The introduction of advanced clinical practitioners (ACPs) has become a pivotal strategy in addressing the increasing demands on health services both nationally and internationally. ACPs are encouraged to develop autonomy within a variety of specialties. This role allows them to expand their scope of practice to allow them to better meet the needs of the people they care for (NHS England, 2025). Despite the existence of a national framework to provide guidance and consistency (Health Education England et al, 2017), there remains considerable variation in training, support and supervision for ACPs, particularly in non-clinical domains (Fothergill et al, 2022).
Background
ACPs have emerged as crucial contributors to modern healthcare systems, addressing the increasing demands placed on health services. Despite the structured national framework provided by the advanced practice multiprofessional framework, which outlines key competencies across four pillars – clinical practice, leadership, education and research – ACPs frequently encounter significant challenges. These challenges primarily stem from the variation in scope of practice, background, and formal governance structures (Fothergill et al, 2022). Additionally, ACPs often report limited support, especially in non-clinical areas, which are essential for practising independently and autonomously across all four pillars of advanced practice. These pillars form the foundation of the ACP role, empowering advanced professionals to deliver high-quality care, lead initiatives, educate others and contribute meaningfully to practice.
The need for non-clinical development
One of the most pressing issues faced by ACPs is the insufficient focus on non-clinical competencies. Although ACPs feel confident in their clinical skills, many express difficulties in achieving competencies in leadership, education and research. This issue is exacerbated by the lack of consistent non-clinical time and networking opportunities, which are crucial for developing these non-clinical skills (Fothergill et al, 2022). Furthermore, a national survey revealed that only 31.6% of ACPs had access to forums where they could discuss advanced practice, despite the reported benefits of group learning (Mann et al, 2023).
Within the Rotherham NHS Foundation Trust, ACPs anecdotally reported feeling most confident in their clinical competencies but expressed concerns about their ability to develop the other pillars due to the demanding nature of their clinical duties. They also highlighted the absence of networking opportunities, which further hindered their professional growth in non-clinical areas. For ACPs, competence in the clinical pillar is more readily maintained as it aligns directly with their practice. However, proficiency across all four pillars, clinical, leadership, education and research are essential. In England, ACP job plans are ideally set at 80% clinical and 20% non-clinical time, although this remains more aspirational than actual for many (Evans et al, 2021; Fothergill et al, 2022). Medical staff in the UK receive ‘supporting professional activities’ (SPA) time, typically at least 4 hours (10%) weekly for specialty doctors, rising to 20% for senior roles (British Medical Association (BMA), 2024). Considering ACPs' growing responsibilities, it could be argued that they too should receive SPA time for parity.
In response to these challenges, it was proposed that a tailored face-to-face study day be developed, delivered and evaluated to address the specific needs of ACPs.
Methodology
Needs assessment
To design an effective study day, it was essential to first identify the specific learning needs of ACPs. A focus group was conducted with ACPs to gather insights into their professional development requirements. The discussions revealed several key areas where ACPs felt they needed additional support. These included initiating and conducting audits and research, understanding the process of publication and poster writing, managing teaching responsibilities within demanding clinical environments, and networking with other ACPs to support each other's teaching and research efforts. Additionally, ACPs expressed a need for guidance on leadership, particularly in relation to supervision and managing difficult conversations, as well as strategies for evidencing non-clinical competencies in their portfolios.
Designing the study day
Based on the feedback from the focus group, a comprehensive agenda was developed for the study day, which was held in April 2024 at Rotherham District General Hospital. The event aimed to provide a focus on the non-clinical pillars of advanced practice and to enhance the opportunity to build an ACP community of practice for informal networking, support and collaboration.
The study day featured a series of talks delivered by experts from across the country, each with substantial experience in their respective fields and tailored specifically for an ACP audience. Topics covered included:
In addition to the formal presentations, a poster competition was organised and judged by the event speakers. Posters were displayed in an online gallery, and prizes were awarded for first and second place, including a funded conference place and an ACP textbook, respectively. The event was sponsored by the Trust's practitioner e-portfolio team, members of which were present to answer any queries regarding the e-portfolio.
Emphasis was placed on networking opportunities, with audience participation, small group work and reflection encouraged throughout the day. A ‘resource list’ was also collated, including recommendations for further reading and development suggested by speakers and attendees, and circulated via email after the event.
Findings
Following the event, an online evaluation survey was distributed to all 32 attendees, including ACPs and final-year ACP students from the South Yorkshire region. The survey revealed overwhelmingly positive feedback. Every attendee affirmed that the study day was both useful and relevant. The importance of attending the event face-to-face was unanimously recognised, highlighting the value of in-person interactions for professional development. Additionally, all participants reported a significant improvement in their understanding of each of the non-clinical pillars. They also noted that they had acquired new skills and knowledge that they planned to apply to their practice and professional development, demonstrating the practical benefits and immediate applicability of the day's learning.
The qualitative feedback from attendees further highlighted the success of the study day. The responses were grouped into several key themes, reflecting the various aspects of the event that participants found most beneficial.
Many attendees expressed that the study day provided valuable learning opportunities, particularly valuing: engaging with peers in a learning environment and covered widespread topics that were relevant to practice.
Comments emphasised the importance of the event in enhancing their professional knowledge. Participants also appreciated the designated time to focus on education, leadership, and research, with one attendee noting that the study day had:
‘[Helped] my competency requirements and provided me with inspiration to write reflections related to the competencies.’
The networking aspect of the study day was particularly well received. Attendees valued the opportunity to meet other ACPs and extend their knowledge base through peer interactions.
