by Dr Nicky Eddison and Matthew Craven

Unlike traditional degree programmes, degree apprenticeships provide people with the opportunity to earn, gain work experience, and achieve nationally recognised qualifications. Research has shown that paid employment and no tuition fees were rated as the highest motivating factor by degree apprentices¹. Importantly, research shows that one-quarter of apprentices surveyed reported they would not have considered any other form of education or training had degree apprenticeships not been available¹. Indicating that this mode of qualification is filling an unmet need. It also has the potential to increase the diversity in our workforce. The NHS offers degree-level apprenticeship routes into several NHS careers,  through a mix of on-the-job training and classroom learning².

Allied Health Professionals (AHPs) are the third largest clinical workforce in the NHS³. Degree-level apprenticeships as a route into the allied health professions have been available for over five years but have not been widely utilised by all NHS organisations. Prior to 2022, Walsall Healthcare NHS Trust (WHT) didn’t offer any AHP apprenticeships.  Since then, the Trust has established apprenticeships in physiotherapy, occupational therapy (OT), and dietetics, intending to establish its first speech and language therapy apprenticeship later this year. The establishment of these apprenticeships took a combination of negotiation, influencing, luck, and a staunch belief that it was important for the future of our AHP services.

This article will explore the journey of developing the AHP apprenticeship offer at WHT, in the hope, it will be beneficial for other organisations who might wish to do the same.

Establishing apprenticeships at Walsall Healthcare NHS Trust

At first, the development of apprenticeships at WHT was relatively straightforward, mainly because we either enrolled existing therapy support workers onto apprenticeships via an internal expression of interest process or we recruited external candidates as apprentices using vacant support worker positions. No acquisition of funding was required to create these posts other than the permission to access the tuition levy funding from the WHT apprenticeship team, and they were eager to oblige given our previous non-utilisation of the resource. The next step was to liaise with the local university apprenticeship providers to agree on a recruitment process and timeline and become familiar with the academic entry requirements for the courses.

The academic prerequisites were circulated to all existing therapy support work staff at WHT with a request for expressions of interest to enrol on the apprenticeship programmes.  For external apprentice recruitment, vacant band three therapy support worker positions were utilised by amending the job descriptions and person specifications to include the academic entry requirements and relevant information about the opportunity. The adverts were extremely popular and some needed to be closed early due to the volume of applications.

The interviews were conducted jointly with the universities. In most cases, we needed to interview over two days due to the volume of candidates. The successful candidates were then taken through WHT employment processes prior to university enrolment. As a result, we established four OT apprentices (two internal, two external) and five physiotherapy apprentices (two internal, three external).

Barriers

We encountered some barriers when we sought to expand our OT apprentice cohort as we didn’t have any support worker vacancies to convert or any remaining eligible/interested support workers to enrol on the programme. Expanding our OT apprenticeship was important for two reasons; we had already had great success with our first wave of recruits from the previous year who were proving very effective in their role, and we were facing incredible OT workforce supply issues, with a 60% vacancy rate for OT across the organisation. The expansion of OT apprenticeships was intended to be just one mechanism of stimulating the grassroots supply of OTs, to hopefully address our deficit in the medium to long term.

A meeting with the divisional director of operations and the divisional finance lead was arranged.  The discussion focused on the reasons for creating additional unfunded apprenticeship positions.  It was explained that our extensive vacancy position would provide a sufficient underspend to offset the creation of these new posts. The financial risk would be temporary as the OT apprenticeship course is only three years, following which, the staff will move into the vacant positions. Additionally, many of our recruited apprentices were existing support workers from neighbouring organisations, possessing extensive clinical experience and thus, would be able to offset some of the qualified OT workload which would otherwise require expensive agency staff.

The financial risk was agreed upon, and we are currently in the process of recruiting four more OT apprentices.

