{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:46:52Z","timestamp":1790171212059,"version":"4.1.0"},"reference-count":30,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2021,8,10]],"date-time":"2021-08-10T00:00:00Z","timestamp":1628553600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Health Education England"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Health Serv Res Policy"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>A major issue facing all health systems is improving population health while at the same time responding to both growing patient numbers and needs and developing and retaining the health care workforce. One policy response to workforce shortages has been the development of advanced clinical practice roles. In the context of an English national policy promoting such roles in the health service, we explored senior managers\u2019 and senior clinicians\u2019 perceptions of factors at the organization level that support or inhibit the introduction of advanced clinical practice roles. The investigation was framed by theories of the diffusion of innovation and the system of professions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a qualitative interview study of 39 senior manager and clinicians in 19 National Health Service acute, community, mental health and ambulance organizations across a metropolitan area in 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Small numbers of advanced clinical practice roles were reported, often in single services. Four main influences were identified in the development of advanced clinical practice roles: staff shortages (particularly of doctors in training grades) combined with rising patient demand, the desire to retain individual experienced staff, external commissioners or purchasers of services looking to shape services in line with national policy, and commissioner-funded new roles in new ambulatory care services and primary care. Three factors were reported as enabling the roles: finance for substantive posts, evidence of value of the posts, and structural support within the organization. Three factors were perceived as inhibiting developing the roles: confusion and lack of knowledge amongst clinicians and managers, the availability of finance for the roles, and a nervousness (sometimes resistance) to introducing the new roles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While the national policy was to promote advanced clinical practice roles, the evidence suggested there was and would continue to be limited implementation at the operational level. Development scenarios that introduced new monies for such roles reduced some of the inhibiting factors. However, where the introduction of roles required funding to move from one part of a service to another, and potentially from one staff group to another, the growth of these roles was and is likely to be contested. In such scenarios, research and business evidence of relative advantage will be important, as too will be supporters in powerful positions. The paucity of publicly available evidence on the effectiveness of advanced clinical practice roles across the specialties and professions in different contexts requires urgent attention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13558196211036727","type":"journal-article","created":{"date-parts":[[2021,8,10]],"date-time":"2021-08-10T08:35:01Z","timestamp":1628584501000},"page":"96-105","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":16,"title":["Are advanced clinical practice roles in England\u2019s National Health Service a remedy for workforce problems? A qualitative study of senior staff perspectives"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8915-5185","authenticated-orcid":false,"given":"Vari M","family":"Drennan","sequence":"first","affiliation":[{"name":"Professor, Centre for Health & Social Care Research, Joint Faculty of Kingston University and St George\u2019s University of London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Collins","sequence":"additional","affiliation":[{"name":"Associate Professor, School of Nursing, Joint Faculty of Kingston and St George\u2019s University of London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Allan","sequence":"additional","affiliation":[{"name":"Professor, School of Health & Education, Middlesex University, Middlesex University, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9873-777X","authenticated-orcid":false,"given":"Neil","family":"Brimblecombe","sequence":"additional","affiliation":[{"name":"Professor, School of Health & Social Care, London South Bank University, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Halter","sequence":"additional","affiliation":[{"name":"Associate Professor, Centre for Health & Social Care Research, Joint Faculty of Kingston University and St George\u2019s University of London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Taylor","sequence":"additional","affiliation":[{"name":"Research Associate, Centre for Health & Social Care Research, Joint Faculty of Kingston University and St George\u2019s University of London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,8,10]]},"reference":[{"key":"bibr1-13558196211036727","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1713"},{"key":"bibr2-13558196211036727","doi-asserted-by":"publisher","DOI":"10.17265\/2159-5313\/2016.09.003"},{"key":"bibr3-13558196211036727","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60785-5"},{"key":"bibr4-13558196211036727","doi-asserted-by":"publisher","DOI":"10.1111\/j.1547-5069.2009.01322.x"},{"key":"bibr5-13558196211036727","doi-asserted-by":"publisher","DOI":"10.1111\/inr.12193"},{"key":"bibr6-13558196211036727","doi-asserted-by":"publisher","DOI":"10.17265\/2159-5313\/2016.09.003"},{"key":"bibr7-13558196211036727","unstructured":"International Council of Nurses. Guidelines for advanced practice nursing, www.icn.ch\/system\/files\/documents\/2020-04\/ICN_APN%20Report_EN_WEB.pdf (2020, accessed 30 October 2020)."},{"key":"bibr8-13558196211036727","doi-asserted-by":"publisher","DOI":"10.15171\/ijhpm.2015.215"},{"key":"bibr9-13558196211036727","doi-asserted-by":"publisher","DOI":"10.2147\/JMDH.S66746"},{"key":"bibr10-13558196211036727","doi-asserted-by":"publisher","DOI":"10.5430\/ijh.v4n1p50"},{"key":"bibr11-13558196211036727","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldz014"},{"key":"bibr12-13558196211036727","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2015.09.002"},{"key":"bibr13-13558196211036727","doi-asserted-by":"publisher","DOI":"10.7748\/nm.22.3.20.e1354"},{"key":"bibr14-13558196211036727","unstructured":"National Health Service England. The long term plan, www.longtermplan.nhs.uk\/ (2019, accessed 20 October 2020)."},{"key":"bibr15-13558196211036727","volume-title":"Investing in people for health and health care","author":"Health Education England","year":"2014"},{"key":"bibr16-13558196211036727","unstructured":"Health Education England. Multi-professional framework for advanced clinical practice in England, www.hee.nhs.uk\/our-work\/advanced-clinical-practice\/multi-professional-framework (2018, accessed 30 October 2020)."},{"key":"bibr17-13558196211036727","doi-asserted-by":"publisher","DOI":"10.1111\/nin.12105"},{"key":"bibr18-13558196211036727","unstructured":"Horsfield C. National critical care nursing workforce survey: overview report of the critical care networks \u2013 national nurse leads, www.cc3n.org.uk\/uploads\/9\/8\/4\/2\/98425184\/national_critical_care_nursing_workforce_survey_report_july_2020_final_v.pdf (2020, accessed 30 October 2020)."},{"key":"bibr19-13558196211036727","doi-asserted-by":"publisher","DOI":"10.1111\/scs.12120"},{"key":"bibr20-13558196211036727","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2019.103443"},{"key":"bibr21-13558196211036727","doi-asserted-by":"publisher","DOI":"10.12927\/cjnl.2010.22272"},{"key":"bibr22-13558196211036727","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2018.08.002"},{"key":"bibr23-13558196211036727","doi-asserted-by":"publisher","DOI":"10.1111\/jan.12915"},{"key":"bibr24-13558196211036727","doi-asserted-by":"publisher","DOI":"10.1111\/j.0887-378X.2004.00325.x"},{"key":"bibr25-13558196211036727","doi-asserted-by":"publisher","DOI":"10.7208\/chicago\/9780226189666.001.0001"},{"key":"bibr26-13558196211036727","volume-title":"The foundations of social research: meaning and perspective in the research process","author":"Crotty M.","year":"1998"},{"key":"bibr27-13558196211036727","volume-title":"Transforming qualitative information: thematic analysis and code development","author":"Boyatzis RE.","year":"1998"},{"key":"bibr28-13558196211036727","volume-title":"Nurses in advanced roles in primary care: policy levers for implementation. 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