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Exclusive: Senior HCA ‘bridging’ role will be piloted next year


Plans for widespread changes to the way nurses and care assistants are trained are underway, with new standards for a senior healthcare assistant “bridging” role due to be piloted next year.

Student nurses could also in the future have a reduced number of placements during undergraduate training, but be assigned a caseload of patients to follow for longer as they access care across a range of settings.

“There’s an opportunity here to see if there is a core caring role we can have national standards around”

Lisa Bayliss-Pratt

A move away from one to one mentoring for student nurses is also being considered in a bid to decrease the large amount of nurse mentors and ensure undergraduates learn from only those who are considered to be “quality educators”.

The “bridging” role was proposed earlier this year by a major review of nursing education and training, which identified a gap in career development between HCAs and registered nurses.

The Shape of Caring review, chaired by Lord Willis of Knaresborough, recommended national workforce planning body Health Education England look into the position, and also whether those that had completed the training for it could then be fast-tracked through a nurse degree.

Up to a 1,000 HCAs are expected to take part in testing competencies for the senior HCA position at around 30 sites in England during 2016.

In an interview with Nursing Times, HEE’s nursing director Lisa Bayliss-Pratt said the core competencies were expected to cover those required for holistic care.

“This role needs to be seen as forward thinking and be seen as part of the future, not the past”

Lisa Bayliss-Pratt

It would be different to the kind of work carried out by senior HCAs already employed in some organisations – usually at Agenda for Change band 4 level and known as assistant practitioners – which often addressed a specific skills gap within the trust, such as phlebotomy.

Opportunities to “bolt on” additional therapy skills were also being considered, said Ms Bayliss-Pratt. “When I’ve spoken to many directors of nursing, if you look at the frailty pathway of an older person for example, actually they don’t just need nursing care – they also need therapeutic interventions.

“There’s an opportunity here to see if there is a core caring role we can have national standards around, and then bolt on competencies to enable people to give basic occupational therapy advice, basic chest physiotherapy to help alleviate an older person’s breathing problems, and exercises to help people become more mobile,” she said.

Health Education England

Lisa Bayliss-Pratt

Due to the range of proposed competencies and skills, until the piloting had been completed it was still undecided as to whether or not the role should be registered with the Nursing and Midwifery Council, she said.

Physician associates – a new support role for doctors imported from the US – are not regulated and “yet if you think about the interventions they do and the way they work they seem to be incredibly successful”, she noted.

Ms Bayliss-Pratt also stressed the proposed role would not be equivalent to a state enrolled nurse – phased out during the 1990s – because trainees would need to meet a set of nationally agreed competencies.

Trainees would also be provided with “clear progression points” along the way and the role would not be a “default” for those who failed to gain a registered nurse qualification, as the SEN was, she said.

“This role needs to be seen as forward thinking and be seen as part of the future, not the past,” she said. “The SEN role was about bedside nursing but didn’t have an academic component. This would have an academic component.”

Discussion around the need for the return of an SEN-style role has increased noticeably in recent months, were especially prevalent in the run-up to May’s general election.

Ms Bayliss-Pratt said HEE was looking at a work-based learning programme that would be around two years in length for entry level care assistants, but those already working in nursing support roles would be able to complete it in less time.

As previously reported by Nursing Times, the body is also investigating how those HCAs who have achieved the core competencies for the bridging role would then be able to complete a nursing degree in less than the usual three years.

When asked by Nursing Times how HEE would fund the senior care assistant training and whether it would commission course places as it does with universities for nursing degrees, Ms Bayliss-Pratt said it was too early to say.

“What we do know is we can’t afford not to invest in our nurses and care workforce”

Lisa Bayliss-Pratt

However, she did confirm that plans were being made “in line with the anticipation that we won’t have as much money” following the government’s next spending review in November.

Concerns have been raised that HEE budget will no longer be ring-fenced following the government announcement , which will set out savings it needs to help eliminate the national budget deficit by 2019-20.

“What we do know is we can’t afford not to invest in our nurses and care workforce,” added Ms Bayliss-Pratt. “However bad the hit is, we are trying to come up with solutions, opportunities and return on investment.”


