The British Association of Prosthetists and Orthotists

Professional Affairs

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HCPC report into poor staff retention in the UK prosthetic and orthotic workforce.

Following the recent publication of the findings by HCPC into poor staff retention in UK prosthetics and orthotics, BAPO will seek a meeting to discuss with each of the UK’s four Chief Allied Health Professions Officers.

Chair Peter Iliff said “We have known this has been coming but now have the data to prove it and expect further publications to confirm the crisis affecting our profession. Whilst we have been highlighting this state of affairs for some time, we will now use this data to escalate our concerns and demand action to address the underlying issues”

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BAPO is alarmed but not surprised by the findings of HCPC[1].

In their report published in January 2023, HCPC has revealed that amongst their regulated UK professions, which includes but is not confined to the 14 Allied Health Professions, retention of staff in their early years is lowest in prosthetics and orthotics. 1 in 8 of those who graduated between 2013 and 2018 have left the profession. 

The reasons for this are varied but not difficult to understand. As practically every current media bulletin will highlight healthcare in the UK, across all professions, is affected by a workforce crisis. However, the comparative analysis undertaken by HCPC shows a contrast with other professions, such as the paramedics, of whom only 1 in 56 left.   

The findings are consistent with those explored by Prosser and Achor (2023)[2]. Whilst confined to orthotics, their findings included a likely crisis in staff retention affecting the profession.

BAPO is confident that the recent workforce study it commissioned from Staffordshire University will highlight similar themes. This work is scheduled to be presented in April 2023.

As a professional body, BAPO will continue to highlight its concerns that the lack of an effective career framework, which it believes is strongly associated with the low level of staff retention.  Our commitment is to work tirelessly to overcome this obstacle to members and colleagues being given the agency and authority to develop rich and rewarding careers.

This workforce crisis was the core theme of recent addresses given by BAPO at the ISPO UK meeting and BAPO’s 25 year celebration of State Registration.

In December 2022 the Association launched its inaugural a Leadership Programme, to develop future leaders with the skills to confront the challenges highlighted and a programme we intend to run annually.

BAPO will support the development of an Enhanced Practice qualification, as a stepping stone to building a career framework that will lead to an Advanced Practice Qualification. This work is in tandem with a Workforce project BAPO is delivering for HEE, to propose new ways to address challenges in the UK P&O workforce.

The professional body will not achieve this in isolation. HCPCs report was designed for

..employers, professional bodies, education institutions, and others, to support their workforce planning programmes.[3]

To that list, I would explicitly add the commissioners of prosthetic and orthotic services, and those responsible for its procurement. The current model, in most cases, is in no way linked to the AHP Strategy[4], which explicitly includes prosthetics and orthotics in its remit.

With similar work underway in Scotland, Wales, and Northern Ireland, now is the time for all parties to look at the models of service delivery which do not allow the space for Prosthetists / Orthotists to develop their practice, in line with the four pillars model[5]. Too many Prosthetist orthotists are trapped in the clinical pillar employed to deliver a service that is only commissioned on the basis that they deliver, technical clinical care for patients in a way that may not evolve greatly during their career.

The other three pillars of practice, described by NHS Education for Scotland and recognised in other UK nations, are:

  • Facilitating Learning:
  • Leadership:
  • Evidence, Research, and Development

This framework enables profession-specific and specialist knowledge, skills and behaviours to be added during the career journey, as opposed to the stifling environment our members and colleagues experience. Starved of role models with broad and varied careers, linked to patient care, Prosthetists / Orthotists are now proven to be leaving in unsustainable numbers.

HCPC’s report was focused on the early years and the training and support contained in Preceptorship, in part because it has been established that 

“The quality of preceptorship support has been proven to improve retention rates. High-quality preceptorship programmes support health and care professionals to develop and maintain confident, safe, and effective practice throughout their careers.”[6]

As a first step to bringing stakeholders together, BAPO has established a Training and Education Network, which includes educators and employers from all sections of the UK landscape to come together and work collaboratively to develop a more resilient, self-confident, and engaged workforce. However, this is not sufficient to address the structural challenges affecting our profession.   

We have highlighted our concerns about the experience of Prosthetists / Orthotists, who provide services in the UK and how the models of service contribute to both constrained career opportunities and poor workforce retention., Having received this report we follow up those conversations by writing specifically to the Chief Allied Health Professions Officer in each nation to express how this data confirms the content of those previous discussions. We will seek an immediate response as to how these issues can be addressed by involving all parties, including health service leaders, service commissioners, employers, and educators.

[1] HCPC Insight & Analytics Team (2023), How long do new registrants stay registered for? An analysis of first-time HCPC registrations: 2013 to 2018

[2] Prosser and Achor (2023). A cross-sectional comparative study: Job satisfaction for orthotists employed by NHS and the private sector. British Journal of Healthcare Management Vol. 29, No. 1

[3] HCPC (2023)

[4] The Allied Health Professions (AHPs) strategy for England – AHPs Deliver, NHS England 2022.

[5] NES NMAHP Post-registration Development Framework (accessed 22 Jan 2023)

[6] HCPC (2023)

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BAPO KAFO Standard 2022

We have recently published a new KAFO Standard.  The standard outlines BAPO’s recommendations for the safe maintenance and use of Knee Ankle Foot Orthoses (KAFO). This guidance is intended to aid governance within a clinical setting and should be read in conjunction with BAPO’s Standards for Best Practice.

