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Delegation to support workers

Support workers within the physiotherapy profession work across settings and specialities and are allocated their work through delegation. This guidance for registered practitioners and support workers details how this can best work in practice. 

Safe, person-centred care and optimal utilisation of the workforce depend on effective delegation, supervision and accountability.

Good delegation in practice

Watch this film to see how good delegation in practice has supported service transformation and improved patient care in a community rehabilitation team in Glasgow. 

What is delegation?

Delegation is the process by which a delegator (registered healthcare professional) can safely allocate clinical or non-clinical care and support to a competent person: the delegatee (support worker).

Who can delegate?

  • Delegation of physiotherapy interventions can be from a statutory registered healthcare professional. This can be someone other than a physiotherapist.
  • Delegation can also be from higher level support workers to other support workers providing they have been trained in delegation and there are clear processes in place to facilitate this in their employing organisation.
  • In services involving non-statutory regulated healthcare professionals, local agreements and governance frameworks must define when delegation is appropriate, ensuring standards equivalent to statutory regulation for safe, effective delegation.

The decision to delegate

The purpose of delegation is to ensure the most appropriate use of skills within a health and social care team to achieve person-centred outcomes, focusing on safety and quality of care.

Those choosing tasks or roles to delegate should consider professional, legal and ethical standards, and decisions should be guided by the following:

  • Patient-centred care: The primary motivation for delegation is to serve the best interests of the patient. Patients have the right to know who is providing their physiotherapy care, and this should be communicated clearly.
  • Scope of practice: Tasks should be delegated only if they fall within the support worker's scope of practice.
  • Competence: The support worker must be competent to carry out the delegated task. Registered staff should be competent in the delegation process. Both should undertake appropriate training, provided by the employer.
  • Supervision: Appropriate supervision and feedback mechanisms must be in place. The task to be delegated should be discussed and both delegator and delegatee must be confident that this task will be carried out competently. Regular supervision time should be agreed and adhered to. This will vary depending on the needs of the support worker, but does not need to be direct and constant.
  • Communication: Clear communication between the delegator and the support worker is essential. Scope of practice and competencies of the support worker should be communicated to the wider team to inform delegation decisions. 

Governance policies and processes should be in place within organisations to support registered professionals in their delegation decision.

Principles contributing to safe delegation

Watch our series of short films showcasing how each of the five principles of delegation can be implemented in practice:

These principles should be used to guide local governance arrangements and individual decision making processes:

  1. Robust risk assessment(s) should be undertaken
  2. Induction for all staff new to a role or area of practice; to include roles, responsibilities and delegation processes
  3. Support workers should have access to registered staff to identify learning and development needs, and those needs should be met.
  4. Competencies should be in place for support workers in relevant physiotherapy interventions and non-clinical skills, and for registered staff in delegation
  5. Professional support and advice for support workers (escalation pathways and real-time clinical advice) should be in place. 

In what settings can support workers be delegated to? 

  • Delegation can take place in any setting where physiotherapy interventions are delivered to patients. Registered physiotherapists and support workers may be employed by difference organisations. Clear lines of communication regarding governance, including training and competencies, should be in place to allow safe and effective delegation to care staff. Clear supervision and support structures should also be in place and clearly communicated to all parties.
  • Further guidance on delegation in social care settings from Skills For Care should be considered alongside this information. 

What can be delegated? 

  • There is no list of physiotherapy tasks that can be delegated to a support worker. This will depend on the service, population need, scope of practice of the support workers and their competencies. Registered clinicians and support workers must work together to determine in their own practice situation and context what is appropriate to be delegated. There may be scenarios where support workers could carry out a task, but it would be more appropriate for a registered healthcare professional to do so.
  • 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 that 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.
  • Support workers can be delegated tasks across the four pillars of practice: clinical, education, research and leadership.

Who is accountable when a task is delegated? 

The employer, the registered staff member and the support worker hold levels of accountability and responsibility for delegation, and all have a legal duty of care.

  • The employer should have structures and policies in place to ensure safe, effective delegation. Organisations are responsible for the governance underpinning delegation and are responsible and accountable for ensuring staff are trained and competent.
  • The registered healthcare professional is accountable for ensuring that the task is appropriately and safely delegated to a competent individual. They should only delegate tasks to a support worker who has the knowledge, skills and experience to do specific tasks safely and effectively (see standard 4.1 in the HCPC standards of conduct, performance and ethics). Registered staff are therefore accountable for their decision to delegate a task and retain overall responsibility for the service users in their care. Registered staff are also accountable to the regulator and should maintain professional standards.
  • The support worker is accountable for the decision to accept a delegated task and should only do so if they are trained, educated and competent to carry it out. They are responsible for their actions or omissions when carrying out the task. 

Supervision 

Effective delegation cannot take place without supervision which are therefore interrelated. Statutory registered healthcare professionals must continue to provide appropriate supervision and support to those that they delegate to (see standard 4.2 in the HCPC standards of conduct, performance and ethics)

Supervision for support workers should be a structured, collaborative and supportive process tailored to the individual’s experience, scope of practice and learning goals, with clear agreement on the purpose. 

Resources regarding effective supervision are available from the CSP and HCPC.

Regular supervision should be combined with a clear process for personal and career development planning. The physiotherapy career framework supports both support workers and registered staff to identify learning and professional development needs across the four pillars of practice.  

Delegation is a professional skill that requires appropriate supervision and support. Registered physiotherapists, students on placement, and individuals new to their roles must also have access to supervision to develop competence in delegating clinical tasks to support workers.

References and resources

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