h Authority), Greater Manchester, and Cumbria and Lancashire to focus on the learning curve at a professional level while achieving academic skills (Advanced Practice Framework, 2005). This is a part of the NHS plan to create a patient led NHS aiming toward client focus and their choice of primary care (Cross et al. 2004). North West NHS has developed a workforce strategy to ensure a sufficient workforce capacity in all health organizations by shifting the current roles of the workforce (Advanced Nursing Practice, 2009). The role of the advanced practice nurses especially is undergoing a lot of changes due to the increased rules and regulations of NHS and NMC (Geest et al. 2008). A measure for efficiency has been developed called productive time which measures the time spent by professionals and nurses on core activities of advanced practices (Cross et al. 2004). By implementing such strategy the Department of Health and the NHS is expected to achieve £6.5bn by 2008 out of which £3.8bn is due to productive time (Burgess, 2007). Still enormous progress needs to be made that can make the service more improved (The future: A mini Prospectus, 2002). The HPC is also stepping in to regulate the practice and training of the professionals and to protect the people (HPC, 2007; Guthrie, 2009).
On the national level, the European Working Time Directive (EWTD) driver has been seen to create different reactions from medical professionals (Little & Bluck, 2006). The main problem that arises is due to the work hour limit defined by the EWTD (Bates & Slade, 2007). The shift in the time limit from the previous 58 hour per week to 48 hour per week is been felt severely by the education and training medical institutions as well as in the delivery of service (Little & Bluck, 2006). The most effect is on the training of new juniors. According to Bates and Slade (2007), the time constraint has had many implications on the operative experience of the surgical trainees making the level