What is the current position of advanced level practice for speech and language therapy and occupational therapy?
Advanced practice encompasses a number of roles, across settings and sectors. As defined by all four Chief Allied Health Professions Officers (CAHPOs) across the UK, advanced practice is a level of practice which involves complex decision making and care, underpinned by postgraduate master’s level learning or equivalent. It comprises the 4 pillars of practice and is delivered by experienced professionals who demonstrate significant autonomy, judgement and responsibility in their roles.
Currently, there are occupational therapists and speech and language therapists working at advanced level practice within certain roles and settings. These individuals are leading the way for our professions. We need to harness their expertise and continue to build our professions’ articulation of advanced practice in alignment with our core values. This level of practice is not new, but our understanding and ways of conceptualising it is evolving. Optimising the potential of occupational therapy and speech and language therapy advanced practice will enable us to deliver services based on population need. We will meet health and care needs in our communities effectively, and align our practice with health and care reform, focusing on:
- prevention and early intervention
- acute to community care
digital-based solutions
Here are some useful links relating to advanced practice across the four UK nations:
Four-country-ap-statement-oct-2024.pdf
Transforming Roles paper 9: allied health professions advanced practice - gov.scot
Multi-professional framework for advanced practice 2025 - Advanced Practice
Professional Framework for Enhanced, Advanced and Consultant Clinical Practice - HEIW
Advanced AHP Practice Framework | Department of Health
What challenges have we faced with advanced practice?
Although our existing advanced practitioners have made great progress for our professions, we have historically faced challenges, including: access to training, clarity of roles, job profiles, workforce planning and course inclusivity. Therefore, in 2024, the ‘Reimagining advanced practice’ project was jointly commissioned by RCOT and RCSLT.
A new conceptual model positions advanced practice through the lens of social justice and the social determinants of health. This broadens and deepens the profession-specific nature of advance practice for occupational therapy and speech and language therapy. Whilst advanced practice in medically aligned teams needs to continually be supported, developed and valued, we also need to broaden the narrative about advanced practice to meet the biopsychosocial needs of the populations we serve.
Find out more about the future of advanced practice in this report and webinar-
Advanced practice | RCOT
Advanced Practice | RCSLT
How does advanced practice relate to prescribing rights?
Historically, many advanced practice roles within biomedical model settings, required independent prescribing. But, as scope of practice evolves and health and care move forwards, these historical perceptions have been challenged. Having independent prescribing rights is not a prerequisite or a defining feature to work at the advanced level of practice.
Whilst enhancing prescribing responsibilities for occupational therapists and speech and language therapists would be beneficial in certain roles and settings, it does not define advanced practice. Advanced practice involves complex decision making and care, underpinned by postgraduate master’s level learning or equivalent . It comprises the four pillars of practice and is delivered by experienced professionals who demonstrate significant autonomy, judgement and responsibility in their roles (see Chief Allied Health Professions Officers four nations statement four-country-ap-statement-oct-2024.pdf). Therefore, advanced practice is about the value and impact of this level of practice and is not related to a specific task.
RCOT and RCSLT continue to collaborate with other AHP professional bodies to advocate for enhanced prescribing responsibilities, as we recognise the benefits for this in certain roles and settings. We are waiting on the UK government to make changes to legislation but in the meantime, it is worth considering other mechanisms for the supply and administration of medicines. These include Patient Group Directions (PGDs).
What does the future of advanced practice look like?
Based on the outputs from the Reimagining Advanced Practice project 2024-2025, the future of advanced practice is about supporting those already in advanced practice roles, whilst also strengthening and broadening our professions’ position for the future. The new articulation of advanced practice for occupational therapy and speech and language therapy, realigns us with the core values of our professions.
Articulating advanced practice through a lens of social justice, ensures our practice and vision takes a biopsychosocial perspective. e.g. tackling health inequalities and responding to changing societal and population needs. This vision for the future embraces inclusivity. It recognises the potential for advanced practice across all four nations, across health and care settings, and in statutory and non-statutory services. Ultimately, we hope to work collectively to realise the potential of our workforce through strengthening our existing position, and growing profession-specific advanced practice opportunities for the future.
Why is this a change movement?
This is a change movement because it requires a significant, collective effort; spanning education, provider organisations, leadership, research, and practice. We need to create an integrated workforce that meets evolving needs. This change movement connects to global strategies, and positions advanced practice as part of a broader transformation in health and care systems.
The articulation of advanced practice through the lens of social justice and health inequity, perfectly positions our professions to deliver services based on the broadest needs of people and populations. This is pivotal for achieving the ambitions of health and care reform. This new articulation of occupational therapy and speech and language therapy advanced practice challenges existing assumptions and enables the development of new pathways of care. These may be supported by less traditional workforce models.
This change movement is bigger than RCOT and RCSLT as professional bodies. We need to join this journey together, and ask-
• what can you do?
• what can the regulator do?
• what can managers, services and organisations do?
• what can workforce planners and strategic leaders do?
• what can education do?
• what can leaders do?
• what can research do?
Who is this relevant for?
The future of advanced practice is relevant to anyone who wants to advocate for this change movement and recognises the potential of this articulation of advanced practice. This is inclusive of all four nations and has the potential to make changes on a significant scale.
