Royal College of Podiatry's response to AHPs Deliver

The framework will replace AHPs Deliver and sets the long-term vision, direction and ambition for the 14 allied health professions within the health and care system. It aims to build on the progress made over the past decade while supporting AHPs to respond to strategic change, advance personalised care and develop a flexible, future-ready workforce.

The College's submission is here. 

Theme 1: Providing safe, high- quality and accessible services

1.  What would make the biggest difference to delivering safe, high-quality and accessible AHP services?

The single biggest change would be ensuring earlier, direct and equitable access to AHP services through integrated care pathways that enable people to receive care from the right professional at the right time. Across many systems, referral pathways remain fragmented, unnecessarily complex and dependent on gatekeeping processes that can delay access to specialist expertise. These delays can lead to avoidable deterioration, poorer outcomes and increased demand on other parts of the health and care system.

Early access to AHP services supports prevention, self management and timely intervention, reducing the need for more complex and costly treatment later. Evidence from NHS podiatry services demonstrates that rapid access pathways, community based services and multidisciplinary models of care improve outcomes, reduce pressure on acute services and prevent avoidable complications (Valabhji 2020). For example, timely access to podiatry can prevent foot ulceration, infection, amputation, and early death in people at risk of foot disease.   

The latest National Diabetes Foot Care Audit reinforces the importance of rapid access. In 2024-25, only 20.2% of people referred by a healthcare professional received their first expert assessment within three days, while 48.5% were seen between three and 13 days. The audit identifies time to first expert assessment as a key factor associated with being alive and ulcer free at 12 weeks and recommends that more than 70% of people with a new ulcer episode receive an expert assessment within 14 days. 

The new AHP framework should therefore prioritise direct access, integrated multidisciplinary pathways and neighbourhood based models of care that are designed around population need rather than organisational boundaries. Particular attention should be given to reducing inequalities in access, as people experiencing deprivation, homelessness, rural isolation, learning disabilities, and long term conditions often face the greatest barriers to timely support. Greater emphasis on outreach, prevention and proactive case finding would help ensure that AHP services contribute fully to the NHS ambition to move from treatment to prevention, from hospital to community, and from analogue to digital models of care. 

2.  How do you know when AHP services are safe and high quality?

Safe and high quality AHP services are characterised by positive patient outcomes, a good patient experience, equitable access, evidence based practice and strong professional governance. Quality should be measured through meaningful outcomes rather than activity levels or waiting times alone, demonstrating the value services deliver to individuals, communities and the wider health and care system. 

For podiatry, indicators of quality include reduced ulceration, infection, and amputation rates, improved wound healing, reduced falls, improved mobility, resolution of pain, maintenance of independence and timely access to care. Compliance with evidence based guidance, such as NICE guidelines, alongside workforce competence and effective multidisciplinary working, also provides assurance that services are delivering safe and effective care. Patient reported outcome measures and patient reported experience measures are equally important, helping to demonstrate whether services are person centred and improving quality of life. 

High quality services also show a clear commitment to continuous improvement through robust governance arrangements, regular audit, outcome measures, learning from incidents, participation in research and quality improvement activity. Services that routinely collect, evaluate and act on outcome data are better able to demonstrate value, identify areas for improvement and respond to changing population needs.  

The Royal College of Podiatry believes that nationally agreed outcome measures for AHP services would support more consistent quality assessment across professions and systems, enabling better benchmarking, fairer commissioning, quality assurance, and service improvement.  

Podiatry quality measures should include indicators for ulcer management, hospital admission and minor and major amputation rates, falls prevention and pain free days in MSK conditions. These should be analysed by deprivation, ethnicity, geography and other protected or underserved characteristics to identify unwarranted variation and inequalities.

3.  What helps AHP services deliver safe, high-quality care? 

Safe, high-quality AHP services depend on strong clinical leadership, multidisciplinary working, a skilled workforce and effective technology. Successful services create a culture of continuous learning, improvement and innovation that enables AHPs to work at the top of their scope of practice and maximise their contribution to patient care.   

This requires investment in education, supervision and mentorship, CPD, preceptorship, enhanced, advanced practice opportunities as a part of clear career pathways. Workforce development should be recognised as a fundamental component of service quality and patient safety, ensuring staff have the skills, confidence and support needed to deliver evidence based care. 

A sustainable podiatry workforce is fundamental to the delivery of safe, high quality care. However, podiatry continues to experience significant workforce supply and recruitment challenges, with the number of registered podiatrists failing to keep pace with rising population demand associated with an ageing population, increasing prevalence of diabetes, cardiovascular disease and musculoskeletal conditions.  

Although the number of HCPC-registered podiatrists has shown modest growth, registration totals do not equate to NHS workforce capacity. NHS England reports that half or more of the registered podiatry workforce is now employed outside the NHS, while podiatry remains one of the professions expected to experience continuing medium-term workforce shortfalls. The central concern is therefore the supply, distribution, retention and NHS availability of podiatrists, rather than the headline register total alone. 

