Category: Support Workforce
Support Workforce Member Meeting – 12th March 2026
Recognising the vital role of the AHP support workforce
October 14th 2025
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On AHPs Day 2025, we proudly reaffirm our commitment to optimising the contribution of the Allied Health Professions (AHP) support workforce. This joint statement, endorsed by professional bodies and trade union partners, highlights the progress made since our 2021 call to action and outlines our shared vision for the future.
The AHP support workforce, including support workers and assistant practitioners, plays a vital role in delivering high-quality, efficient, and safe services across health and care settings. From developing national frameworks to expanding apprenticeships and CPD opportunities, we’ve made significant strides in recognising and supporting this essential workforce.
A call to action
We are calling on support workers to:
- Engage with upcoming projects and workstreams aimed at developing your roles.
- Access and promote profession-specific resources, career frameworks, and guidance on supervision and delegation.
- Connect with professional bodies and trade unions to amplify your voice and access support.
We are asking managers and leaders to:
- Champion the support workforce by embedding inclusive practices and career development pathways.
- Ensure access to education, training, and CPD so support workers can work to their full potential.
- Recognise and promote the value of support workers in service delivery and workforce planning.
To support this call to action, the signatory organisations have jointly developed a suite of resources – including frameworks, guidance documents, and practical tools – designed to empower support workers and equip leaders to foster their development.
These resources are available here and are intended to be used actively in workforce planning, supervision, and career progression.
Together, we can build a future where every member of the AHP support workforce is empowered to thrive, supported in their development, and recognised for their vital contribution.
This statement is jointly signed by:
- British Dietetic Association (BDA)
- British Association for Music Therapy (BAMT)
- Chartered Society of Physiotherapy (CSP)
- British Association of Dramatherapists (BADth)
- Royal College of Speech and Language Therapists (RCSLT)
- Royal College of Occupational Therapists (RCOT)
- The Society of Radiographers (SoR)
- British and Irish Orthoptic Society (BIOS)
- UNISON
New guide to Local Recruitment Pathways for Orthoptic Clinical Assistants
February 27th 2025
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We’ve published a new guide to local recruitment pathways for orthoptic clinical assistants (OCAs), as part of our ongoing work to raise awareness of OCA careers.
Our new guide is all about recruitment into OCA jobs, specifically the various ways in which orthoptic services, working with others, can increase the number of local people working in them, including from groups that might be currently under-represented in the workforce.
This guide is one of a series of resources BIOS has produced that focuses on the OCA workforce. Together, they aim to do a number of things – raise awareness of OCA careers, ensure OCAs have rewarding jobs that enable them to progress if they wish too, (including to become registered orthoptists), and help ensure OCA contribution to eye health is fully realised in services by ensuring OCA roles and responsibilities and training needs are clearly defined at all levels of practice.
The full resources are available on BIOS’s website’s Orthoptic Support Workforce Hub.
Local recruitment brings many benefits with it, such as creating sustainable workforce supply routes and a workforce that better reflects the community it serves. Local recruitment is also a way to work more closely with other Allied Health Professions and external partners, such as colleges and Job Centre Plus.
Read Local Recruitment Pathways for Orthoptic Clinical Assistants
If you are interested in finding out more:
Latest updates from our Project
Not yet a member of BIOS?
We’re currently offering members of the orthoptic support workforce a 20% discount on Associate membership for 2025!
BIOS launch new careers resources for National AHP Support Workforce Week
November 25th 2024
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This week is AHP Support Worker Week, a chance to shine the spotlight on, and highlight, our fabulous Orthoptic and Ophthalmic Support Workforce. To mark the occasion, we’ve launched a whole new careers section, highlighting roles within the support workforce.
This includes a page with details on how to become an orthoptic clinical assistant, details on what might be involved, and case studies and videos giving more details.
As part of BIOS’s commitment to support and develop all areas of its workforce, we’re also using the opportunity to share some of the work we have been doing over the past few months, celebrate areas of success and let you know our plans for the future.
During a webinar on Monday, as well as launching our new careers resources, we shared the findings from our recent national survey, presented the benefits of Associate membership, and had an opportunity for members to ask questions. If you missed it, you’ll be able to access the recording via our website in the next few days.
Keep a look out on the social media pages during the week and please do share, so that we continue to raise awareness of this important and integral part of the team.
If you are interested in finding out more:
Latest updates from our Project
Not yet a member of BIOS?
