Advanced clinical practice roles in the National Health Service, England: a remedy for workforce problems? A qualitative study of senior staff perspectives.

Advanced clinical practice roles in the National Health Service, England: a remedy for workforce problems? A qualitative study of senior staff perspectives.

Abstract
Objectives
Improving population health, while responding to growing patient numbers and needs and developing and retaining the health care workforce, is a major issue in all health systems. One policy response to medical shortages in some countries has been the development of advanced practice roles. In the context of an English national policy promoting such roles in the health service, we explored senior manager and senior clinicians’ perceptions of factors supporting or inhibiting their introduction at the organisation level. The investigation was framed by theories of the diffusion of innovation and the system of professions.
Methods
A qualitative interview study with thirty-nine senior manager and clinicians in 19 National Health Service acute, community, mental health and ambulance organisations across a metropolitan area in 2019.
Findings
Very small numbers of advanced practice roles were reported, often in single services. Five main ‘influencers’ were identified in their development: a strategic response to medical shortages, commissioner-funded new roles in new ambulatory care services and primary care, education commissioner-funded training, roles developed by individuals and the desire to retain experienced staff. Two factors were reported as enablers for the roles: – finance for substantive posts and evidence of value of the posts. Perceived inhibiting factors to developing the roles were: lack of identified finance for training and positions; confusion and lack of knowledge amongst clinicians and managers; and a nervousness (sometimes resistance) to introducing a new role with little evidence and many unanswered questions about its effectiveness and consequences.
Conclusions
While the national policy was to promote advanced practice roles, the evidence suggested there was and would continue to be limited implementation at the operational level. Development scenarios that introduced new monies for such roles reduced some of the inhibiting factors. However, where the introduction of roles required funding to move from one part of a service to another, and potentially from one staff group to another, the growth of these roles was and is likely to be contested. In such scenarios research and business evidence of relative advantage will be important as too will be supporters in powerful positions. The paucity of publicly available evidence on the effectiveness of advanced practice roles across the specialties and professions in the context requires urgent attention.