NHS England reported an overall AHP vacancy rate of 8.9% in June 2024. It also identified reductions in podiatry undergraduate course acceptances of 11% between 2022 and 2024, alongside continuing concerns about course recruitment, student attrition and the transition of newly qualified registrants into NHS employment.  This leaves fewer clinicians to manage an increasingly complex caseload, placing considerable pressure on existing staff, contributing to increased workload intensity, stress, burnout, sickness absence and retention challenges.  

Persistent workforce shortages also reduce the capacity of services to invest in prevention, innovation, service improvement, supervision and workforce development, creating a cycle that further undermines sustainability. Addressing podiatry workforce supply must therefore be viewed not only as a workforce issue but as a patient safety and service quality imperative. Investment in recruitment, retention, education and career progression is essential if NHS services are to maintain safe staffing levels, protect staff wellbeing and meet future population health needs. This aligns with the broader view that workforce development is a core component of service quality and sustainability, rather than a discretionary activity. 

Technology also plays an important role in improving quality and safety. Interoperable digital records, clinical decision support tools, remote monitoring and secure information sharing can improve communication, reduce duplication and support better coordinated care. Investment in research and quality improvement capability is equally important, enabling clinicians to evaluate outcomes, implement evidence based interventions and drive service improvement. 

Strong partnership working across community services, acute settings, primary care, social care, and education is essential. Integrated pathways and multidisciplinary collaboration help ensure continuity of care, improve patient outcomes and reduce variation in access and experience. Examples from podiatry include integrated diabetes pathways, vascular, MSK, and rheumatology services, early detection and diagnostic initiatives, and collaborative education programmes. Sustained investment in these enablers allows Podiatry and other AHP services to maximise their contribution to prevention, population health, reducing health inequalities, and delivering high quality care closer to home. 

NICE recommends that commissioners provide both a community foot protection service and a multidisciplinary foot care service, connected through robust protocols and integrated pathways. Importantly, the foot protection service should be led by a podiatrist with specialist training in diabetic foot problems. This provides an established model for podiatrist-led prevention, risk management and multidisciplinary care that should be consistently commissioned across the country. 

4.  What would help most to make this change possible?

Workforce investment would have the greatest impact. Workforce pressures remain one of the principal barriers to improving access, quality and safety across AHP services, but specifically within podiatry. In podiatry, workforce supply is not keeping pace with demand, and in many areas, services are experiencing persistent recruitment and retention difficulties. At a time when population need is increasing due to increasing rates of diabetes, cardiovascular disease, musculoskeletal conditions, and an ageing population, the available workforce is contracting. This places growing pressure on existing staff, increases workload intensity and reduces the capacity of services to focus on prevention, innovation, education, and service improvement. Addressing these challenges requires sustained investment across the entire workforce pipeline, including education, recruitment, retention, career progression and leadership development. 

Long term workforce planning should be aligned to population need and recognise the growing contribution of podiatrists and other AHPs to prevention, neighbourhood health, long term condition management and reducing health inequalities. Failure to address current workforce trends risks creating a cycle whereby increasing vacancies and workforce shortages place greater pressure on those who remain, contributing to stress, burnout, sickness absence, and further attrition from the profession. Sufficient staffing capacity, supported by clear career pathways within NHS services, preceptorship, enhanced and advanced practice opportunities, and nationally consistent competency frameworks, is therefore essential not only to meeting demand but also to maintaining workforce wellbeing, improving retention and ensuring sustainable services for the future. 

This investment must be supported by improved digital infrastructure, interoperable records, data collection and outcome measurement systems. Many services continue to operate with fragmented digital systems that limit information sharing, reduce productivity and make it difficult to demonstrate impact or support evidence-based commissioning.  The framework should support profession-level workforce datasets covering establishment, vacancies, turnover, age profile, geographical distribution, education intake, student attrition, NHS entry and return-to-practice. Aggregated AHP figures can conceal acute shortages within smaller professions such as podiatry.  

The Royal College of Podiatry believes that achieving sustainable improvement requires a whole system approach that aligns workforce planning, commissioning, service redesign, digital transformation and population health objectives. Without urgent action to stabilise and grow the podiatry workforce, services will struggle to meet future demand and deliver the preventative, community based models of care envisaged within the NHS 10 Year Plan. Conversely, sustained investment in workforce capacity will improve access, enhance quality, reduce health inequalities and protect the wellbeing of the staff upon whom these services depend. 

Theme 2: Keeping People Healthy 

5.  How can AHPs have the greatest impact in helping people stay well and lead healthier lives? 

AHPs can have the greatest impact by being positioned further upstream in prevention, population health improvement, and early intervention. Their expertise, combined with frequent contact with individuals throughout the life course, places them in a unique position to identify risks early, support self management, promote healthy behaviours, and the management of long term conditions. 

For podiatry, this includes preventing foot ulceration, infection, and amputation, reducing falls risk, supporting musculoskeletal health, early detection of cardiovascular risk factors, promoting healthy ageing, and helping people maintain mobility, independence and quality of life. Similar preventative contributions are made across the wider AHP workforce through rehabilitation, physical activity promotion, communication support, dietary interventions, and self management education.  

Foot pain, impaired foot function, inappropriate footwear and reduced ankle strength can all contribute to falls risk. NICE’s 2025 falls guideline includes assessment of footwear and foot condition within a comprehensive falls assessment. Evidence reviewed for the guideline also supports multifaceted podiatry interventions for older people with disabling foot pain. Podiatry should therefore be routinely integrated into multidisciplinary falls prevention pathways.  

