The impact of advanced clinical practitioner roles in general surgery on patient care and the surgical workforce: a scoping review

Advanced Clinical Practitioners (ACPs) are increasingly embedded within UK surgical services, contributing to clinical delivery in the context of rising workforce pressures and service demand. However, despite national efforts to standardise the role, the scope and integration of ACPs in general surgery remain poorly defined. There are limited studies exploring the role of ACPs within general surgical departments. Therefore, this scoping review aimed to map the literature on ACPs in general surgical departments, examining their roles, impacts, and barriers to integration. Methods A scoping review was conducted using Arksey and O'Malley's (2005) methodological framework and the PRISMA-ScR reporting guidelines. A systematic search of five databases (MEDLINE, CINAHL, PsycINFO, Cochrane, and SCOPUS) and grey literature sources was undertaken from 2010 onwards. Severn studies were selected through a five-stage screening process, and data were extracted using a structured template. Thematic analysis was used to synthesise findings. Results Seven studies were included, all of which demonstrated ACP engagement across the full surgical pathway, including triage, clinical assessment, diagnostics, perioperative coordination, and discharge planning. ACP involvement was consistently associated with improved service timeliness, continuity of care, diagnostic accuracy, and patient satisfaction. All studies aligned with the clinical practice pillar of ACP (100%), while fewer addressed leadership (43%), education (29%), and research (14%). ACPs also positively influenced team dynamics by enhancing staff confidence, supporting junior doctors, and improving workload distribution. However, barriers to integration were evident, including inconsistent governance, unclear role boundaries, limited prescribing rights, and lack of recognition across NHS settings. Conclusion ACPs are central to clinical service delivery in general surgery but remain underutilised beyond direct care. Strengthening role clarity, governance structures, and development opportunities across all four pillars of practice is essential to optimise their contribution and support the sustainability of surgical services.