Advanced practice: solution not substitution

In recent months, social media and professional discourse have seen a surge in debate around advanced practice roles across healthcare. Much of this discussion has centred on concerns that the growth of advanced practitioners (APs), represents a form of medical substitution – healthcare delivered ‘on the cheap,’ potentially at the expense of both patient safety and medical training.

While these concerns deserve acknowledgement, they are often rooted in a misunderstanding of what advanced practice is; and what it is not.

Part of the confusion can be traced back to NHS England’s 2017 Multi-professional Framework for Advanced Clinical Practice. This framework, widely adopted by English NHS trusts and the CSP, enabled a broad range of healthcare professionals, including physiotherapists, nurses, paramedics, and others, to undertake master’s level, generic education and develop ‘advanced’ capabilities. Crucially, however, many considered that the framework positioned advanced clinical practice as a specific role, rather than as a level of practice. The updated 2025 framework clarifies that advanced practice is simply a level of practice which describes the complexity, autonomy, and scope of work, rather than a job title or professional identity.

It is within this nuance that much of the current debate becomes blurred.

Physiotherapists working at an advanced level are not, and will never be, medics. They remain firmly grounded in their profession, regulated accordingly, and accountable to the standards set by the Health and Care Professions Council. Advanced practice physiotherapists (APPs) build on this foundation, integrating higher-level clinical reasoning, complex decision-making, and risk management in often uncertain and multifactorial clinical scenarios.

APPs approach patient care through a physiotherapy lens, one that emphasises function, movement, rehabilitation, and holistic management. This represents a distinct and valuable contribution, not a diluted version of medical practice.

The assertion that advanced practitioners are substituting for doctors overlooks the reality of modern healthcare delivery. Increasing patient complexity, rising demand, and workforce pressures require a more flexible, team-based approach. Within this, advanced practitioners are best understood not as replacements, but as complementary professionals, each bringing a specific expertise that enhances the overall quality and responsiveness of care.

The future of healthcare does not lie in blurring professional boundaries to the point of indistinction, nor in reinforcing rigid hierarchies that limit innovation. Instead, it depends on clarity: clarity of roles, clarity of training, and clarity of contribution. APPs exemplify these; expert clinicians working at a higher level within their own professional domain, contributing meaningfully to patient pathways and system efficiency.

The challenge, therefore, is not to defend advanced practice as a concept, but to articulate it more clearly. By doing so, we can move beyond unhelpful narratives of substitution and towards a more accurate understanding: one of collaboration, complementarity, and shared responsibility for delivering high quality patient care.