Lisa Bayliss-Pratt

She was appointed as director of nursing at Health Education England in 2012 and in this role she is responsible for leading national policy, workforce planning, and multi-professional education and training commissioning for the non-medical healthcare workforce.

Key achievements include establishing the Shape of Caring Review, development and piloting of pre-degree care experience for aspirant nurses and leading the ‘return to practice’ initiative.

She is a trustee of the Foundation of Nursing Studies.



Readers' comments (26)

  • I wonder if I could become a senior HCA. I'm an SRN/RSCN retired and now not a registered nurse. Wow, I could be a bedside nurse without all the hassle of responsibility.

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  • Anonymous | 21-Oct-2015 5:29 pm

    I wonder if I could become a senior HCA. I'm an SRN/RSCN retired and now not a registered nurse. Wow, I could be a bedside nurse without all the hassle of responsibility.

    Better still join an agency and you will be paid more than the regular qualified staff, as a qualified nurse approaching retirement it is something I am seriously considering.

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  • I knew it! What kept them? Patients will die! Simple.

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  • As a person who began life as an SEN I beg to differ and say there was an academic element to the enrolled nurse training. Does she thin SENs were given the qualification for just turning up! I have progressed and moved on with my career completing RGN training as well as RSCN diploma and degree and now have a very satisfying career in the private sector who care for their staff. We have excellent HCA and they would be both happy and capable to bridge the gap if given the chance

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  • WOW!!! they have just de banded aload of band 3s in my trust that are compedences can match and exceed the bridging gap and have been used for the past12 years but was down graded to a band 2 to save money for trust this is not a new thing that as appeared
    we helped the nurses with at leased 13 skills
    and we also made sure our basic care came first as this is paramount our training was gov by uin and assessed by a training body n h s
    this included theory and practical we worked hard to complete the moduals and in the end we had more experience then the nurses
    we then asked to be monited with the accountabity instead of the nurse to be accountable on their pin number for a skill they couldn't do?

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  • Here's a link to the recent RCN policy publication on the role of the RN, HCSWs and 2nd level registered nurses. Howard C (RCN)

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  • In my trust i already work with some Nursing auxillaries that have an attitude that they know more than trained staff, and indeed take on some of the roles without the responsibility or accountability. It make me mad, when i have worked hard to get my pin and i am on duty with these. stopping fluids and infusions without the knowledge of why these are running, not filling care plans or fluid charts properly, yet they say they can do a better job. Well if this is what's coming I'm going to be on my guard for the safety of my patients for the next ten years until I retire.

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  • Anonymous | 23-Oct-2015 1:27 pm

    You should be reporting such safety breaches, not just moaning about them here.

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  • (anonymous 23-oct-2015 1:27pm)
    yes I agree with with (anonymous 23-oct 1:55pm.
    STOP MOANING ! Get on with your job while you have one every one works hard we are all accountable and have responsible roles don't be a marter or you will be doing someone else's job you don't get payed for or do you work for free?

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  • I was a band 4 and am am now almost qualified as I went back to uni for 2 years instead of 3 to finish my nursing degree. The foundation takes 2 yrs so in effect to get my BSc has taken 4 yrs. This to me has been a waste of time I should have just done the BSc. The Band 4 role works better in clinics but on the wards there are too many grey areas! I became frustrated as an Assistant Practitioner which is why I went back to university. I do think there are many HCA's who are experienced and very good at what they do and are just not being utilized the way they should be. Instead of recruiting from abroad this Government needs to look at seconding HCA's for the degree maybe then we would not have the nursing shortage we have now. But then again university placements have also been slashed due to the cuts in universities!
    Bad move to cut the number of placements there are many student nurses with no experience of health work and some need the clinical experiences! To be given caseloads is just not practical students need clinical practice! To give mentors more than 1 student is just not viable there is far too much to learn and mentors don't have the time now on busy ward with one student never mind numerous students. What are these people thinking they sit and come up with all these ideas but never think things through!!

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