Assistant practitioners: issues of accountability, delegation and competence

The NHS Modernisation Agenda, alongside workforce shortages in health-care professions, has led to increasing interest in the role of assistant practitioners in the delivery of health and social care. This article describes the introduction and evaluation of assistant practitioners in occupational therapy who were empowered to work independently in a limited number of interventions and services within an NHS trust. The evaluation involved focus groups with four groups of key stakeholders: the assistant practitioners, their supervisors, managers and service users. Key themes included ambiguity about who takes responsibility for the outcomes of care and uncertainty about challenging the role of the ‘professional’ staff. There was a lack of clarity about how work is ‘delegated’ to the assistant practitioners and it was difficult to determine levels of competence in the new workers, because the existing staff did not recognize their qualifications. These issues need to be addressed in order to optimize the relationships between staff, clarify the roles of team members and ensure that service users receive the most appropriate care from the most appropriate practitioner.