We’re currently offering members of the orthoptic support workforce a 20% discount on Associate membership for 2025! Join now and we’ll give you access to the website straight away and you’ll receive all of the benefits of membership starting on 1st January!
The Cavendish Review Ten Years On: Are Support Workers Still Invisible?
August 29th 2024
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The importance of support workers
BIOS has long recognised the importance of the support staff working in orthoptic and ophthalmic services. Support staff are those members of the orthoptic team not registered with the HCPC who work alongside registered orthoptists, supporting them and service users. Last year BIOS were proud to launch its Orthoptic Support Worker Hub which contains a wide range of information, guidance and resources all aimed at helping to ensure that the contribution of support staff is as safe and effective as possible and, if you are a support worker, that you have a rewarding career and our able to develop yourself.
In developing the Hub, BIOS recognised that support workers in the NHS have not always received the recognition they merit. Indeed, a report published by King’s College London (KCL) in July this year shines a light on the issues this important group of staff can face. The report, called The Cavendish Review Ten Years On: Are Support Workers Still Invisible? is the result of a yearlong study carried out by researchers at KCL and the University of Exeter that sought to see whether findings of a landmark review of health and social care support workers carried out by Camilla Cavendish in 2013 still characterise the experience of the support workforce in the NHS.
The original Cavendish Review was commissioned by then Prime Minister David Cameron, following the tragic events at Mid Staffordshire NHS Foundation Trust that had led to up to 1,200 unnecessary deaths. Over a fourteen-week period through a series of meetings, focus groups, roundtable discussions, hospital visits, a survey, a formal consultation which produced 100 individual and organisational responses, and discussions with key stakeholder, Cavendish sought to understand how support staff in England experienced work, and what the consequence of that experience was for them, other staff, their employers and patients.
Cavendish uncovered a large number of issues, barriers and obstacles that many support workers faced – from a lack of standardisation in the tasks they could or could not perform, to poor supervision, to poor access to training, and limited career opportunities. Moreover, the contribution this group of staff made to care, despite them being the key ‘bedside presence’ in many settings, was rarely recognised. Cavendish went as far as to describe support workers as being frequently “invisible” to patients, employers, and policy makers.
During 2023, with the support of national partners including BIOS and other healthcare professional bodies and trade unions, KCL gathered evidence through a national survey, which was completed by nearly 4,300 support workers, interviews with key stakeholders and a review of wider academic research to see what has and has not changed since 2013. Whilst Cavendish only looked at nursing support staff, King’s considered all clinical roles including AHPs. The study focused on England only.
The study found that for most NHS support staff, very little appears to have changed since 2013. Whilst the survey did find that support staff are enthusiastic and proud of the work that they do and strongly believe it makes a difference to patient care –
- Only half feel their contribution is recognized at work.
- Just 20% feel the NHS values support roles.
- Only 53% would recommend becoming a support worker to their friends and families.
- Over half of survey respondents said they could contribute more if they had access to additional training.
- Over half said they did not have access to the information they require to progress their careers
- Just a third thought their appraisals were ‘helpful’.
One area that does appear to have changed for the better, the study found, is clarity about scope of practice. Asked whether support staff were clear about the tasks that they could and could not perform, 80% said that they were. This result, the researchers suggest, may reflect the national competency frameworks that have been produced for several occupations including AHPs and role guidance, such as that produced by BIOS.
In addition to the survey the KCL researchers also reviewed all academic studies that had investigated healthcare support workers published since 2017. What they found echoed the results of their survey and the original review. The common themes that other researchers had identified were-
- Support workers felt undervalued.
- They were underutilised.
- Experienced inconsistent supervision and delegation.
- Had variable and confusing titles.
- Poor access to training.
The researchers did find that a body of evidence is now emerging about the positive impact support workers make to care, and, indeed, the risk of care being missed if a healthcare service’s support workforce is not appropriately developed.
