A cross-sectional, exploratory, mixed-method study examining Advanced Clinical Practitioners’ expectations and experiences of their roles.

Aim: The aim of the research contained within this thesis was to understand the expectations Advanced Clinical Practitioners (ACPs) have regarding the role and to evaluate whether expectations are currently being realised. Previous research identified barriers which prevent the effective implementation of ACPs. To achieve objectives of health service reform, a better understanding of disparities between ACPs expectation and reality is needed for focused initiatives to be implemented. Method: This cross-sectional study used a sequential, mixed method, exploratory design where themes were created from focus groups to construct a follow up questionnaire. UK participants were recruited via social media and ACP networks. Using maximum variation sampling, focus groups took place on-line and were studied via reflexive thematic analysis. The on-line follow up questionnaire collected both quantitative and qualitative data. Exploratory data and reflexive thematic analysis were employed to probe and visualise results, drawing findings together via narrative synthesis. Results: Five themes were constructed from 17 participants over 3 focus group discussions: the need for 1) clinical/ non-clinical balance; 2) full use of knowledge, skills and experience; 3) leadership in quality improvement; 4) career progression; and 5) policy, vision, and structure to support effective implementation of the role. The follow up questionnaire identified divergences in ACPs expectations and their lived experience of the role. Overall respondents (n= 230) did though believe their expectations are being met. Recommendations: To achieve the expected growth of ACP, attention is needed on narrowing the gaps between the expectation and reality of working in this role. This requires ring fencing time for non-clinical activity, providing opportunities for leadership, better access to professional development, and clearer career planning. Initiatives to standardise ACP should be further embedded and measured for impact which will require further research, including gaining a clearer picture of the ACP community.