Abstract Background/Aims Advanced clinical practice (ACP) is a strategic workforce solution that enhances service delivery, improves patient access, and supports multidisciplinary team (MDT) resilience. In rheumatology, ACP roles—spanning nursing, allied health professionals (AHPs) and pharmacy—have been advocated in national reports including the NHS Long Term Workforce Plan (2023), GIRFT Rheumatology Report (2021), and BSR Workforce Reports (2021, 2023). Despite longstanding recommendations, the extent of ACP role adoption across rheumatology services remains unclear. This project aimed to evaluate the current distribution and professional composition of advanced and consultant-level practice roles within rheumatology MDTs across England and Wales, and to explore regional and organisational variations in adoption. Methods A cross-sectional descriptive analysis was conducted using organisational survey data from the 4th edition of the National Early Inflammatory Arthritis (NEIA) Audit (October 2022). The survey, distributed to 191 rheumatology departments in England and Wales, captured whole-time equivalent (WTE) staffing data across MDT roles. Responses from 144 departments (75%) were analysed descriptively, with regional comparisons based on BSR-defined NHS regions. Results Advanced practice roles were present in approximately half of responding departments for nursing, 30% for physiotherapy, 25% for pharmacy, 12% for occupational therapy, and under 10% for podiatry. The Midlands reported the highest total WTE of advanced/consultant practitioners (78.74), followed by London (49.59) and the North West (46.73). Teaching hospitals were more likely to employ rheumatology ACP roles across professions. Most departments with ACP nurses also had ACPs from other professions, suggesting a pattern of multi-professional ACP development. However, the average rheumatology department employed fewer than 1.5 WTE ACPs across all professions combined. Conclusion Despite national endorsement, ACP role adoption in rheumatology remains inconsistent. Regional disparities and professional imbalances suggest variable local implementation strategies, potentially influenced by benchmarking, workforce shortages, or service innovation. Limitations include self-reported data, incomplete national coverage, and lack of qualitative insights into role development and impact.Advanced practice roles are underutilised in rheumatology services across England and Wales. Strategic investment in ACP workforce development, supported by robust governance and equitable access across professions, is essential to meet rising service demands and improve patient care. Disclosure W.J. Gregory: None. M. Troedel: None. K. Kumar: None.
Gregory et al. (2026) studied this question.