Chelsea and Westminster NHS Trust

Leading the Quiet Revolution in Advanced Practice

Chelsea and Westminster NHS Foundation Trust has emerged as a standout example of how Advanced Clinical Practice (ACP) can be embedded strategically within a complex healthcare organisation. This transformation didn’t happen by chance it was the result of a carefully cultivated vision, sustained leadership investment, and effective communication at all levels, particularly with the Trust executive team.

The journey began in 2020 with a strategic workforce review initiated by Nicola Rose, Deputy Chief Nurse. Early findings revealed a fragmented ACP landscape, roles were inconsistently defined, governance structures were lacking, and recognition of ACP contributions was uneven across departments. With the support of the Chief Nurse and the Executive Leadership Team, Nicola presented a compelling case for change. By aligning the ACP agenda with organisational priorities such as workforce sustainability, service redesign, and integrated care, she secured board-level endorsement and catalysed a programme of transformation.

Executive level engagement has been key to this success. Regular updates to the executive board have ensured that ACP progress remains visible and aligned with the Trust’s broader objectives. The ACP lead has a direct reporting line into senior nursing leadership, and ACP development is now part of divisional and service-level planning conversations. This has created the conditions not only for scale but for sustainability.

A major turning point came with the appointment of Antonia Gerontati as Consultant Nurse and Lead for Advanced Practice, who is a Surgical Care Practitioner in January 2025. Her consultant level role provided the operational traction needed to deliver on the strategic vision, standardising processes, driving governance improvements, and expanding ACP opportunities across clinical specialties. She has also secured more than 30 ACP apprenticeships for the next semester across Nursing and AHP backgrounds. She has encouraged peers working across the four pillars to apply for ePortfolio recognition, along side this she has hosted a presentation from the King’s Fund team on compassionate leadership and secured an inspirational message from Lord Darzi (see below).  Together, Nicola and Antonia have ensured that ACP is not seen as a niche initiative, but as a core component of the Trust’s workforce transformation strategy and are trailblazing a model of Advanced Practice that is both visionary and grounded in real-world implementation.

This local vision has also been carefully aligned with national direction. The NHS Long Term Workforce Plan places ACP at the heart of future healthcare delivery, calling for a significant increase in training numbers. The Trust’s strategic commitment to ACPs ensures that it is well-positioned to respond to these national targets, particularly through its focus on growing its ACP workforce pipeline, supporting professional development, and embedding robust governance systems.

Voices from the Frontline

The success of Chelsea’s ACP programme is perhaps best reflected in the experiences of the ACPs themselves:

Luca Cianfrani, a urology ACP trainee, highlights the structured support he’s received, including protected time for study and clear clinical progression. From mastering flexible cystoscopies to contributing to cancer surveillance pathways, his journey reflects the value of aligned clinical and academic development.

Amy Banning, a physiotherapist turned ACP in orthopaedics, underscores how Chelsea helped her transition into an advanced role post-MSc, tailoring the job description and recognising her unique skill set. She’s now actively shaping policy on enhanced recovery while maintaining a strong clinical identity in elective joint clinics.

Anthony Greeves and Felicity Jones, ACPs in acute medicine, speak of breaking down barriers during the early days of ACP at Chelsea. Despite initial confusion and shifting expectations, they’ve built continuity, trust, and leadership credibility, eventually influencing SDEC service redesign and antimicrobial stewardship at a national level.

Miti Rach, a pelvic health ACP, exemplifies the four pillars of advanced practice in action. From gender-inclusive care, leadership, and clinical research in urogynaecology to strategic input at board level, her portfolio showcases what’s possible when diverse expertise is recognised and supported.

Strategic Alignment: The Three Shifts

Chelsea and Westminster’s advanced practice programme exemplifies all three of the radical shifts outlined in the government’s 10 Year Health Plan for England:

1. From hospital to community
The Trust is actively integrating Advanced Practitioners across care settings, from outpatient clinics, to expanding virtual wards and follow-up pathways, while also strengthening collaboration with the community. This mirrors the Plan’s vision to bring care closer to where people live through Neighbourhood Health Services and reduce reliance on inpatient care. ACPs like Miti are leading the way by delivering specialist services in pelvic health and urogynaecology not only within hospital walls but also by educating patients to manage aspects of their care at home and supporting treatments that may help them avoid surgery altogether, ultimately easing pressure on secondary care.

2. From analogue to digital
Chelsea’s ACPs are using digital tools, in virtual consultations, remote monitoring, and shared records to streamline care. This aligns with the Plan’s vision of the NHS becoming a digital-first, patient-empowered system via the NHS App and unified data platforms. For example, Luca’s cancer surveillance work is supported by electronic systems and telehealth, making specialist support more accessible.

3. From sickness to prevention
The Trust places prevention and early intervention at the core, in line with the shift toward proactive care. ACPs in orthopaedics, urology, acute medicine, and pelvic health deliver enhanced recovery programmes, proactive surveillance, and health-promotion clinics, reducing hospital admissions and catching health issues earlier.

Creating a Culture of Possibility

What makes Chelsea and Westminster unique is its belief in potential. Rather than waiting for top-down policy changes, the team has proactively shaped its ACP environment, securing more than 30 apprenticeships for the next semester across Nursing and AHP backgrounds, identifying future consultants and developing career pathways, but also encouraging practitioners working across the four pillars to apply for ePortfolio recognition. Development pathways are being designed that value lived experience as much as formal titles.

Antonia and Nicola leadership and systems thinking, reinforce the idea that success isn’t just about finances or outcomes, it’s about building a culture where ACPs can thrive. This ethos is reflected in the everyday work of the ACP community and in the Trust’s commitment to meaningful, sustainable growth.

As Nicola puts it, “We want advanced practitioners in every department that would benefit from them.” And with leadership that champions ambition without ego, and ACPs who see their development as integral to service change, Chelsea is not just adopting advanced practice, it is defining its future.

In the words of Lord Darzi, who sent a personalised video message to their ACP forum: “Advanced Practice is the quiet revolution.”

At Chelsea and Westminster, that revolution is now in full voice and perfectly aligned with the NHS’s vision for the decade ahead.

Editorial and Interviews by: Ajay Bhatt NHSE – Advancing Practice Faculty London