The aim of this literature review was to examine advanced practice in relation to the role of the district nurse. A significant finding was a paucity of evidence relating to advanced district nursing roles, which may influence future development of the service. A hypothesis drawn from the data is that district nurses are pro-actively advancing their practice but in doing so are changing their role rather than remaining in district nursing. The searched literature supports advanced nursing roles in terms of safe clinical practice, but questions remain over their cost effectiveness. In-depth analysis of the literature also revealed a correlation between the power of the medical profession and advanced nursing practice in primary care.