To maximise this impact, prevention should be recognised as a core function of all AHP services rather than an activity delivered only when capacity allows. Podiatrists and other AHPs should be embedded within neighbourhood health and prevention programmes, working as part of multidisciplinary teams to proactively identify and support people at risk of poorer health outcomes. This requires commissioning models that reward prevention, outcome measures that capture preventative impact, and system leadership that recognises the long term health, social and economic benefits of keeping people well.  

By focusing on prevention and early intervention, AHPs can reduce avoidable deterioration, improve population health and reduce demand on emergency, secondary and social care services.   

Podiatrists assess and manage lower limb musculoskeletal conditions, inflammatory arthritis, peripheral arterial disease, neurological impairment, dermatological conditions, impact from systemic disease like diabetes and mobility problems. They provide gait and biomechanical assessment, exercise and rehabilitation, footwear and orthotic interventions, nail and skin surgery, vascular and neurological assessment and, where appropriately trained, independent prescribing and podiatric surgery. These interventions can reduce pain, maintain mobility, support participation in work and daily life and prevent escalation to more costly services. 

6.  Which people or communities would benefit most from earlier access to AHP support, and why? 

Earlier access to AHP support would provide the greatest benefit to people and communities experiencing the highest burden of ill health, health inequalities, and long term conditions. This includes people living in areas of deprivation, those with diabetes, cardiovascular disease, musculoskeletal conditions, arthritis, learning disabilities and multiple long term conditions, as well as older adults, people experiencing homelessness, ethnically diverse communities, and those living in rural or geographically isolated areas.  

These populations often experience higher levels of unmet need and are more likely to present later with more advanced health problems. Earlier access to AHP services enables prevention, risk reduction, early diagnosis and timely intervention, helping to prevent avoidable deterioration, maintain independence and improve outcomes while reducing demand on other parts of the health and care system.  

Improving access is not solely about increasing service capacity. Services must also be designed around the needs of the communities they serve, using culturally responsive approaches, targeted outreach, proactive case finding and flexible delivery models that reduce barriers to engagement. By addressing both access and equity, AHPs can play a significant role in reducing health inequalities and improving population health outcomes. 

7.  Which people or communities face the biggest barriers to accessing AHP services or achieving good outcomes, and why? 

People experiencing deprivation, homelessness, social exclusion, disability, language barriers, rural isolation, digital exclusion and multiple long term conditions often face the greatest barriers to accessing AHP services and achieving good outcomes.  

These barriers are frequently linked to how services are organised rather than the needs of the individual. Complex referral processes, fragmented pathways, restrictive eligibility criteria, a lack of awareness of AHP services, transport difficulties, language and communication barriers, and poor integration between services can all delay access to care and contribute to poorer health outcomes.  

Reducing these inequalities requires services to move beyond traditional delivery models and adopt more proactive, community focused approaches. This includes outreach, co-production, community engagement, partnership working and flexible models of care that bring services closer to the people who need them most. Services that actively engage underserved communities and work alongside local partners are better able to improve access, reduce health inequalities and achieve better outcomes.  

Addressing these barriers will be essential if the NHS is to deliver its ambitions for prevention, neighbourhood healthcare and reducing health inequalities.  

Barriers to podiatry are particularly consequential for people who cannot safely undertake their own foot care, including people with visual impairment, reduced dexterity, cognitive impairment, learning disabilities, severe obesity or restricted mobility. Housebound people, care home residents and people experiencing homelessness may also struggle to access clinic based services. Eligibility criteria that focus only on diagnosis rather than clinical risk and functional need can unintentionally exclude people until their condition has deteriorated.  Equity should be measured not simply by whether a service exists, but by waiting time, uptake, treatment completion and outcomes across deprivation, ethnicity, disability, housing status and rurality.  

8.  What one change would most help AHPs focus more on prevention? 

The most important change would be a fundamental shift in commissioning, funding and performance frameworks towards prevention. Current systems often prioritise activity associated with managing advanced illness rather than preventing it, limiting the ability of AHPs to deliver proactive interventions that improve health outcomes and reduce future demand on health and care services.  

Prevention should be embedded within service specifications, outcome frameworks and commissioning decisions, with health systems routinely measuring and rewarding interventions that reduce disease progression, support self management, prevent admissions and help people maintain their independence. Recognition of prevention as a core outcome would enable AHPs to play a greater role in improving population health, reducing health inequalities, and supporting the long term sustainability of health and care services.  

A prevention focused funding and commissioning model would allow AHPs to make their fullest contribution to keeping people well, intervening earlier and reducing avoidable demand across the system. 

Theme 3: People and AHP Workforce 

9.  What changes would best support and strengthen the AHP workforce now and for the future?

A comprehensive workforce strategy is needed that addresses education, recruitment, retention, career progression, and workforce supply across all AHP professions, specifically those that are struggling to recruit, particularly podiatry, prosthetics and orthotics, therapeutic radiography, and orthoptics. Workforce planning should be aligned to future population health needs and recognise the growing contribution of AHPs to prevention, neighbourhood health, long term condition management, and reducing health inequalities. 

