Supervision, accountability and delegation of activities to support workers - a guide for registered practitioners and support workers

This paper clarifies the delegation process for registered practitioners and support workers. It also covers accountability and supervision, to ensure clients receive safe and effective care from the most appropriate person.



A great deal of hands-on care is now delivered by support workers. It's essential to remember that while support workers are not registered staff, they must be trained and qualified to a national standard. 

The connection between staff development and quality of service is now central to the NHS.

Patients and clients have the right to know who is treating them and expect that those who provide their care are knowledgeable and competent.

Support workers need to feel confident of their abilities. Registered practitioners need to feel confident in delegating activities to their support workers.

By creating new roles, expanding existing ones and being able to delegate more, the workforce will be more efficient and be able to offer better care.

It is also vital that physiotherapy services meet professional, legal and ethical standards.

This paper has been developed to help clarify the delegation process for registered practitioners and support workers, as well as accountability, supervision, duty of care, scope of practice and PLI issues are also considered.

What is delegation?

In this context delegation is the process by which a registered practitioner can allocate work to a support worker, who is deemed competent to undertake that task. The support worker then carries the responsibility for that task.

There is a distinction between delegation and assignment. With delegation, the support worker is responsible while the registered practitioner retains accountability.

With assignment, both the responsibility and accountability for an activity passes from one individual to the other.

Choosing tasks or roles to be undertaken by support workers is a complex professional activity. It depends on the practitioner’s professional opinion. For any particular task, there are no general rules.

Additionally, it is important to consider the competence of the support worker in relation to the activity to be delegated.

What are the principles of delegation?

The registered practitioner must ensure that delegation is appropriate. The following principles apply:

  • The primary motivation for delegation is to serve the interests of the patient/client
  • The registered practitioner undertakes appropriate assessment, planning, implementation and evaluation of the delegated role
  • The person to whom the task is delegated must have the appropriate role, level of experience and competence to carry it out
  • Registered practitioners must not delegate tasks and responsibilities to colleagues that are beyond their level of skill and experience
  • The support worker should undertake training to ensure competency in carrying out any tasks required. This training should be provided by the employer
  • The task to be delegated is discussed and if both the practitioner and support worker feel confident, the support worker can then carry out the delegated work/task
  • The level of supervision and feedback provided is appropriate to the task being delegated. This will be based on the recorded knowledge and competence of the support worker, the needs of the patient/client, the service setting and the tasks assigned
  • Regular supervision time is agreed and adhered to
  • In multi-professional settings, supervision arrangements will vary and depend on the number of disciplines in the team and the line management structures of the registered practitioners
  • The organisational structure has well defined lines of accountability and support workers are clear about their own accountability
  • The support worker shares responsibility for raising any issues in supervision and may initiate discussion or request additional information and/or support
  • The support worker will be expected to make decisions within the context of a set of goals /care plan which have been negotiated with the patient/client and the health care team
  • The support worker must be aware of the extent of his/her expertise at all times and seek support from available sources, when appropriate
  • Documentation is completed by the appropriate person and within employers’ protocols and professional standards

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