These questions relate to the Supervision, accountability and delegation of activities to support workers guide. They clarify the delegation process for registered practitioners and support workers and provide answers to some common concerns. They also cover issues of accountability and supervision, to ensure clients receive safe and effective care from the most appropriate person.
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Supports workers can deliver an essential role to the care of patients and may provide registered physiotherapy professionals with an extra pair of hands.
Many activities can be delegated to support workers, but there are some key differences between the roles and the abilities and limitations of the support worker. Registered professionals must ensure they are aware of the correct processes and procedures when delegating to support workers.
This page details key facts and questions that will enable registered professionals to delegate confidently and understand important aspects of the support worker's role.
Can someone other than a physiotherapist delegate tasks to a physiotherapy support worker?
Any statutory registered healthcare professional (i.e. registered with the Health and Care Professions Council, Nursing and Midwifery Council or General Medical Council) can delegate to a physiotherapy support worker. The registered healthcare professional is accountable for their decision to delegate and they must be sure that whatever they delegate is appropriate to the support worker’s role and their competence.
I have been asked to delegate certain tasks to a support worker but I’m worried that I will be accountable if they do something wrong. Is this true?
Both registered healthcare professionals and support workers have a duty of care. This means that they are both accountable for their acts and omissions.
The registered healthcare professional is accountable for their decision to delegate, in that they must be sure that the support worker is confident and competent to undertake the delegated activity and that it is in the scope of the support worker’s role.
Thereafter, on accepting the delegated activity, the support worker is responsible for their actions and decisions.
The registered healthcare professional does though at all times retain responsibility for the care of service users/patients.
What can be delegated to a support worker?
Delegation is a process of establishing at a particular point in time and in a particular context what tasks, activities and responsibilities can be safely allocated to a support worker.
The CSP does not hold a list of typical tasks, activities and responsibilities, because registered clinicians and support workers must work together to determine in their own practice situation and context what is appropriate to be delegated.
Some activities cannot legally be delegated. In the context of physiotherapy, these include prescribing medicines and making referrals for diagnostics that involve exposure to radiation.
Some services have local policies which prevent the delegation of certain tasks, activities and responsibilities to support workers. Where these seem arbitrary and preclude safe, effective and efficient practice, they can be challenged.
What should be considered when delegating to a support worker?
You should consider the key principles of delegation:
- patient’s best interests
- scope of role
- complexity and context of the task to be delegated
- competence and confidence of the support worker
- support and feedback systems
Further detailed guidance of how to apply these principles in practice can be found in our accountability and delegation quick reference guide.
Can patient assessment be delegated to a support worker?
When it is necessary but only to support workers at a higher level and within the context of non-complex care where aspects of assessment, treatment planning and providing interventions are largely routine, protocol led and familiar to the support worker.
In this situation the primary assessment will have been completed by a registered practitioner and may be classed as triage or screening.
Depending on the local situation, triage or screening may include:
- paper or e-referral screening
- telephone screening
- adhering to a local protocol
- patient allocation at board rounds or team hand-overs
Following initial triage or screening the whole physiotherapy care pathway for certain patients may be delegated directly to a higher-level support worker (e.g. NHS band 4 or equivalent).
The scope of the role of higher-level physiotherapy support workers means they have the capabilities to undertake an entire episode of care, from the first face-to-face assessment through to discharge for certain patients.
It is imperative, though, that the support worker is suitably trained, educated and competent to carry out these elements of care and that they still report to the registered practitioner for redirection and advice, as necessary. This must include a comprehensive understanding of when to escalate concerns and an appreciation of when a protocol-led assessment or intervention deviates from that expected.
A registered practitioner in the service will retain overall responsibility for patient care but the support worker will be expected to make decisions within the context of the agreed protocol or the designated work with a patient/client, whilst working towards the aims set by or discussed with the registered practitioner.
In these situations local governance arrangements must be in place with clear parameters for support workers to refer patients back to a registered practitioner if required and that the role and specific activities of the support worker are made explicit in the design of protocols.
We see this aspect of higher-level support worker practice as contributing to assessment and care planning.
My service lead says that assessment and care planning cannot be delegated to support workers. How can I challenge this?
Some professional groups do not recognise this as within the scope of practice of non-registered practitioners in their workforce.
It is important to remember that the scope of practice for different professional groups working at varying levels is likely to be different. This is due to the unique professional practice context of each and how the concepts of assessment and care planning are interpreted.
The table below outlines broad and well understood responsibilities of the registered physiotherapist workforce and illustrates how the CSP view the differences in the extents and limits of these responsibilities for higher-level physiotherapy support workers in contemporary physiotherapy practice.