Investment is required across the entire career pathway. This includes supporting HEIs to deliver undergraduate programmes for those programmes that struggle to recruit, increasing pre-registration training places, expanding apprenticeship routes, and creating clear progression opportunities from support worker to preceptorship, enhanced, advanced practice and consultant level roles. Educational pathways must be flexible and accessible, enabling individuals from a wide range of backgrounds to enter and progress within AHP careers. 

Continued investment in preceptorships, enhanced and advanced practice, leadership development, research capability and clinical academic careers are also essential. AHPs need access to protected learning time, supervision and mentorship throughout their careers to maintain competence and respond to changing service needs. Workforce development should be viewed as a core component of service quality and sustainability rather than a discretionary activity. 

Strengthening the workforce will also require nationally coordinated workforce planning, improved workforce intelligence and sustainable funding arrangements that provide certainty for employers, education providers and learners. Developing a skilled and adaptable workforce will help ensure AHP services can respond effectively to future demographic, technological and service transformation challenges.

10.  What changes would most improve retention of AHPs across all career stages? 

Retention is most strongly influenced by workload, wellbeing, CPD opportunities, leadership and organisational culture. AHPs are more likely to remain in the workforce when they feel valued, supported, are provided with development opportunities, and able to deliver high quality care.  

A key priority is ensuring manageable workloads and adequate staffing levels. Persistent workforce shortages increase pressure on staff, contribute to burnout and reduce job satisfaction. Investment in workforce capacity is therefore critical to improving both retention and service quality.  

Access to CPD, supervision, mentorship, and career progression opportunities also plays a vital role. AHPs need clear and flexible career pathways that provide opportunities to develop specialist expertise, advance into leadership roles, undertake research activities and/or pursue advanced practice careers. Access to these opportunities should be equitable regardless of geography, employer or profession.  

Supportive leadership and positive workplace cultures are equally important. Staff are more likely to remain within organisations that promote inclusion, wellbeing, professional autonomy, and continuous learning. Administrative burdens should also be reduced through better use of digital systems and support staff, enabling AHPs to focus on delivering patient care.  

Retention strategies should recognise that workforce needs vary across career stages. Early career professionals may require additional supervision and development support, while later stage career staff may benefit from flexible working arrangements, portfolio careers, and opportunities to contribute through mentorship, education and leadership. 

11.  Where are the main gaps in capability, skills and training that limit AHP impact? 

There are significant capability gaps in advanced clinical practice, leadership, service improvement, digital technologies, research, population health and health inequalities. Addressing these gaps is essential if AHPs are to maximise their contribution to health system transformation and population health improvement.  

Many AHPs have limited access to structured development opportunities in areas such as quality improvement, leadership and strategic service redesign. These skills are increasingly important as AHPs take on greater responsibility for leading services, influencing policy and improving pathways of care.  

Digital capability represents another important area for development. As healthcare becomes increasingly data driven and technology enabled, AHPs require greater confidence in the use of digital tools, data analytics, virtual care models, and emerging technologies such as AI. This includes understanding the opportunities, limitations and governance requirements associated with these technologies.  

Further gaps exist in research capacity and clinical academic development. Limited protected time, infrastructure and funding often restrict participation in research and innovation activities. Expanding opportunities for clinical academic careers and research leadership would strengthen the evidence base for AHP practice and support innovation across health and care systems.  

Emerging areas such as point of care diagnostics, population health management, personalised care, prevention and reducing health inequalities also require targeted workforce development to ensure AHPs are equipped to meet current and future needs. 

12.  What changes would have the greatest effect on building a sustainable, skilled and inclusive AHP workforce? 

The greatest impact would come from long term workforce planning supported by sustained investment in pre and post registration education, workforce development and career progression. Building a sustainable workforce requires a coordinated approach that addresses both current workforce shortages and future service demands.  

Expanding entry routes into AHP careers is particularly important. This includes increasing training places, supporting apprenticeships, promoting widening participation and reducing barriers to accessing professional education. A more diverse workforce helps ensure services are representative of and responsive to the communities they serve.  

Investment in preceptorships, enhanced and advanced practice pathways, leadership development, clinical academic careers and CPD is also essential. AHPs must be able to develop and progress throughout their careers if services are to retain expertise and build future leaders.  

Inclusive workplace cultures are essential. Organisations should create environments where all staff feel valued, supported and able to progress regardless of background, ethnicity, disability, gender or socioeconomic status. Inclusive leadership, transparent progression opportunities and equitable access to development programmes are key to achieving this.  

Finally, workforce sustainability depends on recognising AHPs as a strategic asset within the health and care system. Workforce planning, funding, education and service transformation should be aligned so that AHPs can contribute fully to prevention, integrated neighbourhood services, reducing health inequalities and improving population health outcomes.  

Theme 4: Working Differently 

13.  How can AHPs work differently to better meet people’s needs and deliver care in the most appropriate setting? 

AHPs should be enabled to work across organisational boundaries, lead care pathways and provide care closer to home within integrated neighbourhood and community based models. Delivering care in the most appropriate setting requires services to be designed around people’s needs rather than organisational structures.  