It is relevant for:
• any setting or area of practice- statutory, non-statutory,
voluntary and independent practice
• multiprofessional teams
• educators
• leaders- policy makers, operational managers, workforce planners, strategic leaders
• researchers
• clinicians/practitioners.
Ultimately, this change is essential for our communities, society and populations we serve as it has the potential to transform the future of health and care.
What is the role of the professional body in influencing education, training, funding and resources?
RCOT and RCSLT will collaborate with key partners, including regulators and employers to drive the development of education, training and funding. We will need to build an in-depth understanding of what is required, followed by the development of mechanisms to enable the change. We will work together to deepen understanding of curriculum needs, educational needs, career development frameworks, strategic targets and future accreditation processes. It will need to be adaptable to meet the future needs of the population whilst being consistent and safe. We will ensure practice influences education provision, and that access is considered across professions and pathways. The ambition is to work with education providers to have shared principles around advanced level practice.
This is not about creating bolt-on solutions or replacing existing pathways, this is about producing alternative pathways to broaden opportunities. Therefore, funding processes should remain the same, no matter which pathway to advanced level practice you choose.
Please follow your countries link below for more information on funding:
How will roles be developed, and career pathways created?
This change movement will encourage advanced level of practice to be viewed in different ways to offer an alternate pathway for those who work in a range of settings. The key focus will be on the impact of social determinants on health and care outcomes. This will be consistent with existing pathways to an advanced level of practice and may result in developing new roles.
As the professional bodies, we will look at how we can support health and care professionals, employers, education providers and arms-length bodies to develop resources to support the change movement and ensure it is aligned to strategic targets. With support from members, we will aim to develop toolkits, career pathway examples, guidance for employers and resources to support career development and encourage this shift.
Will advanced practice be regulated and accredited?
Speech and language therapists and occupational therapists working at the advanced level of practice are already statutorily regulated by the Health and Care Professions Council (HCPC) with standards in place to set out the skills, knowledge and behaviours required to practice. All registrants, at all career levels, must work within their scope of practice, appropriately evolving it with additional training if they wish to widen it (Standards of conduct, performance and ethics | The HCPC).
The role of regulator is to protect the public. HCPC has determined that existing regulatory arrangements are in place to manage any risks. Therefore, no additional regulation is required for HCPC registrants at different levels, including the advanced level of practice (Updates on Advanced Practice | The HCPC)
HCPC has recently led work to support registrants, managers and strategic leaders in understanding scope of practice at the advanced levels of practice (Scope of practice, supervision and delegation at advanced levels of practice (2025) - YouTube) and further resources are planned for publication in 2026.
Additionally, many courses in England are accredited through the Centre for Advancing Practice so learning is also standardised and accredited. Advanced level of practice is also standardised through each nations advanced practice framework, setting out clear competencies across all 4 pillars of practice and methods to meet these standards. There is a useful definition from across the Chief AHPs from NI, Scotland, England and Wales which provides consensus. More information from HCPC and their standards can be found here: https://www.hcpc-uk.org/globalassets/news-and-events/blog/four-country-ap-statement-oct-2024.pdf
How will equity, diversity and belonging be embedded?
Principles of equity, diversity and belonging (EDB) are core to the future of advanced practice demonstrated by its articulation through a lens of social justice and the social determinants of health.
Historical inequity still exists, particularly in career opportunities and development. We will work with members to understand these challenges and ensure this pathway provides equal opportunity to progress and develop. This inequity extends to service users so we will work with services to meet the needs of society, removing inequalities within health and care.
As EBD is core to this change movement, those who engage and join this journey have a responsibility and commitment to embed EDB throughout and beyond. EDB will be embedded from an educational perspective, through workforce planning, through delivery of service models and integrating this change across leadership, research, clinical practice and education.
Are other professional bodies included?
As allied health professions (AHPs), we are stronger united. A change movement is more powerful when we work together. Therefore, we are keen for other AHPs to be involved. However, we also recognise the individual differences between professions, so at certain stages there may be a requirement to focus on individual professions.
What are the next steps?
- Working with key partners to create an FAQ to be shared on the webpage
- conversations across the four countries to consider next steps
- Workshop with education providers to consider translating this through education and practice
- Conversations with strategic leaders and operational managers about how this can practically be translated into workforce planning
- Socialising the concept of advanced level of practice through social justice lens with members and wider OT/ SLT community – encouraging a change movement
- Work collaboratively with education providers to explore the potential of developing and credentialing advanced practice programmes.
How can I get involved and be a change maker?
We value everyone's input in this change movement. Whether you are already an advanced practitioner after following the traditional route or have not felt advanced practice was for you due to your clinical focus, your input will be invaluable.
As professional bodies, we will support your involvement by running podcasts and events for you to participate in. We will aim to develop toolkits to support the movement and express how this pathway to advanced level practice is different.
Away from the professional body, you can continue to drive this forward. We need to engage in communities of practice and professional networks, sharing resources and encouraging others to discuss how this could work in their settings. Participating in conversations around advanced level practice, social justice and health inequalities will contribute towards AHPs being recognised in this space and promote the existing knowledge, skills and behaviours in the workforce. Presenting at conferences and leading conversations at team meetings will all contribute towards this change and ensure you are central to the movement.
We look forward to welcoming you to this movement, please reach out to us, your professional body or your manager and see how you can continue to push this forward.