Physiotherapy colleagues explore governing and assuring advanced practice outside of higher education institutions.
Professional education is continuing to shift. Increasingly, professional networks and bodies are developing their own standards and assessment frameworks for advanced practice, operating outside formal higher education institutions (HEIs) but designed to reflect postgraduate-level expectations. This change raises important questions about governance, quality assurance (QA) and the relationship between academic standards and professional self-regulation.
A live example comes from the Physiotherapy Pain Association (PPA), a professional network within the Chartered Society of Physiotherapy (CSP), the UK’s professional, educational and trade union body for physiotherapists. The PPA has developed a framework to credential advanced practitioners working in pain physiotherapy. This activity is not delivered through a university and does not sit within an HEI validation structure. However, it is benchmarked against level seven QA standards, with portfolios ultimately assessed through a higher education institution following professional grading, ensuring academic equivalence, external assurance, and postgraduate-level rigour – while remaining firmly owned by the professional network.
Physiotherapy is a regulated profession, governed by the Health and Care Professions Council (HCPC), which sets minimum standards for safe and effective practice. The development of profession-led advanced practice frameworks, such as the PPA model, exists beyond these baseline regulatory requirements, representing an additional layer of capability assurance led from within the profession itself.
Governance outside HE, quality assurance and level seven benchmarking
Unlike university programmes, external professional frameworks do not automatically sit within established academic boards or validation committees. To ensure trust and transparency, they must replicate or mirror key elements of academic governance: defining how level seven equivalence is evidenced, establishing transparent assessment and moderation processes, ensuring assessor training and calibration, and providing clear appeals and oversight mechanisms.
By building governance structures that parallel those used in higher education, professional bodies can offer credentials that withstand the same level of scrutiny as postgraduate programmes, without being controlled by universities, reflecting contemporary workforce development in clinical practice.
The credibility of these frameworks relies on demonstrating that their assessment processes match the complexity, criticality and synthesis expected of level seven study. This includes explicit capability statements and threshold criteria, assessment rubrics aligned with postgraduate descriptors, transparent moderation and peer review processes, and evidence of consistent, defensible assessment decisions. This approach mirrors NHS England’s model for advanced practice credentialing, where externally delivered programmes are mapped against level seven expectations to ensure national consistency and quality (NHS England, 2025).
Transparency and trust: assessor capability and calibration
Unlike HEIs, professional networks or groups may not have established assessment development structures. To ensure rigour, they must deliberately build: structured assessor training in interpreting level seven descriptors; shared exemplars and interpretation frameworks; moderation panels or peer review mechanisms; and separation of developmental support from summative decision-making. This effectively creates a parallel QA system with the same functions as university quality processes but led by the profession.
For external frameworks to be credible, their QA mechanisms must be visible and clearly articulated. This includes publishing standards and expectations, assessment and moderation processes, roles and responsibilities in decision-making, and the rationale for level seven equivalence.
Transparency signals seriousness and accountability. As Zdunek et al. (2024) reported, new forms of credentialing gain legitimacy not through title but through demonstrable QA structures that external partners can trust.
Navigating the boundary between HE and professional bodies
Professional body-led advanced practice frameworks do not need to be owned by universities to be credible. But they do need to demonstrate parity of standards. This shift represents a broader movement in which professional communities are taking a more active role in defining and governing advanced practice, engaging with HEIs on equal terms rather than in a dependent relationship.
A parallel can be seen in the Musculoskeletal Association of Chartered Physiotherapists (MACP), which has long operated processes of international alignment through International Federation of Manual and Musculoskeletal Physical Therapists Incorporated (IFOMPT) governance, structured educational oversight via its committee for education and approval, supervisor training requirements and HEI sign-off with external examiner input – demonstrating that credible professional governance can sit alongside, rather than underneath, academic structures.
For HE leaders, this is not a threat but a strategic boundary to be managed carefully. It requires shared language, clear benchmarking and mutual respect between clinical and academic communities.
From the PPA experience and comparable developments across professions, several transferable lessons emerge: governance must be formal and explicit, not informal or assumed; level seven equivalence requires evidence, not assertion; assessors must be trained and calibrated to apply standards consistently; transparency builds trust with external stakeholders; collaboration between HE and professional bodies strengthens credibility, while protecting professional autonomy.
Reflective thoughts going forward
The PPA’s development of an advanced practice framework illustrates how a professional network can create a credible, rigorous and transparent process for recognising advanced practice outside formal HE structures. By aligning with level seven expectations and embedding governance and QA processes that mirror academic systems, professional bodies can set and uphold their own standards. Importantly, this also creates additional and portable ways for employers to recognise, benchmark and recruit advanced practitioners, providing assurance of capability that is not tied to any single HE pathway.
This is part of a broader, continuous shift: professional communities are increasingly shaping their own pathways to advanced practice, and HE must continue to learn to work alongside rather than act as a gatekeeper.
Lead and corresponding author, Michael Mansfield, is an Assistant Professor in Musculoskeletal Physiotherapy at the University of Birmingham.
Leilia Heelas works within the OPTIMISE Pain Rehabilitation and Physiotherapy Research Units at Oxford University Hospitals NHS Trust.
Clair Jacobs is a clinician-academic at Guy’s and St Thomas’ NHS Foundation Trust and Brunel University, and PPA Co-Chair.
Tim Noblet is a Consultant Physiotherapist at St George’s University Hospitals NHS Foundation Trust, with adjunct and honorary academic appointments in Western University (Canada) and Macquarie University (Australia), and Co-Chair of the UK Advanced Practice Physiotherapy Network.
Rachel Stovell is a Specialist Pain Physiotherapist and PPA Co-Chair.
Jackie Walumbe is a clinician-researcher at University College London Hospitals NHS Foundation Trust, University College London and the NIHR North Thames ARC.