Direct access to AHP services should become the norm wherever appropriate, reducing unnecessary delays and ensuring people receive specialist support earlier in their care journey.   

Podiatrists should be embedded within primary care and neighbourhood multidisciplinary teams similar to first contact practitioners for appropriate foot and lower limb presentations. Direct access to assessment, diagnostics, treatment, prescribing and onward referral can reduce unnecessary GP and secondary-care contacts, accelerate diagnosis and allow podiatrists to manage complete episodes of care within their competence.  

Greater use of multidisciplinary working, virtual care, community diagnostics, outreach services and proactive case finding can help ensure support is delivered at the right time and in the right place. In podiatry, this would include community based preventative foot protection services, shared virtual reviews with diabetes and vascular teams, point of care diagnostic imaging within community settings, telehealth follow up for stable patients, and outreach services for people who face barriers to accessing care.  

Expanding intermediate care capacity should be a key priority within integrated neighbourhood health services. Too many people are discharged from hospital without access to sufficient rehabilitation, reablement or multidisciplinary support, increasing the risk of functional decline, avoidable readmission and loss of independence. AHPs play a critical role within intermediate care by restoring mobility, supporting recovery, preventing falls, promoting self management and enabling safe transitions from hospital to home. Investment in community rehabilitation services and multidisciplinary intermediate care teams would help ensure that people receive the right level of support before returning home. This approach not only improves outcomes and patient experience but also reduces pressure on acute services, supports more efficient patient flow and helps people maintain their independence for longer.  

Working differently also requires a stronger focus on prevention, self management and population health. AHPs should use every patient contact as an opportunity to support behaviour change, identify risk factors and intervene early to prevent future ill health. 

14.  What would help most to make this change possible? 

Delivering new models of care requires integrated workforce planning, supportive leadership, interoperable digital systems and commissioning arrangements that enable collaboration across organisational boundaries.  

AHPs require access to shared records, common outcome measures and digital tools that support information sharing and coordinated care. Too often, fragmented systems create duplication, inefficiencies and delays in appropriate interventions. Digital infrastructure should support seamless care across primary care, community services, acute services, and social care settings. 

Professional autonomy and clinical leadership are also important enablers. AHPs must be empowered to innovate, redesign pathways and work at the top of their scope of practice. Organisations should actively support service improvement and create cultures where innovation and collaboration are encouraged.  

Commissioning and funding arrangements should also support integrated working rather than reinforcing organisational silos. Aligning incentives around prevention, outcomes and population health would encourage greater partnership working and facilitate service redesign. 

15.  Where do current ways of working need to change most? 

The most significant change is the need to move from reactive models of care towards prevention, early intervention and population health management. Much of the current system remains focused on managing established illness rather than preventing deterioration and supporting people to stay well.  

This shift requires healthcare services to intervene earlier, identify risk proactively and provide support before conditions become more complex and resource intensive. AHPs are well placed to contribute to this approach because of their expertise in prevention, rehabilitation, behaviour change and long term condition management.  

Current models also need to move beyond organisational boundaries. Too many pathways remain fragmented, with patients navigating multiple services and experiencing unnecessary delays. Greater integration between primary care, community, acute care, social care and voluntary sector organisations would improve continuity of care and patient outcomes.  

The future system should place greater emphasis on neighbourhood health, self management, proactive care and multidisciplinary working, with services organised around the needs of people and populations rather than institutions. 

16.  If you could prioritise one change now, what would have the greatest impact? 

The Royal College of Podiatry would prioritise investment in preventative, community based AHP services delivered through integrated neighbourhood health models.  

Earlier access to AHP expertise enables prevention, timely intervention and effective self management, reducing avoidable deterioration and improving health outcomes. Early intervention is more effective and less costly than managing advanced disease and its complications, and this principle is especially important in preventing foot ulceration. When managing foot and lower limb complications associated with diabetes and peripheral arterial disease, timely risk assessment, treatment of pre-ulcerative lesions, education, and integrated multidisciplinary management can reduce progression to ulceration, infection and amputation, while also avoiding the higher costs associated with advanced foot disease (Valabjhi 2020).  

Investment in neighbourhood based AHP services would help reduce health inequalities by bringing care closer to communities, improving access for underserved populations and enabling more proactive support for those at greatest risk of poor outcomes. It would also reduce pressure on acute services by preventing avoidable admissions and supporting people to remain independent for longer.  

A prevention focused, community centred approach aligns closely with the long term direction of the NHS’s 10 Year Plan. It would enable AHPs to make their greatest contribution to improving population health, supporting NHS sustainability and delivering better outcomes for individuals, communities and the wider system. 

Theme 5:  Research, Improvement and Innovation  

The Royal College of Podiatry welcomes the opportunity to contribute to the AHPs Deliver programme. Innovation within podiatry has consistently demonstrated how AHP led research, service redesign and digital transformation can address some of the NHS's most pressing challenges, including prevention, health inequalities, productivity and the management of long term conditions. From national diabetic foot programmes and virtual multidisciplinary models to digital diagnostic tools and large scale clinical trials, the profession has shown how evidence can be translated into real world improvements for patients and services. However, these successes remain dependent on a workforce with the time, capability and infrastructure to undertake research and improvement activity. The responses below therefore focus on the actions needed to embed research, innovation and implementation as core functions of modern AHP services rather than activities undertaken at the margins of clinical practice. 