Camilla Cavendish’s original review included many recommendations to address the issues she found, only one of which, The Care Certificate, was adopted nationally, although even this was not mandated. In the KCL study’s survey support workers were asked whether they thought her proposals were still needed. The results are shown in the table below.
|
Intervention |
Per Cent Agreeing |
| Nationally agreed common job titles | 80 |
| Protected time for studying | 97 |
| Dedicated and protected Continuing Professional Development funding | 96 |
| Representation of support staff on Trust and ICB boards | 93 |
| A national Skills Passport to record learning | 93 |
| Greater support to access pre-registration healthcare degrees | 91 |
| Improvements in the quality of appraisals and setting of PDPs | 89 |
| Creation of competency frameworks for all patient-facing support roles | 94 |
| Nationally agreed descriptions of roles and responsibilities | 94 |
| Support staff should have access to mentors to assist their development | 95 |
| Support staff roles should be formally regulated | 87 |
| The impact of twelve-hour shifts should be reviewed | 82 |
| There should be a dedicated national support workforce plan | 93 |
The KCL study is the first comprehensive national analysis of the NHS support workforce in England for over a decade. It is disappointing that across the NHS little progress appears to have been made since 2013. Camilla Cavendish contributes a foreword to the KCL report and writes that at a time when “the NHS faces acute backlogs and staff shortages, it is vital to maximise the potential of all staff. This group are a strategic resource”.
BIOS recognises the importance of this group of staff, as the orthoptic profession does more widely. Initial analysis of the Society’s annual workforce survey suggests that the experience of orthoptic support workers is more positive than support workers in the NHS generally. BIOS is committed to continuing to develop resources for support staff, and also to help services not only utilise the resources on the Hub, but also the national NHS England Allied Health Professions strategy, including its competency framework. There are many reasons why services and support workers should – and are – using these resources, including to create new roles, ensure clear scope of practice and safe and effective delegation of tasks.
The work on the Hub continues, guided again by a profession-led expert group that includes support workers. Key to this work will be a survey planned for the autumn that will seek to find out more about what support workers and managers need to address any issues. A significant number of services that currently do not employ support staff say that they would like too. The BIOS survey will explore what barriers they face and what can be done to address these.
From the undertaking visual acuity tests, to performing Ocular Coherence Tomography and retinal scans, imaging, installation of eye drops (and potentially much more!), appropriately trained and supervised support staff are key members of the orthoptic team. Being a support worker in itself is a rewarding career, but it can also be a step into becoming a registered orthoptist particularly with the imminent introduction of a Degree Apprenticeship route.
Whilst the KCL study suggests that little progress has been made in addressing the long-standing issues that support workers in healthcare can face, the resources and support provided by BIOS and local services across the United Kingdom means that the picture for orthoptic support workers is brighter. That is not to say more couldn’t be done, which is why BIOS continues to develop its resources to support this vital part of the workforce.
If you are interested in being a member of the BIOS project’s expert group (which meets virtually every quarter) or would like to share good practice, please contact sue.elliott@gstt.nhs.uk.
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If you are interested in finding out more:
Find out more about our current work here.
Support Workforce Job Descriptions
May 31st 2024
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As part of our Support Workforce Project, we’re collating job descriptions for orthoptic clinical assistants to get a view nationally of their roles and responsibilities.
If you’re willing to share examples, please get touch by emailing us at bios@orthoptics.org.uk. We’re looking to collect these by Monday 15 July 2024.
https://www.orthoptics.org.uk/wp-content/uploads/2023/06/Support-Workforce-400×278.png
If you are interested in finding out more:
Access our Support Workforce Hub
Read our Support Workforce Vision Statement
Heads – Check your ESR!
May 22nd 2024
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The Electronic Staff Record (ESR) data for qualified staff is much more accurate, due to our previous efforts, but it is clear that our orthoptic support workforce have not been properly recorded. Without this data it is difficult to know how many services employ orthoptic assistants.
It would be really helpful if all Heads of Service could contact their Informatics department and ensure the support staff who are managed and supervised by the orthoptic manager are appropriately coded.
- Band 4 and Band 5 Orthoptic assistants should be coded as S5
- Band 2 and Band 3 Orthoptic assistants should be coded as S9
More information on occupational codes can be found at https://digital.nhs.uk/data-and-information/areas-of-interest/workforce/nhs-occupation-codes
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If you are interested in finding out more:
Access our Support Workforce Hub
Read our Support Workforce Vision Statement
Support Workforce Programme – Expert Group
May 8th 2024
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Support workers play a vital role in orthoptic services. Between 2021 and 2023, BIOS undertook a series of projects aligned to the, then, new national Allied Health Professions support workforce strategy produced by Health Education England (now NHS England Workforce, Training and Education) that explored the issue support staff faced in the profession. This led to the development of a series of resources, particularly a Roles and Responsibilities Guide and the creation of the dedicated Support Worker Hub on the BIOS website.