BAPO-KAFO-Standard-Sept2022Download

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NICE Osteoarthritis: assessment and management (update)

The National Institute for Health and Care Excellence (NICE) has recently proposed an update for the Osteoarthritis: assessment and management guidance (previously published in 2014). The new guidance recommends a significant change in practice which is likely to impact orthotic provision for adults with osteoarthritis. The new guidance recommends the following:

“On considering the evidence identified in this review, the committee agreed that, in general, the evidence for insoles, braces, tape, splints and supports showed no clinically important benefits from their usage when compared to no device use. In some cases, potential harms from the devices were identified (such as blisters with braces). Given this, the committee agreed that based on the absence of strong evidence of benefit and some evidence of harm, that these devices should not be routinely offered”

The statement can be found in “[H] Evidence reviews for the clinical and cost-effectiveness of devices for the management of osteoarthritis” on page 93 lines 33-44.

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BAPO’s position

The British Association of Prosthetists and Orthotists (BAPO) strongly opposes this recommendation. BAPO feels it reduces the service users’ conservative treatment options, particularly where surgery and pharmaceutical intervention is contraindicated.
It is ambiguous in terms of orthotic provision as an adjunct to other interventions e.g., pre-and post-surgery. Similarly, the use of the term “routinely” creates further ambiguity.

BAPO is also disappointed that an orthotist was not included as part of the committee reviewing these guidelines.

BAPO has submitted an official response to the guidance outlining our concerns. We await a response from NICE and will endeavour to keep our members up to date with any progress.

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CAHPO Awards

The Chief Allied Health Professions Officer awards are a unique opportunity for Allied Health Professionals (AHPs), either nominated by their peers or by themselves, to receive recognition for their personal contributions towards delivery of exceptional care for patients.

For More information or nomination criteria see NHS Englands website

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Health Inequalities in England: The Marmot Review 10 years on

Health Inequalities in England: The Marmot Review 10 years on

On the 24th of February Professor Sir Michael Marmot and the Institute of Health Equity published ‘Health Equity in England: The Marmot Review 10 years on’[i]. This article highlights the key messages in the review report.

In the 2010 Marmot Review ‘Fair Society Healthy Lives’[ii]  Marmot shone a light on health inequalities in England highlighting that those living in the poorest neighbourhoods would on average die seven years earlier than people living in the richest areas and not only would they die sooner they would spend more of their lives with disability. The original report provided six recommendations to reduce health inequalities with a strong focus on social justice. The recommendations included giving children the best start in life and acting across all the social determinants of health including education, occupation, income, home and communities.

The 10 years on review shows that over the last decade there has been a deterioration in health and a widening of health inequalities.

Since 2010 life expectancy in England has stalled; this has not happened since at least 1900.  Life expectancy follows the social gradient in that the more deprived the area the shorter the life expectancy; this gradient has become steeper meaning that inequalities in life expectancy have increased and this is most prominent in women.

The gradient in healthy life expectancy is steeper than that of life expectancy which means that people in more deprived areas spend more of their shorter lives in ill-health than those in less deprived areas.

There are regional differences in life expectancy particularly amongst people living in the more deprived areas; so that deprived people in the North East have a poorer life expectancy than deprived people in London.

Marmot highlights that to reduce health inequalities the same actions as stated in the original report are required:

  1. To give every child the best start in life
  2. To enable all children, young people and adults to maximise their capabilities and have control over their lives
  3. To create fair employment and good work for all
  4. To ensure a healthy standard of living for all
  5. To create and develop healthy and sustainable places and communities
  6. To strengthen the role and impact of ill-health prevention

The main recommendation from this most recent report is to the Prime Minister, to initiate an ambitious and world-leading health inequalities strategy and lead a Cabinet-level cross-departmental committee charged with its development and implementation.

We see the outcomes of health inequalities in clinical practice and we have a role to play in reducing the impact of health inequalities by being aware of the social determinants and inequalities within the populations we serve and ensuring our services are accessible and relevant to those communities who need them most.

[i] http://www.instituteofhealthequity.org/resources-reports/marmot-review-10-years-on

[ii] http://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review

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Developing AHP leaders: a guide for trust boards and clinicians

NHS England and NHSI have produced a new guide to developing AHP Leaders.

This new interactive PDF resource shares the findings from a project thye have been working on to explore common factors which contribute to AHP leadership development.  By combining trust executives’ expectations of AHP leadership, with individual accounts from chief AHP leaders (see also – ‘Investing in chief allied health professional leadership: insights from trust executives’), they have identified the common features that combine to create a platform and framework for AHP leadership at all levels and an extensive list of helpful resources, hints and tips.

It was developed to provide ideas and opportunities for aspiring AHP leaders and those who support the development of the AHP workforce, to ensure that the AHP workforce is developing the leaders required for the future.

guide will also be useful for:

  • AHPs with leadership aspirations
  • those supporting the development of future AHP leaders
  • those developing AHP leadership capacity and capability within their organisation and system
  • those supporting AHP workforce appraisal processes
  • career coaching and mentoring conversations

It can be downloaded on the NHSI website: https://improvement.nhs.uk/resources/developing-allied-health-professional-leaders-guide. or can be downloaded by clicking here