Advanced practice regulation – a developing conversation 

The announcement by the NMC that they are to regulate advanced practice nurses and midwives has created great discussion within not only the two professions directly affected but also within the wider advanced practice space. 

by Abi_Hend

This wider discussion reflects that advanced practice is now securely a multi-professional arena, where any decision that affects one part of the advanced practice workforce will impact on another. 

For years, physiotherapists have been trailblazers, pioneers of patient pathway reform. Many members are now asking, how will this impact me in my current or potential career as an advanced practitioner?  

The answer in the short term is it probably won’t. The HCPC has indicated they do not intend to follow suit, so regulatory requirements for physiotherapists remain unchanged. It will also take significant time and investment to operationalise regulation for nurses and midwives. 

Understandably, we have heard a mixed reaction from members. There are some who work at advanced and consultant levels of practice who feel they would welcome regulation to be seen by employers to be on a par with nurses, to give assurance of their level of practice and to protect the public. 

Others are adamant additional regulation is not necessary, as their regulation as autonomous practitioners from the point of registration is inclusive of practice at all levels. They also point out that good governance is fundamental in the safety of advanced practice, alongside appropriate regulation. 

However, we must not be naive as to the potential this creates for a two-tier system where nurses are viewed as ‘more qualified’ and physiotherapists become overlooked for advanced practice positions. 

This would be hugely detrimental for both patients and the retention and development of physiotherapists – the healthcare system simply cannot afford for this to happen.   

Whilst there is no indication the HCPC will change their position anytime soon, we must be mindful that the NMC decision may represent the start of a gradual change in the regulatory approach to advanced practice across professions. 

We have long-held CSP policy commitments that support expansion of the advanced practice workforce and the accompanying requirements for funded and sustainable education and training pathways.  

Yet there is much work to be done on this, as we know members across the UK don’t all have equitable access to funded, high-quality postgraduate education. 

What are the next steps for the CSP?  

We will secure our place at the right tables to ensure the professional voice of physiotherapy is heard strongly. This will include regular communication with the HCPC, other professional bodies, and engagement with the next phase of the NMC work.  

We will continue and extend our engagement with our professional networks and members more broadly to develop our understanding and respond to any unintended consequences of the NMC decision.  

We will use our governance structures within the CSP, including our Professional Committee and Council to ensure rigour around our decision making. 

As we navigate through this change, we must all remember that healthcare regulators have 'one main purpose and that is to protect the public'.   (PSA, 2018) Professional Healthcare Regulation Explained | PSA (   

Regulation is not the same as recognition and when we consider our next steps as the CSP, this will be in the forefront of our minds

Equally, in the context of uni-professional regulation of advanced practice, I urge members working at this level of practice to consider how they are evidencing the value they are bringing to patient pathways and the impact they are having on population health to advocate for our profession in these roles. 

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