In 2005 the Nursing and Midwifery Council ( NMC ) began a process of consultation in connection with the development of a framework for post registration nursing and the proposed registration of advanced level practice . Unfortunately , this resulted in further confusion in relation to agreed titles and where the term ‘ advanced ’ could be adopted . A report in 2009 by the Council for Health Regulatory Excellence ( CHRE ) concluded that after considering whether advanced practice was a regulatory issue , the outcome was that no additional statutory regulation was required . This led to the Enabling Excellence Command Paper in 2011 ( DH , 2011 ), allowing recognition of self-regulation by the profession . Both these papers led to some confusion over advanced level practice . However , in 2010 the Department of Health produced a Position Statement on advanced nursing practice which helped inform and structure this development ( DH , 2010 ). With the addition of a restriction on junior doctors ' hours of work , required as part of the European Working Time Directives ( DH , 2002 ) within the UK , and arguably the advent of non- medical prescribing , which was supported by the Standards of Proficiency for Nurse and Midwife Prescribers ( NMC , 2006 ), a drive towards autonomous practice was further achieved .
Although direction and structure existed , advanced clinical practice within the UK varied throughout the four devolved nations . The Advanced Nursing Practice Toolkit , launched by the Scottish Government in 2008 ( Scottish Government , 2008 ), updated in 2017 and expanded to phase two in 2021 ( Scottish Government , 2021 ) helped encourage consistency through policy . The Welsh Framework for Advanced Practice ( NLIAH , 2010 ), Northern Ireland Advanced Nursing Practice Framework ( DHSSPSNI , 2016 ), the English Advanced Level Nursing document ( DH , 2010 ) and Multi-Professional Framework ( HEE , 2017 ) followed suite . Although the polices from all four nations relate to the four pillars of advanced clinical practice which are , clinical practice , leadership and management , research and education , there are subtle differences which are noted by the Council of Deans for Health ( 2018 ) in their review .
In addition to national guidance , professional organisations , such as the Royal College of
Nursing ( RCN ), have provided advise relating to advanced practice . Information from the RCN exists in the Standards of Advanced Level Nursing , the most recent publication being 2018 . The Health and Care Professions Council ( HCPC ) have indicated that following a review into the regulation of advanced practice there was insufficient evidence to require a new regulatory framework to be developed . However , it was noted that clarity related to advanced practice would be of benefit to registrants , stakeholders , and regulators ( HCPC , 2021 ). The Royal Pharmaceutical Society ( RPS ) have provided the RPS Roadmap to Advanced Practice ( RPS , 2016 ), the purpose being too clearly identify the professional development , knowledge and skills required to meet the needs of the patients and workforce transformation . These professionally related policies along with the national guidance set by the devolved nations has helped guide the ongoing development of advanced level practice within the United Kingdom . From an international nursing perspective , the International Council of Nurses ( ICN ) produced Guidelines on Advanced Practice Nursing in 2020 to help clarify the definitions related to advanced clinical practice . These guidelines define terms associated with advanced practice , what the title means and what can be expected of someone who holds that title . This document makes clear that the Clinical Nurse Specialist ( CNS ) is a specialist within the field , dealing with patients who have a known diagnosis . The Advanced Practice Nurse ( APN ) or Nurse Practitioner ( NP ) has a broad knowledge , allowing them to make the diagnosis themselves , within their area of competence .
Within the UK West Midlands , a regional advanced practice programme was established which included higher education institutions , acute care , community , primary care and mental health organisations . The Advanced Clinical Practice Framework for the West Midlands ( HEE , 2015 ) provided a definition of Advanced Clinical Practice and a clear model and competency framework , with a standardised core curriculum , to ensure consistency of both clinical practice and education across all nine universities in the region . Whilst this provided standardisation across the region , it could be argued that there were still variations in competencies and education of Advanced Clinical Practitioners throughout the rest of England .