The overabundance of advanced/specialist job titles in nursing has been a longstanding cause of concern among practitioners, planners, the Nursing and Midwifery Council (NMC) and the public. Diverse titles are unlikely to support public understandings of the level of care they can rightly expect from such staff.

We recognise that there have been significant changes in the way that services are delivered to patients, with nurses, midwives and other non-medical professionals undertaking treatment and care that was once the domain of medical staff. As we've already identified, however, there are many nurses who hold job titles that imply an advanced level of nursing practice without having evidence of an advanced level of nursing knowledge and competence.

There are also many nursing staff who do possess the attributes commonly associated with advanced practice and who undertake advanced practice activity, but who lack a standardised role title and consistent expectations about their skills or continuing development requirements.

Effective, high-quality and safe health care delivery is increasingly dependent on multiprofessional teams and the contributions of many health professions, including those working in expanded or enhanced roles. We need to ensure proportionate regulation and governance arrangements based on risk assessment for all the professions involved.