The Case for Change and developing new ways of working

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