LAUSR

As the publicity for the debate made clear, Advanced Clinical Practice is being heralded as one of the solutions to the workforce and service delivery challenges faced by the health service in the UK and in England in particular. But Advanced Clinical Practice across the UK is not regulated and the term is used to cover a range of very different roles across several disciplines, all requiring different education and skills. Obviously a complex and contentious issue – so what better topic could there be for a London South Bank University (LSBU) Health Debate? In the UK, advanced clinical practice roles in nursing started to be developed in the 1970s and 1980s with the introduction of specialist roles for nurses, and the introduction of autonomous community clinical Nurse Practitioners (Hill, 2017). Since then advanced and specialist practice has gone through significant development both clinically and educationally, supported by a number of policy drivers and changes in the National Health Service (NHS) service provision and workforce. Since its inception the role has never been clearly defined, with multiple reasons for the development of the role including shortages of medical staff following reduction of doctors’ clinical time, changing healthcare needs of the population, continuity and quality of care, and the desire of nurses for career progression (Sheer and Wong, 2008). Despite this, no standardisation exists, the skills and the scope of the role(s) remain unclear, and in theory anyone could call themselves ‘Advanced Practitioner’ as the title has no protection. While more recently the focus has broadened to include allied health professionals and pharmacists, the large majority of Advanced Practitioners continue to come from the nursing profession. Challenges to this group are regularly made suggesting that they are no longer nursing but becoming a ‘mini doctor’, and undoubtedly arguments can be made that increasing the numbers remains part of the doctor-substitute agenda. However, others