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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)

  • Great. Good for HCAs to have more progression + development. But will they be paid much more?
    Bad for constant erosion of more experience staff pay, downbanding, deskilling, taking on responsibilities of multiple jobs + of responsibilities of more senior roles without the pay.
    Or would nurses become trained up as practitioners, working like doctors but without the pay, authority but all the responsibility.
    Next great idea will be to get all relatives to perform basic + personal care on the patient, like they do in europe. Volunteers + families can also help patients to eat + drink - dont worry if its safe, therell be a note from SLT by bedside/feeding chart to say if theyre safe to swallow, no risks of aspiration, while nurses + hcas are busy dealing with other patients.
    3rd year student nurses can also manage wards, like they used to. Wonder why that was scrapped?
    Nurses on the cheap is unsafe for patients and staff.

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  • "....Its about saving money..."
    "....The Senior HCA Role will undermine the exclusive preserve of pompous,condescending, conceited and arrogant inflexibe nurses who it appears are sworn enemies to change ,innovation and modernisation"

    In the US and Canada they have Certified Nursing Assistants called Licenced Practical Nurse (LPNs)respectively who need to need to sit and pass a nationally accredited exam- the CPNRE This is the equivalent of the Senior HCA being proposed.

    This role complements the RGN role and does not usurp it.It will be regulated , they will have to sit and pass an accredicated qualification. What more safety nets do you want?

    The Physician Associate Role which is the equivalent of an FY2 Doctor in the UK serves the same purpose. It complements the Specialist Doctors role and does not usurp it.

    A few years ago, resgistered nurses were stuck in a rot, with no clinical career progression in sight apart from becoming a ward sister. Today for those willing to be challenged and to undergo the rigours of academic training , we have Clinical Nurse specialists,Advanced Nurse Practitioners, Nurse consultants etc.

    These innovative roles are having a positive impact on outcomes for patients.

    Those of you Registered Nurses who go on and on about the exclusivity of your esteemed professional status and your superlative IQs why dont you have a go at some practice test questions for the entry to practice NCLEX-RN exam in Canada and see how your IQ ranks

    And yes of course its about money. Anybody who cannot see that is living in a cuckooland. We as nurses need to lead in innovative practices to demonstrate we are worthy custodians of the public trust by pursuing sustainable staffing policies.
    Innovation is driven by change- changing demographics, increasing complexities of care especially among patient populations with multiple co-morbidities.THE NHS's FINANCIAL RESOURCES IS NOT INFINITE.
    The proposed Senior HCA Role in the light of the above should be commended and not villified.

    Change is inevitable. Learn how to adapt to it.

    Auxiliary Nurse- Aberdeen

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  • In over 40 years of nursing as a registered nurse, SEN's were amoung the best nurses I've worked with including in the ITU setting.
    They entered their SEN training by choice NOT because they failed as a registered nurse.
    Ms Bayliss-Pratt needs to get her facts right.

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  • agree

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  • As an AP I wonder what will become of our role! We bridge the gap! Iworked so hard to get my degree as all APs have! But reading this article feel totally deflated what trainingwill this new role entail? Many of the bolt ons can be done within the trust and as extra competencies .training pathways for hca as need to change this would no doubt help with the shortage of RNs :-(

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  • I was an SEN (have since gained RGN, BSc and MSc) I would strongly disagree with the information within this article. SEN's were not failed RGN students and there was academia involved in the training .I applied to do the SEN training, I studied throughout my two years training, took regular exams and practical assessments which had to be passed and had to final examinations to pass before I could call myself a QUALIFIED NURSE. I am astonished that this article has been published just on these incorrect facts.

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