The CSP expects that physiotherapy support workers are judged against physiotherapy definitions of practice and should not have their roles and responsibilities defined by models of practice of other professions such as nursing, which uses an alternative model.
|Registered physiotherapist||Higher-level physiotherapy support worker|
|Be an accountable professional||Be an accountable professional|
|Promoting health and preventing ill health||Promoting health and preventing ill health|
|Provide and evaluate care||Provide, monitor and evaluate protocol led care in routine and predictable contexts|
|Leading and managing care and working in teams||Working in teams|
|Improving safety and quality of care||Improving safety and quality of care|
|Coordinating care||Contributing to integrated care|
|Assessing needs and planning care||Contributing to the assessment of needs and care planning for certain delegated cases in routine and predictable contexts|
More widely, the assessment process should be a continuing element of the overall therapy programme/treatment plan. Support workers may therefore be able to judge the patient/client progress and make some treatment decisions based on that judgement, assess and reassess the patient/client’s progress.
It is always expected that a support worker at any level who is delegated clinical tasks will be competent to continually monitor and evaluate changes in the patient/client’s responses and to feed back relevant information to the registered practitioner(s). This might mean not proceeding with or continuing with an assessment and intervention and immediately escalating to the registered practitioner.
What arrangements need to be in place to ensure delegation is safe?
The CSP asserts that processes and systems must be in place to ensure that delegation occurs in a safe and appropriate way for patients/service users and all staff involved. We have developed six principles that can be used when developing/evaluating these processes:
- Assessment and management of risk should occur in the local context and be undertaken in consultation with registered physiotherapists.
- Induction of support workers new to a role or area of practice should include spending time with registered physiotherapists or higher-level physiotherapy support workers.
- Support workers should have access to the support of registered physiotherapists or higher-level physiotherapy support workers to identify learning and development needs related to physiotherapy practice.
- Support workers should have access to the support of registered physiotherapists or higher-level physiotherapy support workers to develop and sustain their competence to undertake physiotherapy interventions safely and effectively.
- Support workers should have timely access to registered physiotherapists or higher-level physiotherapy support workers for professional support and advice. This must include arrangements to access a registered physiotherapist when the level of support required is beyond the defined expectations of higher-level support workers’ knowledge, skills and experience.
- There should be records of training undertaken and evidence of ongoing competency.
For details on how to put these principles into practice, see our detailed guidance.
Do support workers need insurance?
If they are employed the employer's vicarious liability will cover them for any tasks and activities they are required to undertake as part of their role. (Such as is the case in the NHS or other independent providers).
If a private practitioner/business owner employs support workers they must ensure they have sufficient cover under their business insurance arrangements.
If support workers work with a registered physio in a practice on a self-employed basis, they must have their own insurance. CSP associate membership includes insurance and will cover support workers in this situation, subject to the terms and conditions of the policy; namely that their work:
- is delegated and supervised by a statutory registered healthcare professional
- is in the scope of physiotherapy practice
Can support workers receive delegation and supervision/support over the phone?
It is not necessary to always have face-to-face delegation, support and supervision – this can happen by distant means such as over the phone.
The most important thing is that the support worker is competent and confident to carry out the tasks, activities and responsibilities delegated to them and that they have easy access by phone or other means to a registered healthcare professional to feed back, ask for support, or raise questions and concerns. This does not necessarily need to be a member of the same profession or their line manager, but should be a named individual who has formally been assigned the responsibility to undertake this support.
Can a support worker continue seeing patients alone even on days where no physiotherapists are available to contact?
As long as there is another registered healthcare professional that the support worker can contact for general advice or guidance (e.g. an occupational therapist or nurse) and the support worker is clear of the extent and limits of their practice when a registered physiotherapist is not available to advise them if needed.
In situations where this is a local working practice, other registered healthcare professionals in the team or service should have a good awareness and understanding of the arrangement and that they may be required to provide general support and advice.
The registered healthcare professional responsible for making delegation decisions in the context of this working practice must be aware of the extent of their accountability and responsibility and ensure a robust governance framework is in place.
Can support workers support and supervise pre-registration students?
All staff, whatever their role, can support new and less experienced team members.
Please see our information on the role of the support workforce in practice-based learning.
Can support workers countersign students' notes?
There are circumstances when a support worker can countersign a student’s record. In this situation, there must be local agreement to this approach; the support worker must have competence in practice education and supervision, and the student must only be recording the tasks and activities they have undertaken that are in the scope of the supervising support worker’s role. Please see our information on the role of the support workforce in practice-based learning.