IntroductionAdherence to medicines in osteoporosis is poor, with estimated 1 year persistence rates between 16% and 60%. Poor adherence is complex, relating to combinations of fear of side effects, beliefs about medication being unnecessary, doubts about effectiveness and the burden of medication management. This is compounded by an absence of monitoring, as many patients are effectively discharged from ongoing care following the initial prescription. Clinical pharmacists in general practice are a relatively new workforce in the UK NHS; this is an unexplored professional group that could provide person-centred, adherence-focused interventions in an osteoporosis context.A model consultation intervention to be delivered by clinical pharmacists in general practice for patients already prescribed fracture prevention medications will be developed using existing evidence and theory and empirical qualitative work outlined in this protocol.Methods and analysisWe will investigate the current practice and barriers and facilitators to a clinical pharmacist-led osteoporosis intervention, including exploring training needs, through focus groups with people living with osteoporosis, pharmacists, general practitioners, osteoporosis specialists and service designers/commissioners. Framework analysis will identify and prioritise salient themes, followed by mapping codes to the theoretical domains framework and normalisation process theory to understand integration and implementation issues.We will further develop the content and model of care for the new consultation intervention through co-design workshops with stakeholder and patient and public involvement and engagement group members. The intervention in practice will be refined in a sequential process with workshops and in-practice testing with people prescribed fracture prevention medication, pharmacists and the multidisciplinary team.Ethics and disseminationEthical approval was obtained from NHS North West—Greater Manchester South Research Ethics Committee (Ref 23/NW/0199). Dissemination and knowledge mobilisation will be facilitated through a range of national bodies/stakeholders. Impact and implementation plans will accelerate this research towards a future clinical trial to determine cost and clinical effectiveness.

Approaches to nurse education vary internationally.Our approach in the United Kingdom (UK), together with countries including Germany, Italy, and Republic of Ireland is unusual, where fieldspecific undergraduate nurse education programmes are standard.This approach allows nurses to register as children's nurses without undertaking generalist training beforehand.Recently, arguments have been made for a move back towards generalist nurse education (Purssell and Sagoo, 2023).This has been met with passionate refutation from children's (Fallon, 2023), learning disability (Cogher, 2023), and mental health (Warrender, 2022) nursing colleagues.Internationally, generalist nurse education is standard (van Kraaij et al., 2023).In most countries, nurses wishing to specialise in the care of babies, children or young people, or other specialities undertake post-registration, postgraduate training (Clarke, 2017).Arguments for generalised education surround the universality of this approach, where all nurses are trained to meet the needs of people across a lifespan.Purssell and Sagoo (2023) suggest that removing general elements of nurse education in the United Kingdom has resulted in an inflexible British nursing workforce.In 2018, the UK nursing regulator, Nursing and Midwifery Council (NMC) launched new education standards, designed to tackle the health of the UK population, following national inquiries and reports, including Prime Ministers Commission (2010), Francis (2013), and Keogh (2013).These Future Nurse Standards (NMC, 2018) have led to a move towards 'a model, constructed on quantifiable skills and competencies ' (Connell et al., 2022:473) that are applied to all preregistration nursing students, regardless of field.This approach undermines elements of a children's nurses' role, owing to the generic, skills-based design.Our question is should our children's nursing baby be thrown out with associated bathwater?As children's nursing academics involved in providing care and educating future children's nurses, we strongly support the preservation of

Implications for practice and research• Workforce planning needs to move from 'what role is needed' and focus should be on the level of practice required for service demand.Planners must appreciate the contributions and limitations of practice different ACPs bring.• Research is needed particularly with the current review of advanced practice regulation by the NMC and to move beyond capturing the advancement of roles to exploring changes, in practice and education, and evaluating the improvements made.

Community children's nurses provide a vital service between the hospital and home environment, supporting children, young people and families with their health needs. In the UK, the number of educational pathways providing a specialist practitioner qualification in community children's nursing has declined significantly in recent years. This has left many community children's nursing services with little or no access to educational programmes, despite the rising demand. The four UK governments, together with regulatory bodies such as the Nursing and Midwifery Council, have embarked on ambitious transformation of post-registration career frameworks and standards, the long-term impact of which is uncertain. This article discusses an approach that one community children's nursing service in Scotland took to address these challenges by liaising with a local university and accessing a bespoke advanced practice programme.

Robin Hyde considers some of the anxieties around advanced practice and reflects on how to allay these

Aim: To critically appraise and synthesise the current evidence related to the advanced practice nurse (APN) in the children and young people's healthcare setting. Background: A complex landscape of demand and change has influenced the healthcare delivery for children and young people. In the United Kingdom and internationally, governments have endorsed the need for workforce innovation with APN roles introduced to counter these challenges. However, little is known about the impact of these initiatives in the context of children and young people's health care. Design: Systematic review and narrative summary. Data sources: CINAHL, MEDLINE, DARE, PubMed, Prospero and Cochrane Database of Systematic Reviews were searched for studies published in English language from July 1998 to 2018. Studies were selected based on key search terms and eligibility criteria. Review methods: The selected studies were appraised using the Effective Public Health Practice Project for quantitative studies. An adapted version of the JBI data extraction tool for experimental/observational studies was used to extract the relevant key findings. This was conducted independently by two researchers. Results: Nine studies were included in the review. The review demonstrated roles were comparable in their clinical practice to medics yet offered higher levels of patient satisfaction, role modelling for staff and led practice initiatives to improve health literacy. Conclusion: This review demonstrates that APN roles in children and young people's health care provide clinical, organizational and professional benefits, with added value to organizations and patients, acting as role models and educators. Impact: The findings from this review indicate further research is required to ascertain contextual issues that may influence the implementation of APNs. This research will impact APNs working with children and young people. Equally, it supports the evidence base for service commissioners outlining areas for future research.

The NHS continues to face unprecedented demands and reform which necessitates a move away from traditional modes of delivery. Over the past ten years economic austerity, changes to legislation and professional career developments have led to healthcare service redesign and innovations in nursing roles, including the development of the advanced nurse practitioner (ANP) role. This article explores how one organisation created an ANP service for out-of-hours neonatal and paediatric care in a district general hospital setting. It was found that ANPs help to provide continuity of care, support learning, inspire continued professional development and lead on healthcare agendas. However, the ANP service faced factors not exclusive to local context including an ageing workforce, difficulties in recruiting and retaining suitably qualified staff and economic pressures. The future of the service depends on it overcoming these factors while demonstrating that the shift from traditional models of care can lead to a positive outcome.