Establishing a dietetic apprenticeship provided similar barriers as we had no vacant positions to utilise, and the smaller dietetic service was fully staffed with no vacancy positions to leverage against the funding of any additional posts. Liaising with our workforce intelligence team was key. They provided a report on the dietetic turnover rate for the last five years. The data demonstrated that for any 12-month period, we could expect to have enough staff turnover to have a vacancy underspend that would fund one band three dietetic apprentice position. This data was key in getting approval to fund our dietetic apprenticeship.

Benefits

So why go through all this? The shortlisting process alone requires a significant investment of time. However, providing diverse educational routes into our allied health professions is essential to the sustainability of the workforce and its diversity. Ultimately leading to improved patient care.

Challenges

The apprenticeship process is not without its challenges and for an apprentice to be successful they must have extensive mentorship and professional support in the workplace to apply their new knowledge and learn the trade⁴. In an established workforce this may not pose an issue, but in our circumstance, the OT workforce was significantly depleted, and asking the already stretched workforce to provide mentorship, was particularly difficult. To help address this issue we implemented several measures which have also had other benefits for the staff and services involved, including pooling senior OT resources and cross-supporting between services, utilising interdisciplinary support from experienced physiotherapists skilled in integrated working, and enabling apprentices to work alongside experienced assistant practitioner staff.

Even with generous professional support in the workplace, a challenge for apprentices can be finding the balance between academic study and full-time work in the NHS. To help with this we try to be flexible with study time and last-minute annual leave where circumstances permit, to facilitate the meeting of academic deadlines.

A final challenge to consider is that whilst our apprentices are with us at WHT they are bound by the limitations of autonomy set by their banding, whereas during their placement they can work up to completing tasks autonomously as they would as a higher band. Thus, when the apprentice arrives back from their placement, they can experience conflict between their assistant/apprentice role and the student therapist role. This dichotomy can lead to apprentice dissatisfaction⁵. To try and avoid this we are aiming to take our apprentices gradually through band four competency frameworks over the next 12 months so the disparity between their daily role and their role whilst on placement is reduced.

Feedback

The feedback from the first cohorts of AHP apprentices at WHT has been very positive!

Conclusion

One of the primary barriers for managers is not knowing how to go about setting up an apprenticeship programme within their service. This article was intended to share experiences and guide others on how they can get started on their journeys in recruiting within this very valuable workforce.

WHT are fortunate to have divisional operations leads who are willing to take financial risks to help secure the future of our AHP workforce. Others may face more extensive financial scrutiny. It is always wise to make friends with your workforce intelligence officers and resourcing teams to help provide a compelling case for funding these opportunities without the laborious and lengthy business case process.

The benefits of apprenticeships far outweigh the risks or challenges. At WHT we now have a dynamic workforce who are providing great patient care and our organisation can take pride in the fact it has provided opportunities to a wide range of people, upholding NHS values of equality and inclusion, whilst helping to increase diversity in the AHP workforce on a wider scale than just our organisation.

*Matthew Craven led the implementation of the AHP apprenticeships at WHT. For further information please contact him at matthew.craven4@nhs.net

References

1. Engeli A and Turner D. Degree Apprenticeships Motivations Research Report by Wavehill Social and Economic Research Ltd for the Office for Students.; 2019. www.wavehill.com. Accessed January 25, 2023.
2. NHS apprenticeships | NHS Health Careers. https://www.healthcareers.nhs.uk/career-planning/study-and-training/nhs-apprenticeships. Accessed January 25, 2023.
3. Chief Allied Health Professions Office. The Allied Health Professions (AHPs) Strategy for England The AHP Strategy for England?: AHPs Deliver 2022 – 2027. https://www.england.nhs.uk/wp-content/uploads/2022/06/allied-health-professions-strategy-for-england-ahps-deliver.pdf. Published 2022.
4. Baker. Potential implications of degree apprenticeships for healthcare education. High Educ Ski Work Learn. 2019;9(1):2-17.
5. Jackson. Physiotherapy apprenticeships – building on the experiences of in-service physiotherapy students. Physiotherapy. 2019;105:e118-9.