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Advanced Clinical Practice - Nurses

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Advanced Clinical Practice in Primary Care, Lister House Surgery, Derby  - Health Education England. A case study of advanced practice roles at Lister House surgery in Derby.


The nurse role has developed within general practice in response to extended clinical and patient demand and workforce issues and have been evolving over the last 20 years. The advanced role is as yet not regulated and this can cause confusion for nurses, employers and patients. The term ‘Advanced Practice’ defines the level of practice at which the nurse and other professions work. Advanced Practitioners are responsible for the safe delivery of a number of defined roles not routinely performed by nurses and or other professionals within primary care, and requires competence in specific areas of knowledge, technical skill, nursing expertise and clinical decision-making.

The RCGP/RCN General Practice Advanced Nurse Practitioner Competencies in November 2105 stated “The ANP is an experienced and autonomous registered nurse who has developed and extended their practice skills beyond their previous professional boundaries. The ANP is able to use their expert knowledge and decision making skills, guided by The Code (NMC) in unpredictable situations. This may include managing patients with undiagnosed health care problems and is shaped by the context of their clinical practice”

The RCN’s competencies for ANPs were mapped in the early 2000s against the NHS Knowledge and Skills Framework and are linked to the NHS Career Framework which were updated in 2012.

Department of Health Advanced Practice position statement (2010) describes a level of practice, not specialty or role that should be evident as being beyond that of first level registration. Nurses can also go through the RCN Credentialing route of which there is an initial fee.


In 2020 the Core Capabilities Framework for Advanced Clinical Practice (Nurses) Working in General Practice / Primary Care in England ACP-Primary-Care-Nurse-Fwk-2020.pdf was published commissioned by NHSE/I. “This framework sets a standard and offers the opportunity for practitioners to develop and evidence their knowledge and skills, enabling the highest standards of practice as well as providing a structure for career and role development within primary care.” Skills for Health 2020

Structure of the framework

The framework comprises 4 Domains. Within the Domains, 13 Capabilities describes the skills, knowledge and behaviours required for nurses working at the advanced clinical practice level. The Capabilities are underpinned by core indicative knowledge, key clinical presentations, investigations and referrals. It aligns with the requirements for clinical practice set out in the Multi-Professional Framework for Advanced Clinical Practice in England (HEE 2017). Skills for Health (2020)

E Learning for Advanced Clinical Practice

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Useful Links and Publications

RCN -  End of life care and wellbeing for the nursing and midwifery workforce

RCN -  Advanced Practice Standards

Surrey Training Hub - Additional Roles Reimbursement Scheme (ARRS)

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Updated on Tuesday, 28 September 2021 2375 views