Transforming Roles paper 9: allied health professions advanced practice

Annex 2: Examples of the impact of AHP advanced practice roles

The following examples demonstrate how advanced practice AHPs contribute to achieving priority areas in national policies^[1-3]. They are illustrative only and some examples may be replicated across multiple NHS Boards.

Priority area – Improving access to treatment

Advanced Practice Occupational Therapists in NHS Lanarkshire have streamlined care for simple hand injuries by introducing a direct referral pathway from the Emergency Department to hand therapy, bypassing the Virtual Fracture Clinic when surgery is not required. Additionally, an Advanced Practice Occupational Therapist has been embedded within the Upper Limb Fracture Clinic to improve collaboration between therapy and surgical teams. Evaluation shows this model delivers care that is more efficient than traditional pathways, reducing unnecessary appointments and enabling timely, patient-centred care.

Advanced Practice Orthotists in NHS Greater Glasgow and Clyde accelerate patient diagnosis and treatment, reduce reliance on other services and minimise unnecessary hospital visits. They undertake advanced clinical procedures, including ultrasound-guided botulinum toxin injections for spasticity, local anaesthetic injections for musculoskeletal (MSK) diagnostics, and the ordering and interpretation of imaging tests such as X-ray, ultrasound, and Magnetic Resonance Imaging. This expanded scope has significantly enhanced care for patients with complex MSK, neurological, and diabetic needs, while creating new development opportunities for orthotists.

Advanced Practice Physiotherapists in an integrated spinal service in NHS Lothian work closely with MSK physiotherapists, neurosurgeons, neurologists, primary care clinicians and pain specialists to provide seamless diagnosis, management and care coordination for people with lumbar and cervical spine complaints. They manage lower complex/non-surgical cases re-routed from neurosurgery/neurology/orthopaedics and higher complex cases escalated from adult MSK physiotherapists, removing the need for patients to return to their General Practitioner (GP) for additional referrals or investigations

Advanced Practice Orthoptists in NHS Lothian now assess and manage new adult strabismus patients with double vision, who were previously referred to Consultant Ophthalmologists. Through expert assessment, diagnosis and non-surgical treatment planning, they improve patient outcomes and reduce the risk of falls, while freeing consultant capacity for more complex cases.

Priority area – Shifting the balance of care

An Advanced Practice Speech and Language Therapist within the NHS Lothian Ear, Nose and Throat (ENT) referral pathway delivers a flexible laryngoscopy service for patients with new, low-risk voice symptoms. This model provides direct access to the specialist best placed to manage patients’ needs, reducing waiting times and freeing ENT capacity to prioritise patients with suspected cancer. Evaluation demonstrates the service is safe, effective and patient-centred with high attendance rates, strong patient satisfaction and a more streamlined pathway to voice therapy.

Advanced Practice Paramedics in Urgent and Primary Care rotate through remote consultations, Scottish Ambulance Service car responses, and primary care settings to deliver advanced assessment, independent prescribing, referrals and discharge. This model has significantly reduced unnecessary hospital conveyance, improved access to urgent care through utilisation of referral pathways and enabled early intervention for people with complex needs.

An Advanced Practice Podiatrist in NHS Shetland undertook specialist vascular training and developed a local vascular screening pathway. Patients with signs of claudication or Critical Limb Threatening Ischaemia are referred directly to podiatry, triaged by the podiatrist and assessed using advanced vascular screening techniques. This model has reduced waiting times, streamlined referrals for advanced imaging and eased pressure on surgical services. Earlier diagnosis and intervention have improved outcomes, including fewer hospital admissions and reduced risk of limb loss.

Priority area – Digital innovation and technology enabled services

Advanced Practice Podiatrists are using technology-enabled care to improve outcomes for people with diabetes foot disease in NHS Highland. This has supported faster, more accurate diagnosis and management decisions, prioritising those most in need for specialist input via remote consultations and reducing the need for unnecessary travel and in-person appointments. Additionally, collaboration with the multidisciplinary foot team has enhanced access to specialist expertise, enabled more coordinated care and improved patient experience.

Advanced Practice Physiotherapists in NHS Highland have transformed access to MSK services through a digital-first approach. This includes a digital triage and assessment tool for rapid, accurate identification of patient needs and a supported self-management programme that empower patients to take an active role in their recovery. Almost half of patients who use the app require no further NHS intervention, reducing demand on MSK services and freeing up capacity. It also provides 24/7 access to timely, evidence-based support, improving patient experience and equity of access.

Priority area – Prevention and early intervention

Advanced Practice Physiotherapists in NHS Dumfries and Galloway are playing a key role in preventing fractures by providing early assessment and intervention in primary care. They have been trained to assess bone health using tools such as the QFracture risk assessment and refer patients for appropriate investigations such as DXA scans. This has reduced fracture risk, decreased demand on healthcare services and improved patient outcomes.

Priority area – Care designed around people rather than the ‘system’ or ‘services’

Advanced Practice Neurologic Music Therapists (NMTs) work across in-patient and community services, delivering functional, holistic interventions that address motor, speech, cognitive and psychological needs for patients with neurological conditions. Patients report that NMT improves mood, reduces anxiety, enhances engagement in rehabilitation and supports self-management of their condition, as well as improving physical, speech and cognitive functions. In one service inclusion of NMT services in neurorehabilitation led to patients being discharged 5.5 days earlier, resulting in cost savings of around £10,000 per patient.

Advanced Practice Speech and Language Therapists in NHS Lothian have been integrated into the Neurodevelopment Pathway within CAMHS, working alongside Psychiatry, Psychology, Occupational Therapy and Nursing. By using their advanced practice skills to embed inclusive communication strategies and adapt traditional medical and psychological models, they have helped create more equitable and effective services for young people with severe communication and behavioural difficulties and their families.