Higher level support workers: career conundrum or practice solution?

The support worker (SW) role is evolving, with increased opportunity to carry additional responsibilities in practice. The CSP supports clear opportunities and pathways for SWs to pursue a career in their own right. The introduction of higher-level SW roles, with a focus on development across the four pillars of practice, are a welcome addition. But are these roles a career tick-box exercise or can they really make a difference in practice? We explore what these roles can look like, their benefits, and we encourage managers to consider this as an innovative way to address unmet service need.  

Historically, SW development has focused on basic clinical and administrative tasks, creating a career plateau. Progression beyond this has been limited to pre-registration physiotherapy degrees. However, not all SWs aspire to become registered physiotherapists, nor would we want them to. SWs make a valuable contribution, supporting therapy teams to deliver the increasing demands on services. Without them, our profession would look very different. However, there is huge variation nationally in the career landscape for SWs and opportunities for progression can be confusing. 

But now, with increasing understanding that all roles should reflect the four pillars of practice, SW roles are progressing in areas beyond clinical, incorporating education, research and leadership. They demand a higher level of capability underpinned by the relevant level of academic qualifications. Clinically, the additional scope of a higher-level SW may include greater responsibility for patient care in a niche area of practice through significant depth of knowledge and clinical experience, whilst still operating within robust delegation, accountability and supervision frameworks (clearly distinguishing it from a registered physiotherapist). Higher level SW roles can include line management responsibilities: leading a team of SWs, for example. They may also have opportunities to educate through training and mentoring other staff and supporting practice education for pre-registration students. In research, higher level SWs can lead service and quality improvement programmes or other research activities. 

Antony Smyth, band 5 physiotherapy technical instructor in chronic pain and shoulder rehabilitation at Imperial College NHS Trust says: ‘On top of my years of clinical experience, I had to demonstrate my knowledge through specific competencies to enable me to progress to this role.

‘I’m working more autonomously and making more clinical decisions at this level within my speciality, but I’m still well supported with regular supervision.

‘The biggest distinction between this and my previous band 4 role are my additional responsibilities; inducting new SWs and newly qualified physiotherapists – supporting them to upskill in this speciality. 

I’m heavily involved with students on placement, and I recently led a project investigating DNA rates in our MSK services.

‘The physios are really appreciative of my role. We can offer a better service to patients, and they are freed up to do the things that need a physio qualification.’

How do you know if your service needs a higher-level SW? Think about your specific population and service demands. Are there clinical, leadership, research or educational needs and do these really require the specific expertise of a registered physiotherapist? Can you provide robust governance and clear parameters for this role to be safe and effective for a higher-level SW? 

These answers should then be weaved into broader workforce conversations. Could a higher-level SW provide local workforce stability and continuity of service provision? With consideration of the future workforce needs, and the impact on other staff groups, could a higher-level SW role be justified, and not just used to incorrectly address recruitment challenges? 

By considering who is best suited to a role, we can champion support worker career progression and embed the four pillars of practice throughout the workforce. As a profession, we need managers to be clear on what their services need, when it needs to be delivered by registered staff and when there is the opportunity to think creatively about higher-level SW roles. This need not just be a career option; it could be part of the transformation solution.