Assistant practitioners in the NHS

Newsletter articles

11 Mar 2015

Employment Studies Issue 21

Linda Miller, IES Senior Research Fellow

Demand on the NHS is steadily increasing, with no sign that this will subside in the near future, if recent news items are anything to judge by: there have been reports that pressure on hospital A&E departments has led several to declare ‘major incident’ status. These pressures have led managers to consider potential ways in which services can be delivered more cost-effectively. One of the questions that managers have particularly considered is the nature of the tasks that require professionally-qualified staff – those at band 5 and above in the NHS ‘Agenda for Change’ grading and pay structure – to undertake them.

Demand is not the only factor prompting such considerations. In many areas, technology has changed the nature of the skills required. Tasks that previously needed highly-skilled individuals can now be undertaken by machines. In addition, the evolution of medical technology has changed the nature of the work itself and the nature of service provision. The current focus on joining up health and social care provision – the ‘integrated care’ initiative – too has served to change the types of employees and skills required.

These changes are in line with predictions made as part of work that IES undertook for Skills for Health (SfH), the Sector Skills Council for the health sector. That work1, undertaken in 2010 and aimed at helping SfH to understand the likely shape of the future healthcare workforce, revealed that the profile of the workforce was likely to change significantly. Many of the new posts that would need to be filled over the next 10 years were expected to sit at band 4 in the employment hierarchy. New roles such as a Generic Community Worker, a Personal Health Navigator and a Remote Diagnostic Technician were identified – roles that were completely different from any previously seen in the health sector, predicted on the basis of the large-scale changes to service delivery that have been seen in the NHS, alongside the increasingly sophisticated technologies available to healthcare workers.

Sitting at band 4 in the pay and grading structure, these posts fall into the ‘senior support worker’ category. Such posts – along with others at band 4 – constitute a career progression option for healthcare assistants and support workers, the majority of whom are employed on bands 2 and 3. Most often these posts are referred to as ‘Assistant (or Associate) Practitioners’.

Since 2010, there has been significant growth in the number of these jobs. That said, however, developments have been patchy: while some areas have seen increased use of these roles, other areas lag behind. Given SfH’s remit to support workforce development in the health sector, it was of interest to explore the nature of the barriers to development of these roles, and the types of support employers need in introducing such changes to workforce profile. SfH therefore commissioned IES to undertake two studies, the first of which examined the situation in Wales2, while the second examined factors affecting the introduction of assistant practitioners in England3.

Both projects revealed that assistant practitioners are helping with service delivery in a range of clinical, community and laboratory situations. The work identified examples of their use in radiography and screening services, in cellular pathology laboratories, in smoking cessation clinics, learning disability services, neuro-rehabilitation services, pre-operative assessment, pulmonary resuscitation, stroke rehabilitation, ophthalmology and emergency admission units, as well as in wards. There is growing recognition of the value of these posts, and stakeholders across the sector identified many positive examples of how the Assistant Practitioner role is contributing to improvements in quality, productivity and efficiency. Importantly, in the context of the drive to provide more integrated care, they are increasingly seen in roles that cross health and social care and professional boundaries, with re-ablement officers already being employed by at least one local authority (in partnership with the NHS) in a role that combines health and social care competences to improve support in the community for people with long-term conditions.

The research also shows that Assistant Practitioner posts are more likely to be successfully introduced where their development is part of workforce planning. Assistant Practitioner posts succeed where their introduction within a team meets a clearly identified need and where the new roles and responsibilities – both of the Assistant Practitioner and of the wider team – are clear and understood. Staff engagement with the implementation process, and ensuring that all grades of staff benefit from the changes, are central to success.

However, the introduction of Assistant Practitioner posts often appears to be prompted by the appearance of funding rather than planning. The research also found a lack of consensus regarding the clinical areas in which they are able to practice, with variations seen both between Trusts and between departments within a Trust. There remain, too, concerns around delegation and supervision and the lack of registration and regulation, although there are notable differences between occupational groups on these points. Some organisations have started to make steps to address these issues, with a great deal of success. These potentially provide a model for future developments and examples are given in both reports of the approaches adopted by employers and professional bodies.

The Francis4 and Cavendish5 reviews have led employers to be wary of providing training that might be challenged as being of insufficient quality or rigour. Given the wide range of education and training routes available (including but not limited to foundation degrees, apprenticeships, HE Certificates and Diplomas and NVQs), it is unsurprising that employers seeking to introduce Assistant Practitioner roles would value information about the education routes chosen by other employers.

Both reports conclude with recommendations for a range of ways in which Skills for Health can help employers in the sector to further embed the Assistant Practitioner role and expand its use in the future. There is likely to be an increasing need for support in future: while the focus of developments to date have largely been in acute settings, the changes planned for how healthcare is delivered will mean that there is likely to be an increasing focus on the need for Assistant Practitioner posts in primary and community care in future.

The report Assistant Practitioners in the NHS in England, by Miller L, Williams J, Marvell R and Tassinari A, will be published shortly by Skills for Health and will be available as a free download from its website:

The earlier report Assistant Practitioner roles in the Welsh Health Sector: Enhancing the potential for future development (2014) Miller L, Williams J, Edwards H, is available from:


  1. Miller L, Fairhurst P, Hurley P (2010) ‘Uncertain Futures: Scenario Building for Skills for Health’. Bristol: Skills for Health. Available as a download from:
  2. Miller L, Williams J, Edwards H (2014) Assistant Practitioner roles in the Welsh Health Sector: Enhancing the potential for future development Skills for Health
  3. Miller, L, Williams, J, Marvell, R and Tassinari, A (2015) Assistant Practitioners in the NHS in England. Skills for Health
  4. The review following on from the reports of ill-treatment and increase mortality rate of patients at Mid Staffordshire Trust
  5. Review of preparation and training given to health care support workers