17.  How can we embed research, improvement and innovation more sustainably to improve everyday care and future services? 

Research, improvement and innovation should be recognised as core components of healthcare delivery rather than optional activities undertaken alongside clinical work. To achieve this, services require protected time for research and quality improvement, sustainable funding streams, stronger partnerships between healthcare providers and universities, and clear clinical academic career pathways for AHPs.  

Many of the most successful innovations in podiatry have emerged directly from frontline clinical challenges. For example, the ACT NOW programme (Edmonds et al 2020) translated evidence relating to diabetic foot disease into practical educational resources that improve recognition of urgent foot complications, promote timely referral and support reductions in avoidable amputations. The initiative has subsequently been incorporated into podiatry guidance across the four nations and recognised as best practice within national programmes. 

Similarly, the development of virtual multidisciplinary foot teams has expanded access to specialist expertise beyond acute settings and demonstrates how service innovation can improve access, prevent deterioration and support integrated community care.    

Embedding research sustainably therefore requires systems that support clinicians to identify problems, evaluate solutions, disseminate learning and scale successful approaches. Research, innovation and improvement should be integral to workforce planning, service specifications and commissioning arrangements. 

18.  How can we better connect service improvement, research and innovation to strengthen everyday practice? 

Research, improvement and innovation should operate as a continuous cycle. Research generates evidence, improvement helps translate that evidence into practice, and innovation enables successful approaches to be scaled and adopted more widely. When these activities operate separately, opportunities to improve services and patient outcomes can be lost.  

The most effective approach is to create multidisciplinary learning systems where clinicians, researchers, patients and service leaders collaborate to identify priorities and evaluate outcomes. ICSs, HEIs, and professional bodies all have an important role in facilitating these partnerships.  

The development of the CUBED app provides a strong example of this approach. A survey of podiatrists identified a need for greater confidence in assessing suspicious skin lesions. This workforce intelligence informed the development of a digital melanoma screening application that supports assessment and referral pathways while generating practical tools for use in everyday clinical practice. The innovation emerged from identified service need, was supported by the profession and has subsequently achieved widespread national and international uptake.  

Likewise, the virtual multidisciplinary foot team model demonstrates how evidence, digital technology and pathway redesign can be combined to strengthen routine care delivery and improve clinical outcomes.   

Connecting research and improvement activities more effectively will require shared outcome measures, implementation support and greater opportunities for collaborative learning across organisations. 

19.  How can we turn evidence into real-world change more quickly?

The challenge is rarely generating evidence; it is implementing evidence consistently at scale. Implementation science, leadership, digital infrastructure and workforce capability are therefore as important as research itself. Organisations should invest in systems that support the adoption, evaluation and spread of evidence-based practice. Examples such as ACT NOW and virtual multidisciplinary foot teams demonstrate how research can be translated into measurable improvements in care when implementation is properly supported.  

By translating complex clinical guidance into simple, accessible messages for patients and professionals, the initiative has strengthened referral pathways and supported earlier intervention for diabetic foot disease.   

Similarly, the virtual multidisciplinary foot team approach successfully leveraged existing digital infrastructure and governance arrangements rather than creating entirely new systems. This enabled rapid implementation, wider access to specialist expertise and greater integration across primary, community and secondary care.   

The Royal College of Podiatry believes that implementation should be recognised and resourced as a specialist capability within NHS organisations if research, improvement and innovation are to deliver meaningful population-level benefits. 

20.  What strengths, skills or support are needed to make this happen? 

A sustainable culture of research, improvement and innovation requires investment in people, leadership and infrastructure.  

Firstly, the workforce requires stronger capability in research methods, evidence appraisal, quality improvement methodology, implementation science, health economics and data analysis. These skills should be embedded within undergraduate education, post-registration training and continuing professional development.  

Secondly, organisations must provide protected time, mentorship and career pathways that support clinicians to participate in research, improvement and innovation activity. Clinical academic opportunities remain limited across many AHP professions and require significant expansion.  

Thirdly, digital capability will be increasingly important. Innovations such as virtual multidisciplinary teams, digital clinical support tools and technology-enabled screening programmes all demonstrate the potential for digital approaches to improve outcomes when implemented appropriately. The atrial fibrillation detection programme undertaken by the team featured in Hywel Dda Podiatry and Arrhythmia Service Atrial Fibrillation detection project team illustrates how podiatry services can use technology and multidisciplinary collaboration to identify previously undiagnosed conditions, improve patient outcomes and reduce pressure on other parts of the healthcare system.    

Finally, strong collaborative networks are essential. The success of initiatives such as ACT NOW, the CUBED melanoma screening application, the virtual multidisciplinary foot team model and the BigToe osteoarthritis trial demonstrates the value of partnerships between clinicians, researchers, patients, universities, professional bodies and healthcare organisations. The BigToe study secured £1.8 million of funding for one of the largest foot health trials undertaken internationally and exemplifies how research leadership and collaboration can generate evidence capable of changing practice at scale.  

