Exploratory evaluation of advanced clinical practitioners' engagement with the four pillars of advanced practice

Background The multi-professional framework for advanced clinical practice sets out expectations for advanced clinical practitioners to practise across the four pillars of advanced practice. However, existing literature suggests that advanced clinical practitioners' engagement remains predominantly clinical, with limited evidence exploring how they engage across all four pillars at local and national levels. Aim To evaluate the extent to which trainee and qualified advanced clinical practitioners at Northampton General Hospital engage with the four pillars of advanced practice and to explore the barriers and enablers to full implementation of the framework. Methods A qualitative service evaluation was conducted involving six advanced clinical practitioners from a range of specialties at Northampton General Hospital. Semi-structured interviews were carried out and analysed thematically to explore experiences of practice across the four pillars. Findings Clinical engagement was high, with advanced clinical practitioners demonstrating significant autonomy in assessment and management. However, barriers such as restricted diagnostic authority, limited supervision and confusion around role identity were identified. Engagement with leadership, education and research was inconsistent, often hindered by time constraints, lack of formal structures and inadequate support. Conclusions This evaluation demonstrates a disparity between the intended scope of advanced clinical practitioner roles and their current practice. Structural limitations, inconsistent governance and a clinically driven culture impede full engagement with the framework. Implications for practice Targeted organisational strategies are required to support advanced clinical practitioners in fulfilling their roles across all four pillars of advanced practice.