Case studies

Podiatry apprenticeships with East London NHS Federation Trust (ELFT)

About ELFT

ELFT offers mental health, community health and primary care services across East London, Luton and Bedfordshire. It employs over 6,000 people and has 200 apprentices.

Watch the video below to meet three of ELFT's podiatry apprentices:

• Phoebe Edwards wants to gain clinical skills while learning and earning and hopes to specialise in future in diabetes or musculoskeletal podiatry
• Harriet Akinrinade, a former podiatry assistant, sees the apprenticeship as a means of advancing her career, enabling her to do more and help more people
• Lucy Beaumont is keen to develop her clinical skills further, as well as leadership and management skills, to enable her to help lots of different people in different areas.

Citation for ELFT podiatry apprentices

In the recent Stars of the Future Awards, Phoebe and Lucy received the following citation:

“These colleagues have demonstrated inspirational qualities going above and beyond all expectations of their role. 

They have embodied professionalism through presenting at regional and national meetings, acting as ambassadors in their profession, supporting and attending local and online events and inspiring the future generation through their commitment to co-production work.”

Find out more about Phoebe's apprenticeship journey here

Hasina Aziz:  Clinical lead podiatrist, Midlands Partnership NHS Foundation Trust, East Staffordshire

Hasina talks about the benefits of apprenticeships and the value they bring in a busy NHS setting

Having an apprentice is great and I would say more beneficial for the individual studying than the qualified. They are there to learn and pick up different ways of working and this is the valuable bit.

For a qualified clinician, and I speak for myself and probably a lot of others, I have always loved having an apprentice. For me it is about sharing the knowledge I have gained through experience with other colleagues. No amount of theoretical work can give you the experience of “hands-on experience”. Yes, there is the added time pressure but if we know in advance when we will have them we can look at adjusting appointment slots to give the best care/treatment without feeling rushed, and also allow the qualified clinician to fully support them.

With the increasing problems in recruitment/retention, and the increase in demand to see complex patients within podiatry, I do think we should be utilising not only our apprentices but also podiatry students. Organizations need to look at ways where we can offer these apprentices/students work incentives to ensure we retain them once qualified.

I also think apprentices should be asked to work alongside our nursing colleagues not just with podiatrists because with the caseload of patients we see, a vast majority are seen by multiple services and we should be encouraging collaborative working to reduce pressures across not just podiatry but other services such as nursing.

Hannah Thornton: Podiatry apprentice

Please tell us a little bit about the service and team where you work

I was one of the first apprenticeships for podiatry in 2019, with Harrogate and District NHS Foundation Trust (HDFT). I am now a new graduate still working for HDFT continuing in the Scarborough area.

At the beginning of my apprenticeship, I shadowed a lot of other podiatrists and helped in the lab alongside the technicians, gaining some great experience making insoles. I didn’t start my clinics until I had passed and received my first year (foot care) certificate.

As one of the first apprentices, it was very much trial and error throughout for both the Trust and the university: it had not been done before and it was all a learning platform for us all.

When I began my unsupervised clinics, it covered the foot care assistant role. But when I was supervised and shadowing, I observed and treated high-risk patients, mostly with active ulcerations. I also gained a lot of shadowing experience within the biomechanical team. The whole team at Scarborough were fantastic throughout my university degree, and just as supportive to me as a new graduate.

Why did you consider an apprenticeship in podiatry?

I had already been offered a place at the University of Huddersfield but then the apprenticeship became available which allowed me to study and commute instead of having to move me and my family away. The apprenticeship also gave me an income, and the degree was paid for, which meant I had no student loan to pay back.

How did you get started?

From the age of 9, I knew I wanted to be a podiatrist. Leaving school, I continued through college hoping to do podiatry at university, but unfortunately my path to university changed. Ten years later, after having a family, I decided it was now my time to pursue the career I always wanted.

Tell us about the benefits of being an apprentice

• Support through colleagues who are already podiatrists/specialists, even if it's study/work or personally related
• Being in the workplace enables more hands-on practice
• You already know your colleagues before graduating.

Top tips for future apprenticeships

• Ask questions
• Be prepared and be organised
• Be aware that university and the workplace are different environments and learning spaces.

David Piper, podiatrist, and Emily Piper, apprentice at the Exeter Clinic, Exeter, Devon.

In David's words

Please tell us a little bit about your practice

We are in a 2000 sq ft practice and currently have seven team members, including three full-time podiatrists and two podiatry apprentices. We see a wide range of cases and pride ourselves on offering the most up-to-date treatments and assessments including Swift, Lunula, K Laser, RSWT, Run3D with 3D additive and traditional methods of bespoke orthotic manufacture.