Building on the progress already made, over the next twelve months, BIOS will be undertaking a new work programme focused on the Orthoptic support workforce that will:
- Work with members to identify and produce any national or local resources required to assist implementation of the Roles and Responsibilities Guide.
- Work with services in one region to model implementation of the Roles and Responsibilities Guide and related guidance, in order to assess the difference implementation will make to support staff, their colleagues, services, and patients.
- Raise awareness of the resources amongst members and the benefits of implementation.
- Model how services can engage more with their local communities, including Further Education colleges, to recruit residents into support worker roles and pre-registration orthoptic degrees, including Degree Apprenticeships.
This work, as before, will be profession-led. An Expert Group is being established to guide, steer, and lead the project. It will meet virtually, for no more than six times over the course of a year for between one to two hours. In between meetings members views may be sought to comment on draft documents and complete short surveys.
Involvement in this work is an opportunity to help ensure that the contribution of support staff is maximised, that they have rewarding careers and are able to develop within their role and progress if they wish. We would love as many members of the Support workforce, registered staff and mangers to be involved as possible. Please share this with anyone you think it may be of interest to.
For further information contact: sue.elliott@gstt.nhs.uk
https://www.orthoptics.org.uk/wp-content/uploads/2023/06/Support-Workforce-400×278.png
If you are interested in finding out more:
Access our Support Workforce Hub
Read our Support Workforce Vision Statement
The 1st meeting date is Wed 19th June 12.45-1.30 (via Teams)
Response to the NHS Long Term Workforce Plan
July 7th 2023
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The NHS Long Term Workforce Plan recognises many of the challenges facing the workforce in England in the coming years. We welcome the move to address issues with recruitment and retention but this will need to be underpinned with adequate funding, both to increase workforce numbers and to ensure staff are sufficiently compensated, if these plans are to be realised.
Train
Key points:
- Education and training places for the AHP workforce are estimated to need to grow by 19–25% by 2030/31.
- More than a third of AHPs could train through apprenticeships, compared to 6% now
- Increasing the number of advanced practitioners and independent prescribers, and AHPs acting as senior decision-makers in appropriate settings.
- More than 47,000 new healthcare support workers will be required to meet demand over the next 15 years
We welcome the commitment to increasing the workforce, including the 60-74,000 extra AHPs. However, it is essential that Orthoptists are included in these numbers. While there is a recognition of the increasing healthcare need, driven in large part by ageing, outstripping the growth in the workforce, there is very little specific mention of eyecare. Primary eye care providers are identified as having the skills and knowledge required to deliver more services in the community, alleviating pressure on both general practice and hospital eye services. However, this will not address all of the shortages in eyecare; a significant expansion of the hospital eyecare workforce is needed on top of this.
Indeed, there is a focus on expanding enhanced and advanced roles to deliver care, but this is only possible if there is an increase in the number of trained professionals such as Orthoptists able to take them on. Conversely, our workforce survey from May 2023 highlighted a shortfall of 84.7 WTE, over 10% of the workforce.
Part of the answer to meeting this demand is through increased recruitment to Orthoptics. There is a promising commitment in the Plan to opening up diverse routes into healthcare, with an increase in training places for the AHP workforce of 25% to over 18,800 places by 2031/32, which includes a significant 35% through apprenticeship routes. We are currently working on developing an apprenticeship route into Orthoptics, and fully support the diversification of the workforce this offers, but it is essential that traditional routes, through undergraduate and postgraduate course at HEIs, are not reduced.
We were extremely encouraged to see the specific commitment to the expansion of the support workforce by over 200,000. Huge progress has been made recently in recognising the role of the support workforce, but in order to ensure recruitment and retention of these staff, more has to be done to ensure they are rewarding careers where it is clear how they can develop.
https://www.orthoptics.org.uk/wp-content/uploads/2023/07/NHS-Workforce-Plan.jpg
If you are interested in finding out more:
Read the full NHS Long Term Workforce Plan here
Get statistics from our latest workforce survey here.
Retain
Key points:
- Ensure our staff, learners and volunteers are treated fairly within a compassionate and inclusive culture
- Everyone working in the NHS should be recognised and rewarded fairly
- Ensure that all staff are working within an environment that supports their health and wellbeing
- Reforming the system of regulation for healthcare professionals, making it faster, fairer, more flexible and less adversarial
- Continuing national CPD funding for nurses, midwives and AHPs
- To go beyond statutory requirements for flexible working
The Plan also recognises the need for greater staff retention if workforce shortages are to be countered, with the aim of ensuring up to 130,000 fewer staff leave the NHS over the next 15 years. This includes welcome commitments to deliver on the actions from the HGS People Plan, such as ensuring staff can work flexibly, have access to health and well being support, and work in a team that is well-led. In particular, we welcome the commitment to being ‘compassionate and inclusive’, with a focus on tackling prejudice and discrimination experienced by staff.
