New opportunities at advanced clinical practice level in the NHS

Each month, the CSP’s professional advisers share advice and guidance on a topical matter

New opportunities at ad vanced clinical practice level in the NHS: what d o I need to know?

We answer your questions on: New opportunities at advanced clinical practice level in the NHS: what do I need to know?

The advanced clinical practice (ACP) agenda is fast-paced, complex and constantly changing. The CSP professional advice service gets frequent enquiries about it, and we address some of the questions here

The term ACP is now widely used to describe a level of practice that can be achieved by healthcare professionals from a range of professional backgrounds. In this article, ACP covers other common advance practice terms including advanced physiotherapy practice and advanced physiotherapy practitioner. Due to the recent growth in professionals at this level, CSP members regularly contact us for information.

There is no UK-wide definition or standards for ACP. However, there are multiple national allied health professions (AHP) frameworks that describe the level and range of capabilities needed in the workplace. See existing country specific frameworks in the links at the end. 

The four pillars of advanced practice are:

  • clinical practice
  • leadership 
  • education
  • research

Increasing numbers of ACP opportunities are now available in the NHS. The CSP welcomes the opportunity for physiotherapists to develop and expand their skills in different roles at this level. Many ACP roles were traditionally carried out by other professions and therefore there are several important things to consider. 

Regulation and governance

All ACP practitioners are regulated by their profession and are autonomous in practice. For physiotherapists this means that they must be physiotherapy registrants of the Health and Care Professionals Council (HCPC) and will be regulated as physiotherapists. 

The HCPC will draw on professional resources from the CSP in establishing a registrant’s practice, including what is, and is not within the scope of the practice of the profession.

The HCPC standards apply to all activities undertaken as a physiotherapist. The HCPC may question activities that may encroach on another protected title profession, or impact on their status as a registrant or delivery of safe practice.

At present, there is no annotation to the HCPC register to recognise ACP level, such as that for nurses via their regulatory body. However, registrants working at ACP level are expected to be able to demonstrate their capabilities with reference to all four pillars of clinical practice listed above.

Individuals will demonstrate their capabilities in different ways, depending upon the nature of their profession, role and practice setting. 

Scope and insurance

The HCPC standards set an expectation that registered practitioners restrict their work to activities that they are educated, trained and competent to undertake. 

The CSP does not maintain a list of activities that fall within scope of practice. Instead, to ensure that a certain activity is covered by the CSP professional liability insurance (PLI), subject to terms and conditions, we ask members to critically reflect on the context and purpose for using a specific activity, how that fits with the scope and purpose of physiotherapy and that it has an established research base recognised by peers.

The CSP’s professional advice service gives advice and support to members on complex and specialist enquiries about physiotherapy practice, including professional practice issues, standards, values and behaviours, international working, service design and commissioning, and policy in practice. 

The scope and insurance pages on the CSP website will help you with this process. See the links on the right.

In the NHS, an employer is responsible for providing vicarious liability insurance for employees. In the case where the employer requests that a physiotherapist carries out activities outside of the scope of the profession, the physiotherapist will need to be vicariously covered by NHS insurance. This means that the employer is responsible for supporting the physiotherapist to become educated, trained and competent. It is also imperative that any work that falls outside of the scope of the profession is clearly outlined in the job description, otherwise the vicarious liability insurance will not apply.


The CSP believes that physiotherapists are well placed to take up new ACP positions.  We aim to keep you informed with developments and clarify the implications. This is an evolving area of practice and therefore some of your queries may require bespoke advice. For individual queries contact us at 

More Information

National frameworks

Alex Hough and Jenny Nissler are professional advisers at the CSP.

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