Why did you consider an apprentice?

We considered the apprenticeship as a long-term approach to the increasing challenges associated with recruiting and training within podiatry. We believe that apprenticeships can offer several benefits to both parties, by developing the knowledge required through the University of Plymouth and the practical skills through our clinic and student placements. The apprentice can also develop valuable business, leadership skills and knowledge that are the foundations of a successful and effective podiatry clinic.

We are very lucky as a private practice to have three podiatrists who can assume the role of educator, providing security for the apprentice should one of us be unavailable. We have had to restructure the diary to accommodate leave for lectures and study days, although once it was set up and the receptionist was on board with the new rota, things flowed smoothly. There is an additional demand on the clinical educator, which has been managed by providing additional time in the diary to help with this. All our team members are very committed, and much work has been done outside of the clinic by those involved to help things run smoothly. The initial completion of application paperwork and forms is involved but not too onerous. Funding is available for most of the cost of the course with the employer making up the balance, in addition to the salary that the apprentice receives. There is a learning curve in getting accustomed to the online resources that are used by the University, the apprentice, and the employer to plan activities, upload assignments and track progress.

How did you get started?

I originally heard about the apprenticeship scheme at a Devon area branch meeting when Phil Hendy from the University of Plymouth presented the early concept of what is now the apprenticeship. I was initially sceptical about how this might work within private practice, but kept an eye on what was developing. I was approached to see if I would like to be part of the apprenticeship steering group and found this informative as well as providing a voice for private practice.

Our first apprentice is our daughter Emily, who had already completed a three-year BSc in Sports Science in July 2021, and originally wanted to pursue further studies and a career in physiotherapy. Emily spent a few weeks in early 2021 observing our podiatry clinic and learning more about the benefits of doing an apprenticeship. She enjoys challenging herself and decided that a career in podiatry had much to offer. She started her two-year podiatry MSc with the Exeter Clinic in September of 2021.

Our second apprentice joined us through a different route, having contacted us several years prior. As a Foot Health Practitioner, Jess reached out to see if we could assist with a patient and I was surprised and disappointed to hear she had not had a great response when she had asked for help elsewhere. Rather than just accepting a referral from Jess I arranged to have an informal meeting over coffee to see what else we could do to assist. We kept in touch and when our first apprentice Emily started, and we could see the benefits for all concerned, I reached out to see if Jess would be interested in joining us as an apprentice. It turned out that Jess had long wanted to develop her skills and knowledge and become a podiatrist but did not realise there was a pathway that allowed her to earn and learn at the same time. She was quick to respond and is now a valued member of the team in her first year of her BSc.

Tell us about the benefits of employing an apprentice

The benefits of employing an apprentice stem from the culture and team building that are core from day one. We believe that everything matters, and the way we do anything is the way we do everything. To train and qualify as a podiatrist is only part of the journey and it’s essential for the patients, the clinic, and the team that we all have a common set of values. These are instilled at every patient contact and interaction and ultimately help us to develop a great team.

The apprenticeship model has worked very well for Emily. Now Jess is on that journey too, she is helping patients daily and is improving her skills and knowledge, starting the journey to her long-term goal of becoming a podiatrist. The enthusiasm and energy she delivers are great because she has a vested interest in the success of her apprenticeship through the clinic.

Top tips for employers wanting to employ apprentices

Take a long-term view of apprenticeship, and don’t just focus on the immediate time and monetary cost. The benefits to your clinic, patients and team can make it well worth the time and energy. Do some research into what is required and be flexible in your approach to managing the diary. Plan so you have time to complete the applications and paperwork required. Think outside the box – maybe you have a patient or a contact who is already a medical professional that has expressed an interest in or fascination with podiatry. They may be unaware they can earn and learn, providing opportunities for both of you.

Consider what you can offer an apprentice. It will pay dividends time and again. Jess has been able to join a friendly and welcoming team rather than working alone, has seen an improvement in salary with the potential for significant progression as well as enjoying other benefits of being employed, including paid holidays, sick pay, employer pension contributions, and training for, and access to, equipment and services that were previously out of reach. She has her clinical room that is hers to manage and arrange to meet her needs. She has access to regular team and individual support meetings as well as regular team meals  and team-building events. Offering an apprentice great benefits, clarity, certainty, and structure creates confidence and commitment that will benefit the patients, and the employer.

