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The Case for Change and developing new ways of working

Using the Standards in conjunction with established apprenticeship routes can give a huge boost to developing your support workforce. The case studies in the section below show how using both the Standards and the apprenticeship routes can help redesign services and develop the Podiatry support workforce.

In the example below, The Standards were used to map job roles and clinical skills for support workers. In the ‘Grow your own’ section the case studies further demonstrate how the Standards can be used in the development of existing staff alongside the apprenticeship routes to offer the skill mix and career development of existing staff.

Case study: Service Development

The Podiatry Service in Torbay and South Devon had a waiting list and were unable to deliver a service for patients with diabetes in line with National Institute for Health and Care Excellence (NICE) guidance, waiting times of nail surgery increased and MSK interventions were not able to be seen in a timely way.

To clear the waiting list and deliver in line with the MSK framework and Diabetes NICE guidance the team decided to look at new ways of working. An options appraisal was undertaken for seeking new investment for additional podiatrists, reskill mix to meet the demands within the existing budget, or focus on high-risk interventions only.

Recruitment of additional podiatrists was not feasible and so the reskill mix option was undertaken with a capacity demand analysis and a 60:40 split of skilled registered to skilled un-registered staff to meet the service demand. Some appointment times were reduced. The use of support staff in wound clinics and new patient assessment clinics meant that the podiatrist was able to offer an enhanced level of care in line with NICE recommendations.

The perceived barriers to delivering non-medical prescribing by podiatrists, undertaking ABPI’s and TBPI’s, arranging x rays, reviewing bloods, and offering off-loading devices/footwear or casting in the community had been put down to time constraints.

The new skill mix freed up capacity for podiatrists to deliver these additional clinical services within the same time slots. The new freed up capacity from nail surgery - where support workers were assigned to re-dressing clinics and assisting in nail surgery - was put into additional assessment clinics to help clear waiting lists. The MSK team were able to offer an enhanced level of care such as shock wave therapy and administer steroid injections and in addition - supported research projects.

Grow Your Own (GYO)

Grow your own refers to workforce strategies that seek to attract and recruit locality-based people into health and social care employment. This is achieved, for example, by engaging with local schools and colleges, working with job centres, local work and health programmes, and also adults who may be considering a career change or others who might be economically disadvantaged. Once in employment, a GYO strategy will look to support individuals and develop their careers whether they remain in a particular post or progress upwards.

In the NHS podiatry support workers typically work between education level 2-5, and are often called podiatry assistants, foot care assistants, or podiatry assistant practitioners. Depending on the level of training and competence, they often carry a patient caseload, and carry out a range of tasks working under the supervision registered podiatrists. They are key in helping you create the right skill mix in your team, and enabling your podiatrists to provide specialised, high-quality patient. Support workers can complete the level 3 or 5 apprenticeship which helps grow and develop the skill mix needed within an NHS podiatry service and helps with sustaining the GYO model.

The AHP Support Worker competency framework enables employers, networks, integrated care systems (ICSs) and services to effectively plan, develop, and deploy their AHP support workforce.

As part of this work, NHSE have launched a nationally led procurement process, focusing on the following apprenticeships:

  • Level 3 Senior Healthcare Support Worker
  • Level 5 Assistant Practitioner

For more information on the apprenticeship routes available follow this link to access the relevant information:

GYO case studies

The following case studies have utilised the Standards to develop support workforce at level 3, 4 and 5 employing the apprenticeship training routes to support career development and GYO strategies. The final case study highlights a further route that has been developed in South Devon, that has been mapped onto the Podiatry degree programme that is provided by the University of Plymouth. This provides support workers with real opportunities to train to become podiatrists. If you are an NHS service that is looking to develop your podiatry support workforce, the case studies will show you how to grow your own staff and optimise your skill mix utilising the Standards and apprenticeship pathways available. Megs story shows how you can use the Standards and the apprenticeship routes to offer routes into regulated workforce and the final case study shows how podiatry services in Gloucestershire are using the Standards alongside the apprenticeship options to help improve the pipeline into the registered workforce.

Training for the support workforce to offer career development using the GYO model.

“Utilising an apprenticeship route meant we didn’t have to fund the course as we were already paying for the support workers salary at either band 2 or band 3, so the apprenticeship option helped with meeting salary costs for trainee podiatrists and avoided finding course fees.”

Angie Abbot - Podiatry Service at Torbay & South Devon NHS Foundation Trust.

AfC band 2 (aligned to academic level 3)

The indicative AfC Band 2 support worker role is to assist registered podiatrist to undertake nail surgery.  The support staff set up and clear the nail surgery trolley, time the procedure and tourniquet application, make up and give out the dressing packs for patient self-care redressing’s, and demonstrate how to apply dressings. Counter check expiry dates and support the patient during the procedure. They help needle phobic and anxious patients by explaining the option for the wearing of a virtual reality headset. Monitor patients’ Blood Pressure and O2 saturation. Provide the links to the dressing videos and leaflets.  They support stock management, and they assist in new patient assessment clinics including some MSK clinics.


Support workers at this level are also assigned to community ulcer clinics working alongside the podiatrist in a clinic setting to safely support patients into and out of clinics, remove wound dressings, recognising signs of infection or deterioration then reapply dressings under direct supervision of the podiatrist. They provide skin and nail care on high-risk patients to include nail cutting and use of nail drill, undertake monofilament test and doppler sounds, take insole template.  They can cut out and apply padding and strapping. In a directly supervised, supporting role, they support the podiatrist to provide additional community based high risk interventions such as taking SWABS for suspected infection, non- medical prescribing, review of bloods and requests for X-rays. They can support the podiatrist to provide off-loading devices and footwear, fit an insole to ensure good fit in a shoe. They help provide the foot health education, rebook appointments and support records management. Support workers will assist in nail surgery and general assessment clinics supporting history taking.

