ADVANCED PRACTICE


System-level implications for pathology services A central conclusion of the study is that access to advanced practice should be understood as a system-level workforce issue rather than an individual career challenge. Although personal motivation and capability are important, they are insufficient in the absence of supportive organisational structures, clear career pathways, and equitable access to development resources. The consistency of findings across


career stages indicates that these barriers operate throughout the professional lifecycle, beginning at undergraduate level and continuing into senior practice. This highlights the need for interventions that address the entire career pathway rather than focusing solely on individuals approaching advanced roles. The study also demonstrates that enthusiasm for advanced practice already exists within the profession; the primary challenge is therefore not one of engagement, but of enabling progression through appropriate structural and organisational support. Effective improvement will require coordinated action across employers, professional bodies, education providers, and policy organisations.


The findings highlight the importance


of translating identified barriers into targeted interventions. The Theoretical Domains Framework provides a structured basis for designing such interventions, ensuring that they address the underlying behavioural and organisational determinants of progression. Future development is likely to benefit from co- produced approaches involving biomedical scientists at all career stages. Potential areas for action include the development of structured mentorship schemes, improved clarity of career pathways, enhanced succession planning, and greater consistency in governance and role definition. Early exposure to advanced practice concepts during undergraduate and early career stages may also help to improve awareness and long-term career planning. The research team plan to explore this further in a subsequent Delphi study to identify areas to prioritise in addressing barriers moving forwards.


Conclusions Advanced practice represents an important and evolving element of the biomedical scientist workforce. While biomedical scientists are generally motivated to pursue advanced roles, their ability to do so is shaped by complex interactions between organisational culture, resource availability, professional identity, and structural workforce planning. Improving access to advanced


The study also demonstrates that


enthusiasm for advanced practice already exists within the profession; the primary challenge is therefore not one of engagement,


but of enabling progression through appropriate structural and organisational support


practice will therefore require coordinated system-level change rather than reliance on individual effort alone. By addressing barriers related to clarity, culture, and resources, the profession can develop more equitable and sustainable career pathways that support both workforce development and high-quality patient care.


References 1


Institute of Biomedical Science. IBMS Long Term Workforce Plan. (IBMS, 2023) htps:// www.ibms.org/resource/ibms-long-term- biomedical-scientist-workforce-plan.html


2 NHS England. NHS Long Term Workforce Plan. (NHSE, 2023) htps://www.england. nhs.uk/publication/nhs-long-term- workforce-plan/


3 Palmer W, Julian S, Vaughan L. Independent report on the regulation of advanced practice in nursing and midwifery. (Nuffield Trust, 2023) www.nuffieldtrust. org.uk/research/independent-report-on- the-regulation-of-advanced-practice-in- nursing-and-midwifery


4 Fothergill LJ, Al-Oraibi A, Houdmont J, et al. Nationwide evaluation of the advanced clinical practitioner role in England: a cross-sectional survey. BMJ Open. 2022;12(1):e055475. doi:10.1136/ bmjopen-2021-055475


5 NHS England. Multi-professional Framework for Advanced Practice. 2nd edn. (NHSE, 2025) htps://advanced-practice.hee. nhs.uk/multi-professional-framework-for- advanced-practice/


6 Evans C, Poku B, Pearce R, et al. Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review. BMJ Open. 2021;11(8):e048171. doi:10.1136/bmjopen-2020-048171


7 Busca E, Savateri A, Calafato TL, Mazzoleni B, Barisone M, Dal Molin A. Barriers and facilitators to the implementation of nurse’s role in primary care setings: an integrative review. BMC Nurs. 2021;20(1):171. doi:10.1186/ s12912-021-00696-y


8 Fosah R, Llahana S. Barriers and Enablers 26 WWW.PATHOLOGYINPRACTICE.COM October 2026


to Leadership in Advanced Practice Nursing: A Systematic Review. Int Nurs Rev. 2025;72(2):e70034. doi:10.1111/inr.70034


9 Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37. doi:10.1186/1748-5908-7-37


PPi


10 Atkins L, Francis J, Islam R, et al. A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12(1):77. doi:10.1186/s13012-017-0605-9


11 Feters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs-principles and practices. Health Serv Res. 2013;48(6 Pt 2):2134-2156. doi:10.1111/1475-6773.12117


12 Shorten A, Smith J. Mixed methods research: expanding the evidence base. Evid Based Nurs. 2017;20(3):74-75. doi:10.1136/eb- 2017-102699


13 Farmer T, Robinson K, Elliot SJ, Eyles J. Developing and implementing a triangulation protocol for qualitative health research. Qual Health Res. 2006;16(3):377- 394. doi:10.1177/1049732305285708


14 Gledhill R. Updates on Advanced Practice. (Health and Care Professions Council, 2024) htps://www.hcpc-uk.org/news-and-events/ blog/2024/updates-on-advanced-practice/


Acknowledgement Dr Alex Scot and Debbie Stevens-Gill, both Department of Psychology, Keele University, were co-authors of the mixed methods study.


Aimee Pinnington is an HCPC- registered biomedical scientist and PhD researcher at Keele University. Her research explores advanced practice and workforce development within biomedical science, with a particular focus on applying implementation science to improve equitable access to advanced practice roles. She is passionate about supporting the future development of the biomedical scientist workforce through evidence-informed research and collaboration.


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