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

Evans, Catrin; Poku, Brenda Agyeiwaa; Pearce, Ruth; Eldridge, Jeanette; Hendrick, Paul; Knaggs, Roger; Blake, Holly; Yogeswaran, Gowsika; McLuskey, John; Tomczak, Philippa; Thow, Ruaridh; Harris, Peter; Conway, Joy; Collier, Richard


Professor of Evidence Based Healthcare

Ruth Pearce

Jeanette Eldridge

Paul Hendrick

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Professor of Behavioural Medicine

Gowsika Yogeswaran

Ruaridh Thow

Peter Harris

Joy Conway

Richard Collier


Objectives In 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. Design A scoping review was undertaken following JBI methodological guidance. Methods 13 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. Results 191 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. Conclusion This 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.


Evans, C., Poku, B. A., Pearce, R., Eldridge, J., Hendrick, P., Knaggs, R., …Collier, R. (2021). Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: A scoping review. BMJ Open, 11(8), Article e048171.

Journal Article Type Article
Acceptance Date Jun 23, 2021
Online Publication Date Aug 5, 2021
Publication Date Aug 5, 2021
Deposit Date Jun 28, 2021
Publicly Available Date Aug 5, 2021
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 11
Issue 8
Article Number e048171
Public URL
Publisher URL


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