We also welcome the ongoing commitment to CPD funding for AHPs. This needs to be combined with clear career pathways so that Orthoptists can identify a variety of areas and roles for them to train towards. This also requires that staff are provided with the guaranteed time to take advantage of these funds.
However, without addressing the issue of pay, these changes are unlikely to have the necessary impact on staff retention. While there is a statement that staff should be “recognised and rewarded fairly”, significant investment would be required to reverse the real-terms pay cuts that have contributed to the current shortages.
Reform
Key points:
- Deliver higher level of productivity, within range 1.5-2%
- Make use of technological and digital innovations, including AI
- Addressing geographical inequalities in distribution of staff, by reviewing distribution of training posts
- Embed digital technology in learning pathways, including £300,000 for simulated learning
- Increase clinical academic posts
- Over 6,300 clinicians starting advanced practice pathways each year by 2031/32
- Broadening training to shift care towards prevention and early intervention
We are supportive of many of the suggested ways for reforming the way staff work, drawing on innovation and multi-disciplinary working. We welcome the focus on advanced and enhanced care, with the aim of more than 6,300 clinicians starting advanced practice pathways each year by 2031/32. Orthoptists are already making significant progress in this area and are ideally placed to take on these roles within Ophthalmology. However, again, this will only be possible if there are sufficient numbers of staff to take on these roles.
Linked to this, we are pleased to see a focus on increasing the number of AHPs who are independent prescribers. This would be a significant change for Orthoptists, enabling them to provide more timely care for patients and better support overstretched eye health services. Over 81% of Orthoptic Heads of service felt this would enhance practice. We await a clear timetable from the government as to when this change will be implemented for Orthoptists. The ability for Orthoptists to prescribe glasses within a hospital setting will also be key to freeing up stretched services.
Much of the focus on innovation and technology is particularly pleasing to see, particularly relating to practice-based learning. The targets for increased workforce numbers can only be achieved through increasing educator and placement capacity. We have already made huge progress in diversifying clinical placement experiences, through the development of the Placement Expansion Resource Library (PERL) and the use of HoloLens technology. We also welcome the £300,000 that is being made available to support the development of simulated learning.
One further concern we have is that the target of increasing productivity by 2%, while largely premised on technological and infrastructural improvements, could place a further burden on an already exhausted workforce. Over 67% or Heads of Service reported to us that staff were experiencing a significantly increased workload compared with a year ago, and over 62% reported that staff were experiencing a significantly increased workload. This will only be eased significantly with the necessary increase in resources.
Next steps
Much about the NHS Long Term Workforce Plan is extremely encouraging and shows a real recognition of the challenges facing the workforce over the coming years. However, delivering on the Plan will require a real commitment from the government to invest in the workforce and make the necessary changes, such as enabling independent prescribing responsibilities, to empower healthcare professionals across the service.
We look forward to hearing more detail on the implementation of the Plan and working with NHS England to ensure that Orthoptists receive the recognition and support they need to fulfil their considerable potential within the NHS workforce.
BIOS launch Orthoptic Support Workforce Hub
June 16th 2023
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We’re delighted to launch our new Orthoptic Support Workforce Hub today, bringing together all our information and resources for clinical assistants in one place.
As the culmination of one of the strands of the Health Education England-funded Workforce Development Project, the hub already features an FAQ, case studies, and example job descriptions and person specifications for managers. Later today, we’ll be celebrating our support workforce at an Orthoptic and Ophthalmology Support Workforce Webinar, where we’ll be launching our Roles and Responsibilities Guidance covering levels of practice and recommended standardised titles.
You can access the hub here
Our vision is for all orthoptic staff wherever they work to feel valued, integrated into teams, able to work fully to their potential; with access to lifelong learning including relevant formal qualifications.
We wish employment in the clinical support workforce to be seen as a career that is valued and valuable. Moreover, whether staff wish to pursue their careers in the clinical support workforce or progress onto registered grades we want to ensure they have rewarding careers and are clear how they can develop, accessing the support they need.
The support workforce is an integral part of the orthoptic clinical team.
You can read our full vision statement here.