The quality of the speakers was another significant highlight of the event. A ‘Teach the Teacher’ session aimed to support ACPs to take educational theory into the busy clinical environment in an effective way to support both themselves and learners. Attendees described the Teach the Teacher session as ‘inspirational’. They praised the speakers for their compassion and knowledge. Comments reflected the positive impact of the speakers on the participants' learning experience.
Although the feedback was positive, attendees also provided constructive suggestions for future events. Some participants suggested improvements in technical aspects, such as better audiovisual equipment and receiving session slides in advance. Additionally, there were requests for more diverse topics in future study days, including clinical elements to incorporate all pillars, quality improvement, and career progression such as PhD and consultancy career paths.
Discussion
The study day had a significant impact on ACP development, addressing the specific needs identified in the initial focus group. By providing this study day and promoting a supportive network, the event successfully enhanced ACPs' awareness and competencies in the non-clinical pillars of advanced practice. The positive feedback from attendees highlights the value of dedicated time for non-clinical development, which is essential for ACPs to achieve a well-rounded professional profile.
This outcome aligns with recent literature highlighting the importance of comprehensive training for ACPs. A study by Scott (2024) noted that ACPs are not receiving enough opportunities for development and recommends ring-fenced opportunities for non-clinical development such as leadership, quality improvement and educating others. Developing these capabilities alongside clinical work ensures that ACPs are able to thrive as holistic professionals.
One of the key outcomes of the study day was the establishment of an ACP ‘community of practice’. This initiative aims to provide a platform for ongoing networking, support and collaboration among ACPs. By encouraging a sense of community, ACPs can continue to share knowledge, support each other's professional development, and work together to address common challenges.
The value of communities of practice in professional development is well documented. Wenger et al (2015) described communities of practice as groups of people who share a concern or passion for something they do and learn how to do it better through regular interaction. For ACPs, such communities provide opportunities to discuss experiences, share best practices, and develop innovative solutions to common challenges. This collaborative learning environment is particularly beneficial in healthcare settings, where continuous learning and adaptation are essential for high-quality patient care (Wenger et al, 2015).
Building on the success of the study day, future initiatives should include regular non-clinical learning events, expanded topics based on attendee suggestions, and continued efforts to establish a robust ACP community of practice. These initiatives will ensure sustained support for ACPs in all pillars of advanced practice, ultimately benefiting patient care and healthcare systems.
To maintain the momentum from the study day, a comprehensive programme tailored to the diverse needs of ACPs is essential. Suggestions include allocating protected non-clinical time equivalent to 10% of the week (7.5 hours) to benchmark against the BMA's guidance for medical staff (BMA, 2024). This programme should offer varied learning opportunities, including workshops, seminars, online courses and mentoring schemes. Du et al (2022) noted the effectiveness of blended learning approaches, which combine face-to-face and online learning to provide flexibility and accessibility for busy professionals.
Additionally, incorporating feedback from attendees is essential for ensuring that future events remain relevant and valuable. For instance, participants suggested topics such as clinical elements to incorporate all pillars, quality improvement, and career progression, including PhD opportunities and consultancy-level career paths. Addressing these topics in future events will provide ACPs with the knowledge and skills needed to advance their careers and contribute to the healthcare system more effectively.
Establishing a formal ACP community of practice will provide a platform for ongoing networking and collaboration. This community can facilitate regular meetings, workshops, and informal networking events, allowing ACPs to share their experiences, challenges, and successes. By promoting a supportive and collaborative environment, ACPs can continue to develop their skills and knowledge, ultimately improving the quality of care provided to patients.
The benefits of such communities extend beyond individual professional development. A study by Li et al (2009) found that communities of practice in healthcare settings can lead to improved organisational performance, enhanced patient outcomes, and increased job satisfaction among practitioners. These communities create a culture of continuous improvement and innovation, which is essential for addressing the complex challenges faced by modern healthcare systems (Li et al, 2009).
Reflective practice is another critical component of professional development for ACPs. Encouraging ACPs to engage in reflective practice allows them to critically evaluate their experiences, identify areas for improvement, and develop strategies for enhancing their practice. According to Schön (1983), reflective practice involves both reflection-in-action, where practitioners think on their feet during practice, and reflection-on-action, where they review and analyse their experiences after the fact.
Incorporating reflective practice into the programme can help ACPs develop a deeper understanding of their roles and responsibilities. This approach aligns with the findings of Mann et al (2023), who highlighted the importance of reflective practice in enhancing the professional growth of ACPs. By providing opportunities for reflection, learning events can help ACPs identify their strengths and areas for development, leading to more effective and confident practice (Mann et al, 2023).
Online learning platforms, virtual simulations, and digital collaboration tools can enhance the accessibility and effectiveness of these programmes. For example, virtual simulations allow learners to practice in a safe, interactive environment and can help translate knowledge into practice (Kuszajewski et al, 2021).
Online discussion forums and activities can empower practitioners to take ownership of their professional development while developing critical thinking skills and sharing perspectives (Zubala et al, 2018). The wide range of technologies available have made it possible to deliver high-quality content in a flexible and interactive format. By using these technologies, healthcare institutions can provide ACPs with the resources and support they need to succeed, regardless of their location or schedule.
Conclusion
The study day at the Rotherham NHS Foundation Trust was a valuable step toward supporting ACPs' non-clinical development. By concentrating on education in leadership, research and teaching, and promoting a community of practice, the event significantly enhanced participants' competencies. The positive feedback highlights the importance of dedicated time for non-clinical growth. Future initiatives should expand on this success by hosting regular learning events, incorporating topics suggested by participants, and establishing a formal ACP community of practice. This structured support for non-clinical skills will enable ACPs to fully meet the demands of their roles and make a meaningful contribution to patient care and healthcare advancement.