In Emily's words

Tell us about the practice

I work in a five-chair private podiatry practice in the centre of Exeter. We offer a variety of treatment options for patients with a wide array of pathologies. No two days are ever the same, from routine care to state-of-the-art 3D biomechanical assessments to gold-standard verrucae and onychomycosis treatments: each day is fast-paced and rewarding in its own right.

Why did you consider an apprenticeship in podiatry?

Podiatry is a profession I have always been aware of, having grown up around podiatrists in my family. I knew that I wanted a career where I was challenged and where no two days were the same. I had just finished my degree in sports and exercise sciences and knew that this knowledge would stand me in good stead for whatever career I chose, but I wanted to specialise. The opportunity of a podiatry apprenticeship arose which was perfect, as I would be able to immerse myself in my learning with continual hands-on experience and clinical development allowing me to hit the ground running when I graduate, all whilst getting paid!

How did you get started?

I was aware of podiatry apprenticeships before the program was made available through our family clinic. It wasn’t until I had finished my sports science degree that I considered using it in a different direction to what I had originally planned. I thought I was going to enter the world of physiotherapy. However, whenever I pictured my role, it was always in the capacity of helping patients with lower limb complaints. After spending a few weeks observing podiatry clinics I decided this would be my preferred career and the apprenticeship would be the best way for me to achieve this.

Tell us the benefits of being an apprentice in private practice

There are many benefits to being an apprentice in a private podiatry practice. First and foremost is the variety of treatments that you can offer patients. This means being able to give patients the convenience of many treatment options under one roof when it comes to their care, in addition to external referrals. The range of care available has helped expand my knowledge and experience with ongoing developments in technology within healthcare. I love building relationships with patients and becoming invested in their care and wellbeing, seeing them regularly and working together to achieve their goals. I also appreciate the benefits of being part of a close-knit team, unafraid to learn, support and develop together.

Top tips for future apprenticeships

Be organised. This is a fast-paced degree because you are working and studying full-time. Having good organisational skills from the start will allow you to stay on top of your work and studies. Being organised has meant I’m able to balance life outside of work with my studies and enjoy both. Sacrifices will have to be made in the short term to take full advantage of an apprenticeship in podiatry, but the benefits make it well worth the effort.

Jacki Turner: Podiatry degree apprentice

Why did you choose to study for an apprenticeship?

I completed my Podiatry Assistant training four years ago and felt that I wanted to continue developing my knowledge and progress in my career. I am a mature student with the financial responsibilities of a family. The apprenticeship route meant that I could continue earning whilst I study. I have asupportive team at work who are on hand to offer advice and guidance throughout my training which is a huge advantage.

Looking back over your time on the apprenticeship so far, how have you found the whole experience?

My first year has flown by. At times it has been difficult to juggle work, study, travelling and family life, but on the whole, it has been fulfilling.

What has been your proudest achievement on your apprenticeship to date?

I found one module particularly difficult, but I persevered and put lots of effort into my study and managed to get a good mark.

What do you want to do once you complete your apprenticeship?

I will continue to work for my Trust as a podiatrist.

What benefits do you think apprentices bring to the team?

At the end of the programme they will have a qualified podiatrist (all being well) that is known to the team. They already know my strengths and weaknesses and I know exactly where to turn to for support during the early days of my band 5 position. I already know the systems and processes in place in my Trust. I think the apprenticeships will really help with the retention of Band 5 staff for these reasons.

Benefits to patients

Many of our patients know me and have enjoyed watching my progress. Recruitment and retention are a problem currently in podiatry and can only have a knock-on effect on patients. More qualified staff will lead to improved patient care and reduced waiting times.

What would you say to someone considering anapprenticeship?

If you love everything podiatry and are willing to put the time and work in, I would recommend it.

Marian Bennett: Specialist podiatrist and clinical educator in Bedfordshire

Marian Bennett is a Specialist Podiatrist and clinical educator in Bedfordshire and has been supporting apprentices in the workplace since September 2020. The team currently have three apprentices at the University of East London: two have just completed Academic Level 5 and are in their third year of the four-year programme and they had a new apprentice start in September 2022 who is in the first year of the programme.

All three apprentices are on a progressive Job Plan and Pay Scale using Annex 21 of Band 5. See:

• NHS terms and conditions of service handbook
• Apprenticeships in the NHS - NHS Staff Council guidance

Annex 21 of Agenda for Change enables employers to adopt a % of full salary whilst an employee is training with them. Typically, these employees develop their knowledge and skills significantly during a period measured in years. Pay is determined as a percentage of the pay for qualified staff on that band.