They can be developed using an academic level 3 apprenticeship – see appendix 1 for an example job description which has been benchmarked against the Standards.

AfC band 3 (aligned to academic level 4)

The indicative AfC band 3 support worker role will assist a podiatrist in the acute step-down ulcer clinics and multi-disciplinary foot team (MDFT) clinics. They will safely support patients into and out of clinics. The patients attending these clinics could be new to the multidisciplinary team (MDT) for deteriorating or non-healing ulcer and require medical opinion. The support worker will set up and clear dressing trolleys, removes post-surgical dressings or specialist dressings and have the knowledge and skills to remove and re-apply specialist dressings under the direct delegation and supervision of the podiatrist or consultant. They will also provide any additional nail or skin care and monofilament test or doppler test on ulcerated patients. They check blood pressures and can monitor O2. They deliver patient education. The support worker may be involved in records management, appointment bookings and stock control and stock ordering. They take casts or impressions and can manufacture simple chair side appliances, and general padding and strapping. They can fit insoles to ensure good fit in shoe or post-surgical temporary shoes and offer after care advice.


The support worker can provide diabetic foot reviews, offer patient education, skin and nail care and notify delegating podiatrist when patients care plan requires review or escalate deteriorating foot. In this case the support worker is employed as an AfC band 3. They offer support to the inpatient podiatrist to care for patients admitted that have diabetes. They review alerts for admitted patients and support inpatient podiatrist to deliver treatment and wound care and liaise with members of the MDFT.

By utilising this route support workers can be qualified at level 3 whilst being developed using a level 4 qualification or level 5 Assistant Practitioner/foundation degree. This route also allows a step on point onto a level 5 assist and practitioner apprenticeship and then a level 6 pre reg apprenticeship programme or degree programme

See appendix 1 for an example job description which has been benchmarked against the Standards.

Training Pathways

In this section, there are examples of how developing innovative training pathways using the apprenticeship routes, can aid support worker career development as well as benefitting the development of sustainable service provision. The Standards are being used to develop these pathways and the new Standards accreditation process for education providers and individuals will further support this development.

At the University Centre in South Devon, they have developed a podiatry specific programme that maps to year 1 of the BSc Hons podiatry course provided at University of Plymouth. Candidates completing this qualification can APEL onto year 2 of a degree. This provides an ongoing development pathway to grow our own support workers and facilitates a pipeline to training podiatrists. This supports career development of the whole team and retention of support staff.

The RCPod is developing an accreditation process for the support workforce, informed and developed around The Standards. With an accreditation process in place, people training for podiatry support roles, at accredited institutions in the independent sector, and people already in practice in the independent sector, who can demonstrate their competence, will in future be, able to work in the NHS. It is hoped that this example programme at South Devon will become accredited when the process is launched.[1]

Visit the web pages Podiatry and Lower Limb Orthotics - https://www.ucsd.ac.uk/courses/podiatry-and-lower-limb-orthotics/ for more information 

[1] https://rcpod.org.uk/blog/strengthening-the-foot-health-workforce

In 2017 when the apprenticeship levy was first introduced, we were encouraged by our organisation to see if we could offer any of our roles as apprenticeships. Then the podiatry graduate apprenticeship hadn’t been thought of so we looked at other roles and felt that the podiatry assistant role would fit well as an apprenticeship.

It was important to work with the apprenticeship team as this was all new to us and there were a lot of preconceived ideas about apprenticeships. At the time there wasn’t a dedicated AHP support worker apprenticeship so we had to adapt a level 2 healthcare assistant apprenticeship.

We went out to interview in June 2017 and appointed Meg into the apprentice role. It was clear from the interview that Meg was hard working and enthusiastic, it was fantastic to be able to offer an opportunity to someone who had just completed their A levels, wasn’t sure what she wanted to do but going to university wasn’t an option for Meg due to financial reasons.

Twelve months later Meg passed the course with a distinction and was nominated for apprentice of the year in healthcare in the South West, which she won!! On completion of the course we offered Meg a permanent band 2 role and 6 months later following in house competencies Meg was successful in getting a band 3 role.

Working with the apprenticeship team we looked at what was the next step and in 2019 Meg started doing a foundation degree along with others in the organisation. This apprenticeship was level 5 so assistant practitioner level, Meg successfully completed this in early 2022 and is now working as a band 4 in the Podiatry Department. Her ambition is to apply and be accepted onto the podiatry degree programme and become a qualified podiatrist.

[2] Permission given to publish from Meg and Gloucestershire Health and Care NHS Foundation Trust


Meg started her journey before the Standards were available, however her career journey maps well to the Standards and we would recommend others exploring the route that Meg took, to use the Standards to help provide guidance and direction. In Gloucestershire Health and Care NHS Foundation Trust we now use the Standards to help us plan for and develop our podiatry workforce from support workers to HCPC registered podiatrists. The apprenticeship route we have found has worked well in our department, as it is well structured, the candidate is supported by the team providing the training and there are regular support meetings. It has been fantastic to watch Meg develop into a competent assistant practitioner and that we have been able to give her the opportunities to grow and follow a career that previously she wouldn’t have been able to.

[3] Permission given to publish from Gloucestershire Health and Care NHS Foundation Trust

Podiatry Support Worker Career Growth and Development Pathway used at Gloucestershire Health and Care NHS Foundation Trust 


Diagram showing career pathway


[3] Permission given to publish from Gloucestershire Health and Care NHS Foundation Trust

Related documents

Below you will find links to the Band 2 - 4 job descriptions: