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Knowledge and Skills Framework

If you work in the NHS, find out how use of the Knowledge and Skills Framework (KSF) can make you more effective in your job.

The NHS Staff Council has now simplified the Knowledge and Skills Framework making it easier to use and giving trusts the flexibility to tailor it to meet local needs: KSF review.

The Knowledge and Skills Framework was introduced under Agenda for Change (AfC) and is central to the learning and development, career and pay progression element of AfC.

It sits squarely with the other two main elements of the AfC agreement, notably the terms and conditions of employment, and the AfC pay and band structure, underpinned by the NHS job evaluation scheme.

Bearing in mind this recent review, it's still worth finding out about the original implementation of the KSF:

Structure of the KSF

The NHS KSF is made up of 30 dimensions which identify broad functions that are required by the NHS to provide a good quality service.

There are 6 core dimensions which are relevant to every NHS post, whether a specialist therapist or a domestic assistant.

There are also 24 specific dimensions which apply to some but not all jobs. Each job is likely to have 3 to 6 specific dimensions.

Most physiotherapy post outlines are likely to include Health and Wellbeing dimensions numbers 6 and 7, Assessment and Treatment Planning (HWB6) and Interventions and Treatments (HWB7).

KSF 'core' dimensions

ksf core dimensions

Each core dimension has 4 levels. The levels are hierarchical within the dimension but not hierarchical across posts, eg a band 5 physiotherapist might be working at a lower level on a dimension such as health, safety and security than an assistant who could have a special remit to undertake health and safety checks on electrotherapy equipment.

Each level has a title or 'descriptor' which describes what the level is about. Attached to the level descriptors are 'indicators' which describe how knowledge and skills need to be applied. Alongside these are some examples of 'application' which can be profession-specific. The dimensions, levels and indicators cannot be changed but the examples of application can be added to. A fuller discussion on how the dimensions work are contained in the briefing paper: NHS Knowledge and Skills Framework and the Development Process.

KSF 'post outlines'

Every post in the NHS has or will have a KSF post outline. This sets out the dimensions and levels that apply to a particular post. The combination of dimensions and levels gives a broad post outline. Identifying the specific areas or activities of a post and adding areas of application gives a full post outline.

Post outlines are about posts and not people. They specify the knowledge and skills that need to be applied in a particular post. They need to be realistic and reflect the actual demands of a post without imposing unnecessary requirements.

The 'foundation gateway outline' is a subset of the full post outline and identifies the basic skills and knowledge required after 12 months in the post. The subset lays out the essential demands of the post and should be developed at the same time as the full post outline.

Post outlines must be developed in partnership between management and trade unions/professional bodies. Further information on the different approaches to developing outlines is available in the CSP briefing Developing NHS KSF post outlines.

The NHS KSF Development Review Process

The NHS KSF is designed to form the basis of a development review process by applying a KSF post outline to an individual, looking at their work and their learning needs to enable development over time. A development review is an ongoing cycle of review, planning, development and evaluation, similar to an appraisal review which physiotherapy staff should be familiar with.

All staff will have an annual development review usually undertaken by their line manager to consider how an individual is developing in relation to the duties and responsibilities of their post, the application of knowledge and skills and consequent development needs. Part of the process is the production of a jointly agreed personal development plan (PDP) which identifies learning needs and interests. Again, this shouldn't be anything new to physiotherapy staff.

It is expected that many NHS organisations may subsume their appraisal process into the development review process so both development and performance can be reviewed and assessed within one process. It is expected that reviewers will have regular informal discussions with individual staff members throughout the year. Any disciplinary issues will be dealt with through the normal channels outside the development review process. There should be 'no surprises' at the review.

Pay progression and pay gateways

There is a link between the KSF and pay progression at two points within each pay band, at the foundation gateway and the second pay gateway. In other years, there is normally expectation of progression so there is an annual increase in pay from one pay point in the band to the next.

The foundation gateway takes place no later than 12 months after an individual is appointed to a payband regardless of where he/she is appointed on the pay band. There is only one foundation gateway review within each pay band regardless of the number of employers.

For example, a physiotherapist is newly employed at Trust A on band 6. After 12 months, he has his foundation gateway review assessed against the foundation post outline and demonstrates that he meets the essential requirements of the post. Development needs are identified from the review which he works towards over the next year. However, before his next review, he needs to relocate and is appointed as a band 6 physiotherapist at Trust B. His first development review at Trust B is a normal one and he progresses to the next incremental point. He does not have another foundation gateway review in Trust B.

On assimilation under Agenda for Change, individuals will only have a foundation gateway if they have been in post for less than a year regardless of where they are on the payband.

The second pay gateway takes place towards the top of a payband:

Pay band Position of second gateway
Band 1 Before final point
Bands 2-4 Before first of last 2 points
Bands 5 - 7 Before first of last 3 points
Band 8 a - d Before final point
Band 9 Before final point


The purpose of the second gateway review is to confirm that an individual is applying his/her knowledge to meet the full demands of the post as set out in the full KSF outline. Having gone through the second gateway, individuals will progress to the top of the pay band and the development review should be addressing career development needs as well as reviewing the requirements for the current post.

There is no automatic progression from one payband to the next and individuals will have to apply for the posts in the next payband in the normal way.

It is expected that individuals will progress through the pay gateways. If there are problems with individuals developing towards the full KSF post outline or there are disciplinary issues, these must be addressed by reviewers before the gateway reviews.

The pay gateway reviews should not be any different to the other development reviews. The individual should provide evidence, drawn from their CPD portfolio, to demonstrate how he/she meets the post outline. One piece of evidence may cover more than one dimension. The reviewer should also identify the different ways the individual has met the KSF outline.

Some physiotherapists and assistants may reach their full post outline before they reach their second gateway. However, there is no fast tracking (other than the band 5 to 6 run through and the development review process should identify development opportunities.


By October 2006, all NHS postholders should have had their first KSF development reviews. It was expected that all post outlines would be developed by October 2005 but this has been overshadowed by the job matching and banding process. However, the pressure to implement pay gateways is likely to focus NHS employers during 2006.

The development review process can be introduced without completed post outlines as a basis for development. If the process is not in place, individual members of staff will automatically progress through the pay gateways.

If you are unclear about the progress of your post outline or broad band outlines, you should contact your manager, steward or KSF lead in your organisation. Trusts should be providing awareness training and development review training for both reviewers and reviewees.

Relating the KSF to other competence frameworks

The NHS KSF is an overarching generic framework which has been developed from an analysis of competences that currently apply to the different staff groups within the NHS. Other national competences and competence frameworks that have been externally quality assured and/or approved can be linked into the KSF, eg HCPC Standards of Proficiency, National Occupational Standards, National Workforce Competence Frameworks.

Locally developed competences are not directly recognised within the KSF and current advice is that no new local competences should be developed. There is some scope to use existing ones within areas of application of the KSF post outline as evidence for the development review.

The KSF and the CSP Core and Service Standards of Physiotherapy Practice: Mapping Links

The CSP has mapped the links between the CSP Core Standards (2005), the Service Standards of Physiotherapy Practice (2005) and the NHS KSF (2004). This work was commissioned in response to requests from members working in the NHS for help in relating CSP Standards to the KSF.

Although the KSF is linked to nationally quality assured standards (eg national occupational standards, HCPC Standards of Proficiency) members find it is more useful to link the KSF with CSP Standards to enable them to describe areas of application more accurately when developing KSF outlines.

KSF iCSP network

InteractiveCSP has a KSF network: sign up via iCSP.

Further resources


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