In conversation with Emma Stoneman

Emma : What are the benefits of a progressive apprenticeship?

Marian: Well, Emma, initially, it can feel very tricky because they're coming in to the apprenticeship completely new. It's not like taking on students who are already part way through their study, you're taking on someone who has, generally speaking, absolutely no podiatry experience or knowledge at all.

So initially they're not overly helpful for the team, but what we tried to do was to start by getting them to do administrative tasks. They weren't able to do things clinically independently, but we were able to quite quickly get them to start doing clinically related administrative tasks. So things like putting referrals onto the system, checking tasks and forwarding them, putting the programme on to the system, bits like that.

We were able to quickly train them up to assist in clinics, for example, getting patients into the clinic, removing dressings, cleaning up between patients and helping with re-dressings.

Their workload, clinical skills and on-the-job learning have developed in line with their academic training and modules as they have completed each academic level.

Within the first six months, we were able to get our apprentices to assist in nail surgery, nail surgery re-dressings and independently completing simple nail surgery assessments on healthy low-risk patients.

In terms of getting their clinics off the ground and being able to support us as a team to manage our waiting lists and get through our backlog, the benefits are visible even after the first 4-6 months. Our current third-year apprentices are only at a stage where we're able to allow them to semi-independently run their high-risk and ulcer clinics, which is amazing, as well as starting their training in nail surgery and assisting in MSK clinics.

And because we have two apprentices that's working out well because we can have one podiatrist overseeing two apprentice clinics. So we're able to get through a greater volume of patients.

Emma: So would you say there's a benefit to taking two apprentices rather than one? If you've got an opportunity?

Marian: Definitely and we've asked to take on two again in September. I spoke with our 3rd year apprentices and it was so useful to them to start at the same time because they've been able to support each other. If they're not quite sure what's going on, they can talk to each other and help each other. They're doing the clinics together, they're learning together.

Emma: And what would you say to an employer that was not considering apprentices due to the current pressures that podiatry services are under with increasing acuity of patients, backlogs and service recovery?

Marian: Investing in apprentices can sometimes feel like you are putting in a lot of time for little return as there is no guarantee the apprentice will stay with you, however, the sense of satisfaction knowing that the apprentice will be ready for the workplace and could easily sit within a Band 6 role is worth it.

We know there is a workforce gap and even with traditional undergraduates they need a lot of early career support and a good preceptorship to help the transition from student to newly qualified podiatrist.

With an apprentice, while you're putting the time in, they do graduate as extremely rounded, capable clinicians who could go straight into a band six job doing high-risk work, MSK clinics, nail surgery and everything else. Our apprentices will have completed all their workplace competencies by the time they graduate.

Emma: And that's because they have had the exposure to the workplace and all the different areas of the profession?

Marian: Yes, because they've had the exposure and a lot of real life experience.

And of course it would be great if we could all just recruit experienced podiatrists at Bands 6 and 7 whenever we wanted one and bring them straight in but that’s not the reality of the workforce. We have to invest in our workforce if we want those quality candidates in the future. At least this way you're building a workforce that understands how to work within the NHS, that understands how processes work and systems work, and they’re used to being in a workplace - which again a lot of undergraduates, they come out and they don't have that knowledge or experience.

Emma: One of the questions I get asked a lot is how to get started. So what do you do in the first few weeks?

Marian: It's about getting to know the team and how the department works so just shadowing lots of different clinics and meeting everyone.

Starting the apprentices off with clinical administrative tasks, and getting simple tasks completed independently to give them confidence and start to embed them in the team is important. I think the first thing we got our apprentices to do when they started was to get the referrals processed. It’s part of the learning, to start seeing what we're dealing with as a team, understanding the kind of referrals that come in  and understanding the systems that we're using.

We also got them doing patient call-backs, so they can start talking to patients whilst supporting the team. And again, they're starting to get some idea of the things that we're dealing with in the department

Then we just started them off with simple clinical tasks, things like nail surgery re-dress - it's not something that you need a huge amount of training to do but releases capacity within the team. They can then move on to assisting in nail surgery and carrying out simple nail surgery assessments.

It is tricky in the first year because there is only so much you could do with them, especially with the acute workload and complex patient demographic. However our apprentices have become exceptionally helpful, they do a huge amount for the team and department, and ultimately both the profession and patients benefit as a result. This is why we are excited to continue taking on apprentices, because they are a true asset to the team.