticeship routes can support employers to:

grow advanced practice capability in a planned way
support workforce development and retention
align education investment with service and population need.

Employers are encouraged to work with their NHS England regional teams, education providers and workforce partners to understand current funding options and eligibility.

Watch how Nottingham University Hospitals NHS Trust are using the apprenticeship route to train their Advanced Clinical Practitioners in this video.

The advanced practice career trajectory

Advanced practice develops along a continuum, from enhanced to advanced and consultant‑level practice. Understanding how these levels connect may help plan roles deliberately, support progression and align development opportunities with service need. Read how this fits with the six steps of capability development in The Centre for Advanced Practice Implementation guide.

Enhanced practitioners are highly experienced, knowledgeable healthcare professionals managing increasing complexity and clinical risk within a defined scope of practice.
- primarily work within the clinical pillar
- operate as part of multidisciplinary teams
- work across a wide range of settings, including acute, community, primary care, mental health, social care and dentistry
- come from all multi‑professional backgrounds.
At this level, practitioners typically:
- make complex decisions using specialist knowledge and skills
- manage discrete aspects of patient care, specific to the service, pathway or population
- contribute to service productivity, quality and continuity.
Enhanced practice can be a developmental stage on the pathway to advanced practice, and a career destination in its own right.

NHS England's Principles of enhanced-level practice positions enhanced practice as a critical level for building workforce capability and capacity, reducing reliance on advanced roles for routine complexity, and supporting retention.

National AHP programme for enhanced practice

This session explores how enhanced level practice is being used to effectively optimise the workforce across health and care. Presenters from Coventry University and the University of Salford share how enhanced level practice can help manage complexity and risk, reduce reliance on advanced practice for routine care, and create clear progression pathways that support retention.
With the appropriate experience and development, advanced practitioners may progress to consultant‑level practice.

Consultant practice focuses on:
- leadership and impact beyond individual services
- system‑level change and service transformation
- strategic influence, innovation and improvement.
The multi‑professional consultant‑level practice capability and impact framework supports practitioners and employers to plan progression from advanced to consultant level, recognising that pathways are individual, contextual and service‑led.
Advanced Critical Care Practitioners (ACCPs) are part of the multidisciplinary team within intensive care medicine.

ACCPs:
- assess and manage patients receiving critical care
- undertake defined procedures and interventions
- work under appropriate clinical supervision within clearly governed scopes of practice.
ACCPs represent a distinct, nationally recognised advanced practice role with specific training and governance arrangements. Read our guidance on how ACCPs fit into the NHS workforce.