Working towards Advanced Practice: using co-production with Physiotherapists to understand perceptions and shape development pathways. A qualitative service evaluation


With the Health Education England (HEE) Centre for Advancing Practice’s (‘the centre’) progressing agenda to develop national standards for advanced practice (AP) education and registration, Nuffield Health is reviewing their approach to best support existing Physiotherapists working at advanced or extended scope capacity (hereinafter ALP), to develop skills and demonstrate how they meet required standards. The purpose of this service evaluation was to involve Nuffield Health ALP’s in early/discovery stages of this development pathway, better understand their perceptions and collaborate from the outset using co-production theory.

80%, 4/5
of interviewees showed preference for the portfolio route into registered advanced practice.


Using a phenomenological approach, semi-structured interviews (SSI) were conducted using a representative sample (considering those with secondary roles) of Nuffield Health ALP’s until data saturation reached (n=5). Open-ended questions allowing exploration of emerging themes focused on their understanding of AP, beliefs relating to personal and organisational value of AP, preferred route into AP (accredited course vs portfolio) and perceived derailleurs/facilitators of implementing AP within Nuffield Health’s musculoskeletal (MSK) Physiotherapy services. SSI’s were conducted by two members of an AP working group (CD and TC). Data was transcribed verbatim from interview recordings, coded and placed into themes (CD). A sample of coding and all emergent themes were reviewed and validated by two members of the AP working group (TC and AL).


Emergent themes from qualitative analyses:

  1. ALP’s saw personal value in AP registration as a learning and development catalyst (across all 4-pillars), to facilitate role-consistency across organisations/sectors and to drive engagement.
  2. Organisationally, it could aid workforce development, improve engagement and support talent retention.
  3. A registered AP service could enhance our stakeholder proposition, drive business and improve commercial growth opportunities.
  4. It could contribute towards improving the professional reputation of Physiotherapy and public trust.
  5. The preferred registration route into AP was via Portfolio (80%, 4/5 interviews), with rationale including already holding capabilities through previous academic or professional experience, familiarity or confidence with portfolio generation, and to avoid unnecessary time and cost commitments.
  6. Perceived facilitators of achieving AP registration should include organisational/executive buy-in (including effective communication and resource allocation), timely strategic service evolution to encompass all 4-pillars and access to developmental support from appropriately skilled mentors.
  7. Derailleurs mirrored the facilitators, with the expectation of individuals resistance to change being an additional notable theme.


This service evaluation demonstrates there is a strong appetite for Nuffield Health Physiotherapists currently working at advanced or extended scope capacity, to become registered as AP’s with HEE and ‘the Centre’. The portfolio route seems to be preferred and would require strong organisational/executive buy-in, adequate professional development support (including access to mentors) and resources to succeed.

Cost and savings

Due to the nature of this research, the only costs were associated with salaried time taken for the interviewers and interviewees. There were no direct or known cost savings associated with this project.


At organisational level, this service evaluation will support workforce development, strategic planning and the evolution of our existing contemporary MSK Physiotherapy services towards registered AP.

At professional level, the findings of this service evaluation contribute towards the wider understanding of complexities surrounding AP registration with Physiotherapists currently working at an advanced or extended scope capacity.

Top three learning points

  1. Strong appetite exists for Nuffield Health Physiotherapists currently working at advanced or extended scope, to become registered with the Centre for Advancing Practice.
  2. Our findings support wider understanding of complexitiesaround AP registration with those already working at an advanced or extended capacity.
  3. Our findings are supported by similar research and strengthen messages to enable or facilitate effective implementation of AP in other organisations and sectors.


Funding acknowledgements

This service evaluation was unfunded. The author is an employee of Nuffield Health and all time used to design methodologies, collect data, analyse and write-up was completed within salaried hours.