TY - JOUR
T1 - Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: A scoping review
AU - Poku, Agyeiwaa
AU - Pearce, Ruth
AU - Eldridge, Jeanette
AU - Hendrick, Paul
AU - Knaggs, Roger
AU - Blake, Holly
AU - Yogeswaran, Gowsika
AU - McLuskey, John
AU - Tomczak, Philippa
AU - Thow, Ruaridh
AU - harris, Peter
AU - Conway, Joy
AU - Collier, Richard
A2 - Evans, Catrin
N1 - Funding Information:
Contributors CE: coordinated and conceptualised the project. Developed all aspects of the project methodology and manuscript. Undertook key elements of the review. BP: reviewed and commented on the whole manuscript. Undertook all elements of the review. RP: conceptualised the project. Reviewed and commented on the whole manuscript. Assisted with study selection. Contributed to formulation of recommendations. JE: developed and implemented the search strategy. Reviewed and commented on the manuscript. PHendrick: reviewed and commented on the manuscript. Assisted with study selection. RK: reviewed and commented on the manuscript. Assisted with study selection. HB: reviewed and commented on the manuscript. Contributed to development of the methodological approach. Assisted with review of primary care sector data and formulation of recommendations. GY: reviewed and commented on the manuscript. Undertook some aspects of data extraction. JM: reviewed and commented on the manuscript. PT: reviewed and commented on the manuscript. Developed implications for non-traditional healthcare settings. RT: reviewed and commented on the manuscript. PHarris: reviewed and commented on the manuscript. JC: contributed to conceptualising the project. Reviewed and commented on the manuscript. Contributed to formulation of recommendations. RC: contributed to conceptualising the project. Reviewed and commented on the manuscript. Contributed to formulation of recommendations. Funding This work was supported by Health Education England (DN384826— Evaluation for HEE ACP Programme—Current Evidence Based for Advanced Level Practice within Health and Related Environments). Competing interests RC is Clinical Lead for Musculoskeletal Practitioners in Primary Care and Lead of the Centre for Advancing Practice, Health Education England. JC is a Research Advisor to Health Education England.
Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/8/5
Y1 - 2021/8/5
N2 - 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.
AB - 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.
KW - England
KW - Health Education
KW - Humans
KW - Medicine
KW - State Medicine
KW - United Kingdom
U2 - http://dx.doi.org/10.1136/bmjopen-2020-048171
DO - http://dx.doi.org/10.1136/bmjopen-2020-048171
M3 - Review article
C2 - 34353799
SN - 2044-6055
VL - 11
JO - BMJ Open
JF - BMJ Open
IS - 8
M1 - e048171
ER -