The benefits of ‘Advanced Clinical Practice’ (ACP) training and education for key stakeholders. A systematic, mixed-method, literature review

Background: The ‘Multi-Professional framework for Advanced Clinical Practice (ACP) in England’, (Health Education England 2017) sets out the definition of ACP, the scope of practice and practitioners this applies to, and the standards and capabilities expected in order to practice under this title. This provides a benchmark by which training providers can badge their products as leading to advanced clinical practice, employers can use to select individuals to work in ACP roles or undertake ACP related tasks, and individuals can provide evidence against to support their credentials as an ACP. Alongside this, additional funding was released specifically for the support of ACP, the NHS People Plan was published, and an ACP Apprenticeship route was approved. Covid-19 sharply bought into focus the demands upon health services and those that work within them, including ACPs who have often had to ‘step up’, be re-deployed or work in different ways than they have done before. Aim: The review’s purpose was to identify research that had been conducted with regard to ‘Advanced Clinical Practice’ benefits and impact, so that the evidence base of ACP for key stakeholders in this field could be evaluated. Method: Mixed method systematic literature review to inform a narrative interpretive synthesis. Findings: 44 papers of mixed quality were identified that had used a range of methodology. Convenience sampling was a common feature with use of self-report from a sub set of the diverse ACP community. There was an absence of longitudinal research, particularly that might evidence outcome measures such as cost effectiveness. Conclusion: Consensus could be found regarding the definition, barriers, and facilitators of ACP; that it can be split into ‘substitution’ and ‘supplementation’ roles, and that the clinical practice element of the role dominates. Variation is evident in the training and education, scope of practice, and regulation of ACP.