Education, supervision and delegation
Support worker roles
Improvements in service delivery and patient care within the foot health workforce commissions new roles. These roles can be seen at all levels, on the Health Education England (HEE) foot health care map.
The support worker's educational requirements and academic level are defined into three typical job titles:
- The Foot Care Assistant/Foot Health Practitioner - Level 3
- The Foot Health Practitioner - Level 4
- The Associate/Assistant Practitioner – Level 5
A readiness toolkit has been designed to support the integration of the support workforce into clinical practice.
The Standards for the Foot Health Workforce (FHS) were published by HEE in 2021, and provide a structured career ladder for the foot health support workforce. They form part of a process to increase the foot health workforce to meet growing demand, whilst ensuring that everyone working in the field of foot health operates at an appropriate and safe level. Through a wide stakeholder consultation process, The Royal College has established a portfolio route for accreditation of individuals and training providers. This process will be operationalised in the coming months.
The AHP Support worker competency, education and career development framework enables employers, networks, integrated care systems (ICSs) and services effectively plan, develop, and deploy their AHP support workforce. Download here.
It guides on training, education and competencies for AHP support workers and demonstrates a clear pathway for recruitment and progression, with common and transferrable skills across eight domains:
| Formal knowledge | Supporting service users | Clinical, technical and scientific roles and responsibilities | Communication and information |
| Safe and inclusive environments | Research and service improvement | Leadership | Personal and professional values and behaviours |
(Adapted from AHPSW framework)
Scope of practice
The scope of practice of the podiatry support workforce is evolving rapidly because it needs to provide effective support to the healthcare professional to sustain the provision of foot care services. Qualifications, as seen in the HEE foot health map above, as well as experience, general skills and behavioural requirements, support job descriptions and personal specifications when planning service provision to include the support worker. Each job is unique and will have nuanced approaches to patient services. Utilising clinical capability frameworks and guidance against the foot health standards for each of the ‘typical job roles’ identified in the HEE FHS can support workforce planning and development of job descriptions across all health and social care services. Owing to the recent construction of the FHS in 2021, many of the established capability frameworks do not offer the full complement of support worker offering across the designated academic and educational levels at the time of writing this document.
The examples of the job profiles below are adapted from the FHS document and complimented with a generic mapping of behaviours taken from within the Capability framework for integrated diabetic lower limb care.
- Job profile: Level 2/3 Foot care assistant/Foot health practitioner
- Job profile: Level 4 Foot health practitioner
- Job profile: Level 5 Assistant practitioner in podiatry
In consideration of assurances in patient safety and public perception, surrounding the foot health team is a responsibility to maintain clinical professional development. It is for both the employer and the employee to ensure that they are kept up to date with clinical, professional, and legal research and/or regulation. The FSH states that the support worker is under the delegation and supervision of a podiatrist and therefore it would be for both parties to identify current and future education and development needs to support career progression and service needs. Within NHS and private podiatry teams, reviewing population health against skill mix and job descriptions would identify the learning and capability requirements for the service. HEE have suggested in their AHPSW Framework to incorporate the four pillars of clinical practice; clinical practice, leadership and management, education, and research to provide personalised job profiling for career development, workforce, and service need. A readiness toolkit for the support workforce can be found here.
NHS England is currently developing a standardised delegation and supervision guidance document which will be available on their webpages, when available.
The role of the podiatry assistant is explored more fully here.
The Saks Report
In 2021 RCPod commissioned a landmark report, The Saks Report, looking at the future of podiatry.
It made 28 recommendations of what the profession needed to do to secure the workforce of the future. There were 28 recommendations of which number 12 suggested more delegation of routine work to support workers. When looking at a value chain analysis of foot health service provision within the UK from 1996-2020, (see diagram below) some footcare provision can be delegated to the support workforce allowing for more complex decision-making to be carried out at the appropriate academic and educational level.
(Diagram above from: A Value Chain Analysis of UK Foot Health Service Provision 1996 – 2020. Abbott and Wylie, 2020)
It is clear from the Saks report, with the recommendations for the profession, in collaboration with the value chain analysis (as in the diagram above) that the foot health team is imperative in the drive to support the foot health needs within the UK. The value that the podiatry profession brings to patient care and medical management is evident and can be seen in this video.
Embracing the transformation of services and implementing new posts across the support workforce, in conjunction with quality assurance mechanisms, will contribute significantly to the integration of the foot health team and what we can offer to our patients and service users as well as the profession.