Position statement on advanced practice

In response to the recent BMA survey and statements on preventing doctor substitution by advanced practitioners, NHS Employers, on behalf of employers in the NHS in England, reaffirms its support for advanced practice and the value it brings to patients, teams and employers. 

Great health care needs great teamwork with mutual respect, trust, collaboration and understanding between team members. Teams are multi-professional and multi-disciplinary. They draw on the skills and expertise of a wide range of health and care professionals to ensure patients receive the right intervention at the right time.

The recent action by the BMA risks damaging the critical inter-professional relationships needed within teams to deliver safe care. 

We need constructive dialogue across professional organisations, employers and regulators to ensure that advanced practice continues to develop in a way that is beneficial for patients and with the trust and confidence of professionals and employers. 

Advanced Practice: a level of practice within an existing regulated profession 

• Advanced practice is a level of practice within an existing regulated profession, not a separate profession or an access route to a new one.  

• It is not a new concept and has been established in UK nursing for example, for more than 30 years. 

• For example, when a nurse, paramedic, physiotherapist or pharmacist has qualified, they may be supported to gain experience, capability, skills, additional qualifications and accreditation around four pillars (clinical practice, leadership, education and research) leading to advanced practice status in their respective regulated profession. 

• An advanced practitioner is an autonomous, highly trained and regulated healthcare professional supporting multi-disciplinary teams including consultant-led teams. 

Advanced practice: enhancing multi-disciplinary teams and patient care, accountability and regulation 

• When introduced with clear purpose and proper support, advanced practice roles can help employers redesign services, strengthen multidisciplinary working and leadership, expand workforce capacity and flexibility, improve the continuity and quality of care for patients and enhance staff experience. 

• These benefits can be realised when advanced practice is planned as part of a wider workforce approach with clear role design and governance. It isn't a short‑term fix for immediate pressures.

• Employers will have protocols which stipulate that all registrants (doctors and advanced practitioners in other regulated professions) are required to practise in compliance with their respective code of professional conduct, within their scope of practice and ask for help when needed.

• Team members must also speak up about patient safety risks and report safety incidents should these occur.

• Decisions relating to diagnosis, prescribing, or complex clinical management must always be supported by appropriate training, governance arrangements, and escalation pathways.

• Job titles, responsibilities, and clinical activities must be clearly defined, transparent, and have locally agreed governance in place. A governance model is available from the NHS England Centre for Advancing Practice

• Patients should always be informed about who is providing their care.