Team ReSNetSLT are delighted to share this post that was contributed by Dr Lisa Newington & Prof Caroline Alexander
Not just doctors and nurses
A third of NHS staff are allied health professionals (AHPs) [1]. The NHS lists 14 AHP clinical disciplines who have shared national leadership under the Chief Allied Health Professions Officer, an official logo, and an annual AHP day on 14 October.
There is also a plan for a national NHS uniform, with a single base colour for all AHPs [2]. Despite the clear signposting to the existence and importance of AHPs [3], much of the narrative about the health service, including the current crisis and future workforce planning, focuses on a binary description of doctors and nurses [4, 5].
While there are increasing numbers of AHP leadership roles [6], and several NHS strategies for the collective AHP group [7, 8], it was unclear whether ‘allied health professionals’ was a meaningful term for patients and other users of health and social care. So, we decided to ask them.
This work was embedded in larger study looking at experiences of research involvement [9]. We interviewed 21 individuals with previous experience as AHP research participants or patient or public advisors across England and Wales (age range 33-93 years, 13 male, 8 female, 19 White British).
What does the term ‘allied health professionals’ mean to you?
We specifically asked: the term ‘allied health professionals’ is used to describe a particular group of professionals within the NHS – what does this term mean to you?
This was followed by prompts about the categorisation of healthcare professionals and the perceived impacts of uniforms within health and social care.
‘Allied health professionals’ was not widely understood. Less than a quarter of interviewees provided a description that was close to the NHS definition, and of these, nurses were often included as AHPs.
Many interviewees tried to explain the term through their understanding of the constituent words. This generated positive descriptions, including “someone who is on your side” and “trying to achieve a better standard of care”.
Others thought more tangentially and considered pharmaceutical companies, private healthcare, and health information technology teams as AHPs.
Several interviewees did not think ‘allied health professionals’ was a useful term, rather it was “civil service speak” that could be “interpreted as anything”. While others suggested that it was useful to have a collective term, but that more was needed to be done to make sure the term was widely understood.
Views on healthcare uniforms
Interviewees’ opinions on healthcare uniforms predominantly focused on being able to identify who was in the room.
However, most suggested that personal introductions and name badges were more important than specific uniforms. A small group of interviewees suggested that all healthcare professionals should wear uniforms to differentiate them from “members of the public”.
Conversely, one interviewee reported that healthcare professionals appeared “more approachable” if not wearing uniform. Although this individual also emphasised that they should still be smartly dressed.
Several interviewees recalled personal experiences of being confused by the different uniforms they encountered: “I go to hospital and I’m totally confused, baffled by the multitude of colours.
“There is a chart, and it said if it’s very pale blue it is somebody and if it’s slightly pale blue it’s somebody else, and if it’s medium blue… and this sort of thing. You think, hang on a minute!”.
What’s in a name?
Our research suggests that the term ‘allied health professionals’ (never mind the AHP acronym) is poorly understood by patients and other users of health and social care. And this was across a group of highly engaged individuals who had volunteered to take part in healthcare research.
As AHPs, we could do more to clearly define, discuss, and explain the range and importance of this ‘third member’ of the healthcare workforce. The press also has an important role to play in increasing public awareness, with a shift from sloppy descriptions of hospitals being staffed by doctors and nurses.
We may be unified in our collective desire to champion the provision of appropriate, high-quality and timely health and social care interventions. Similarly, we all look for equitable and sustainable access to research funding, clinical academic careers, and appropriate pay.
But what about individual clinical identity? Uniforms appear to be an emotive subjective for AHP groups, for example, the Chartered Society of Physiotherapists reported that 88% of their membership were opposed to the mandatory introduction of a new AHP uniform [10].
Possible reasons for this response include the desire to maintain separate professional identities, for the uniform to clearly identify those working at specialist levels, or concerns about uniforms having negative impacts on interactions with patients/service users. However, these concerns did not appear to be important for the majority of interviewees in the current study.