The Royal College of Podiatry therefore recommends a long-term national commitment to: 

• Expanding clinical academic career pathways for AHPs 

• Providing protected time for research and quality improvement 

• Investing in implementation science and digital capability 

• Strengthening partnerships between healthcare providers and academic institutions 

• Supporting leadership development across the AHP workforce 

• Embedding research, improvement and innovation within commissioning, workforce planning and service design.  

These measures would ensure that research, improvement and innovation are not isolated activities but become central drivers of safer, more effective and more sustainable healthcare services.  

Theme 6 – Digital, Data and Technology

21.  How can we make better use of data, digital and technology to improve AHP services and demonstrate their impact? 

The Royal College of Podiatry believes that data, digital technology and artificial intelligence have significant potential to improve patient outcomes, reduce health inequalities, increase productivity and demonstrate the value of AHP services. However, this potential can only be realised if digital systems are designed around clinical pathways and population needs rather than organisational boundaries.  

AHP services require access to interoperable digital systems that enable professionals to record, access and share information across primary, community, secondary and social care settings. Too often, AHP contributions remain invisible because outcome measures are inconsistently collected and digital systems are unable to capture the full impact of interventions. The new AHP framework should support the development of meaningful outcome measures that demonstrate prevention, admission avoidance, improved quality of life and cost-effectiveness. These metrics are essential to inform service planning, workforce investment and commissioning decisions.  

Examples from podiatry demonstrate the transformative potential of digital innovation. The virtual multidisciplinary foot team model has used digital platforms to extend specialist expertise into community settings, enabling earlier intervention, admission avoidance and more equitable access to specialist care regardless of location. This approach supports integrated decision-making and demonstrates how technology can improve outcomes whilst making more effective use of existing workforce capacity.  

Similarly, digital innovations such as structured wound monitoring technologies, remote specialist review and electronic patient records have improved clinical decision-making, communication and service efficiency across podiatry services. The future framework should encourage widespread adoption of such technologies where there is evidence of benefit. 

22.  What would improve how AHPs use data, digital and technology including Artificial Intelligence (AI) to support people and deliver care? 

The most important requirement is investment in digital infrastructure, interoperability and workforce capability. Technology alone will not improve care unless staff have the confidence, skills and support required to use it effectively.  

For podiatry, digital records should support structured recording of diabetic-foot risk, wound characteristics and severity, vascular and neurological findings, infection status, offloading, photographs, treatment outcomes and escalation decisions. Systems should enable automatic transfer to the National Diabetes Foot Care Audit and permit longitudinal tracking across primary, community and acute settings.  

Artificial intelligence and digital decision-support tools have considerable potential to support earlier diagnosis, patient self-management, risk stratification, clinical documentation and population health management. However, implementation should be evidence-based, ethically governed and focused on enhancing rather than replacing professional judgement.  AI tools used for wound assessment, skin lesion recognition, risk prediction or remote monitoring must be clinically validated in representative populations and evaluated for false reassurance, bias across different skin tones, accessibility, information governance and the risk of widening digital inequalities. Responsibility for clinical decisions must remain clear.  

Innovations emerging from podiatry demonstrate what can be achieved when digital technologies are developed around identified clinical need. The CUBED app translated a recognised workforce development need into a practical digital solution that supports the assessment and referral of suspicious skin lesions. The application provides an accessible decision-support tool for clinicians and demonstrates how technology can improve confidence, consistency and patient safety.  

The Royal College of Podiatry would support greater investment in: 

• Interoperable digital records 

• AI-enabled clinical support tools 

• Remote monitoring and virtual care models 

• Digital triage and referral pathways 

• Data analytics to support population health management 

• Evaluation frameworks to assess safety, effectiveness and equity.  

23.  What knowledge and skills will AHPs need to use data, digital and technology effectively in the future? 

Future AHP workforces will require a broader range of digital, analytical and leadership capabilities than are currently included within many educational programmes. 

Core skills should include: 

• Digital literacy and confidence in using new technologies. 

• Understanding of data quality, governance and information governance principles 

• Ability to interpret and use population health and outcome data 

• Understanding of artificial intelligence and its appropriate application within healthcare 

• Skills in quality improvement, implementation science and evaluation 

• Digital leadership and service redesign capability 

• Competence in virtual consultation and remote monitoring approaches.  

Beyond technical skills, AHPs must also understand the ethical implications of AI, addressing issues such as transparency, bias, equity, accountability and patient trust.  

The development of innovations such as the virtual multidisciplinary foot team, the CUBED application and digital screening programmes demonstrates that future AHP leaders will increasingly need skills that combine clinical expertise with digital transformation, research, improvement and innovation. 

24.  What do we need to get the basics right in data, digital and technology? 

Before implementing increasingly sophisticated technologies, there must be a focus on getting the fundamentals right.  

The Royal College of Podiatry believes that the priorities should be: 

• Universal access to reliable and secure digital infrastructure 

• Interoperable electronic patient record systems across organisational boundaries 

• Consistent national datasets and outcome measures for AHP services 

• Robust information governance and cyber security 

• User-centred system design involving clinicians and patients 

• Adequate training and ongoing technical support 

• Protected time for workforce development and digital adoption 

• Reduction of duplicate data entry and administrative burden.  

Too many clinicians continue to work across multiple non-interoperable systems, reducing productivity and limiting opportunities to use data effectively. The new framework should emphasise digital maturity across health and care systems and ensure that all AHP professions can contribute fully to integrated records and shared care pathways. 

Without these foundations, the benefits associated with AI, advanced analytics and digital transformation will not be realised at scale.  

Additional Feedback

25.  Is there anything else that you would like to see in the new AHP framework? 

The Royal College of Podiatry would welcome a framework that explicitly positions AHPs as leaders of prevention, population health improvement, community-based care and health inequalities reduction. 

The framework should recognise the significant contribution that AHPs make to: 

• Preventing avoidable hospital admissions 

• Supporting people to remain independent for longer 

• Improving management of long-term conditions 

• Reducing health inequalities 

• Delivering neighbourhood health services closer to home 

• Supporting economic productivity through improved health outcomes.  

The framework should also place greater emphasis on: 

• Workforce planning and supply 

• Clinical academic careers 

• Research, improvement and innovation capacity 

• Digital transformation 

• Advanced and consultant practice 

• Leadership development 

• Prevention-focused commissioning models.  

Podiatry provides numerous examples of how AHPs contribute to national priorities through innovation, research and prevention. Programmes such as ACT NOW have improved awareness and timely referral for diabetic foot disease, helping to prevent serious complications and amputations.   

Research initiatives such as the BigToe trial demonstrate the importance of investing in AHP-led research to generate evidence that can improve patient outcomes and inform future service delivery.  

Digital innovations such as the virtual multidisciplinary foot team, the CUBED melanoma screening application and podiatry-led atrial fibrillation detection programmes demonstrate the profession’s capacity to lead service transformation, improve access, support earlier diagnosis and deliver prevention-focused care.  

Foot and lower limb problems also have implications for employment and economic participation. ONS analysis found that, among people economically inactive because of long-term sickness, reported problems affecting the legs or feet increased by 243,000 (29%) between 2019 and 2023. Earlier access to podiatry and lower-limb MSK services can therefore contribute not only to health outcomes but also to job retention, return to work and reduced economic inactivity.  

The new framework should also recognise environmental sustainability as a dimension of service quality. Podiatry services should be supported to evaluate the environmental as well as clinical and financial impact of care pathways, including travel, procurement, instrument use and decontamination, waste, prescribing and digital delivery. Care closer to home and appropriately designed virtual follow-up may reduce patient and staff travel, but environmental benefits should be evaluated alongside safety, access and health inequalities.  

The Royal College of Podiatry would therefore encourage the new AHP framework to be ambitious in recognising AHPs as system leaders who are central to delivering the NHS's prevention, integration, neighbourhood health and productivity ambitions.  

References  

Edmonds, M., Phillips, A., Holmes, P., Odiase, C., Robbie, J., Grumitt, J. and Halloum, H. (2020) ‘To halve the number of major amputations in people living with diabetes, “ACTNOW”’, Diabetes & Primary Care, 22(6), pp. 139–143. Available at: https://diabetesonthenet.com/wp-content/uploads/pdf/dotn318d3b978cb76f0b39bd2339507cbf33.pdf  

HCPC (2026), Register summary. Available at: https://www.hcpc-uk.org/data/the-register/register-summary/  

NHS England (2023), NHS Long Term Workforce Plan. Available at: https://www.england.nhs.uk/long-read/nhs-long-term-workforce-plan-2   

NHS England (2024), Submission to the NHS Pay Review Body: evidence for the 2025/26 pay round. Available at: https://www.england.nhs.uk/long-read/submission-to-the-nhs-pay-review-body-evidence-for-the-2025-26-pay-round   

NHS England (2025), National Diabetes Foot Care Audit 2020 to 2025. Available at: 

https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-footcare-audit/2025  

NICE (2019, with 2023 reviewed recommendations), Diabetic foot problems: prevention and management, NG19. Available at: 

https://www.nice.org.uk/guidance/ng19/chapter/recommendations  

NICE (2025), Falls: assessment and prevention in older people and in people aged 50 and over at higher risk, NG249. Available at: https://www.nice.org.uk/guidance/ng249/chapter/Recommendations  

ONS (2023), Rising ill-health and economic inactivity because of long-term sickness, UK: 2019 to 2023. Available at https://www.ons.gov.uk/employmentandlabourmarket/peoplenotinwork/economicinactivity/articles/risingillhealthandeconomicinactivitybecauseoflongtermsicknessuk/2019to2023  

Spink, M.J. et al. (2011), “Effectiveness of a multifaceted podiatry intervention to prevent falls in community-dwelling older people with disabling foot pain”, BMJ, 342, d3411. Available at: https://doi.org/10.1136/bmj.d3411   

Valabhji, J. (2020) ‘Rapid access to multidisciplinary diabetes foot care teams’, BMJ, 368, m773. Available at: https://pubmed.ncbi.nlm.nih.gov/32132089/   

Van Netten, J.J. et al. (2020) ‘Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review’, Diabetes/Metabolism Research and Reviews, 36(S1), e3270. Available at: https://doi.org/10.1002/dmrr.3270.