We could be more consistent in the description of AHPs. The eagled-eyed among you will have noticed that the NHS lists 14 AHPs, but associated imagery often displays 16 professions (see image). The discrepancy appears to be separating diagnostic and therapeutic radiographers, and prosthetists and orthotists.
This also raises questions about how to describe the remaining clinical professions. AHPs are delineated by our HCPC (Health and Care Professions Council) registration, but is this a meaningful distinction?
The term NMAHPPs (nurses, midwives, allied health professionals, healthcare scientists, pharmacy staff, and psychologists) is used to denote this larger group of clinicians, particularly within healthcare research.
Given our findings, we propose that the term ‘allied health professionals’ is not well-known and suggest that clinicians and researchers should be mindful to clearly (and repeatedly) define both the term and acronym.
Expanding the AHP definition to be fully inclusive of all healthcare professionals who work alongside doctors and nurses might be one strategy to simplify healthcare workforce nomenclature for patients and the public. We welcome further discussion on this topic.
Image courtesy of Council for Allied Health Professions Research
This blog post was authored by:
Dr Lisa Newington @Lisa_Newington
Postdoctoral Research Fellow and Advanced Clinical Practice Hand Therapist (Physio)
Imperial College London and Guy’s and St Thomas’ NHS Foundation Trust
Prof Caroline Alexander @CMarthaAlex
Lead Clinical Academic Allied Health Professionals and Professor of Practice Musculoskeletal Physiotherapy
Additional information
Ethics approval: NHS Research Ethics Committee and Health Research Authority (IRAS 298078, REC 21/WA/0229).
Funding: This work was supported by NIHR Imperial Biomedical Research Centre and Imperial Health Charity.
Full summary available from the Open Science Framework: https://osf.io/6st73/.
References
- National Health Service. Allied Health Professions. https://www.england.nhs.uk/ahp/. Accessed 22 Mar 2022.
- NHS Supply Chain. National healthcare uniform. 2023. https://www.supplychain.nhs.uk/categories/hotel-services/national-healthcare-uniform/. Accessed 16 Jan 2023.
- Fowler JR, Cipolli W, Hanson T. A Comparison of Three Diagnostic Tests for Carpal Tunnel Syndrome Using Latent Class Analysis. J Bone Jt Surgery, Am Vol. 2015;97:1958–61.
- Triggle N. The NHS crisis – decades in the making. BBC News. 2023. https://www.bbc.co.uk/news/health-64190440. Accessed 16 Jan 2023.
- Elgot J. Tory NHS plan will not fix shortage of doctors and nurses, says Wes Streeting. The Guardian,. 2022. https://www.theguardian.com/politics/2022/sep/21/tory-nhs-plan-will-not-fix-shortage-of-doctors-and-nurses-says-wes-streeting. Accessed 16 Jan 2023.
- NHS England and NHS Improvement. Investing in chief allied health professionals: insights from trust executives. 2019. https://improvement.nhs.uk/resources/investing-chief-allied-health-professionals/. Accessed 30 Mar 2022.
- Health Education England. Allied health professions’ research and innovation strategy for England. 2022. https://www.hee.nhs.uk/sites/default/files/documents/HEE Allied Health Professions Research and Innovation Strategy FINAL_0.pdf. Accessed 14 Feb 2022.
- NHS England. The Allied Health Professions (AHPs) Strategy for England: 2022-2027. Chief AHPs Office. 2022. https://www.england.nhs.uk/wp-content/uploads/2022/06/allied-health-professions-strategy-for-england-ahps-deliver.pdf.
- Newington L, Alexander CM, Kirby P, Saggu RK, Wells M. Reflections on contributing to health research: a qualitative interview study with research participants and patient advisors. PLoS One. 2022;17 (12):e0279354.
- Chartered Society of Physiotherapists. NHS national uniform “will not be enforced” after CSP challenge. 2021. https://www.csp.org.uk/news/2021-10-18-nhs-national-uniform-will-not-be-enforced-after-csp-challenge. Accessed 22 Mar 2022.