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Healthcare assistants: a welcome change

Marilyn Eveleigh,
Consultant Editor

Changes in healthcare provision are coming from all angles - those that have been fuelled by government strategies such as access targets, technological advances that support portable and more rapid patient diagnosis out of hospitals, and altered clinical practice determined by evidence-based guidelines and raised patient expectations.

For me, one of the most welcome changes has been the growth of healthcare assistants (HCAs) in primary care. They have liberated qualified nurses from essential but domestic tasks such as stock control and maintenance of infection control measures. They have successfully taken on clinical roles such as venepuncture, checking inhaler techniques and the recording of ECG and spirometry tests. They have established a skillbase in health promotion and patient history taking and screening. I predict that they will not stop there. Although controversial at present, their role has expanded in some surgeries to include taking cervical smears, giving childhood and flu immunisations, and undertaking leg ulcer

HCAs have allowed practice nurses to concentrate their skills where a registered qualification is required - establishing or modifying chronic disease management programmes, administering or prescribing medicines, and identifying and managing undifferentiated conditions. It was inevitable that, as GPs have delegated clinical roles to nurses over the past 20 years, then nurses would need to delegate to assistants to enable them to take on the more complex needs of patients in the shift from secondary to primary care. HCAs offer a pragmatic workforce solution where we nationally have a diminishing and ageing nursing profession with a parallel demand for more and better preventive healthcare. HCAs now have their own web-based toolkit that offers guidance on:

  • Employing a HCA - including information on job advertising and job descriptions.
  • Integrating a HCA into general practice - including training options, induction kits and timetables.
  • Supporting the HCA in their role - including appraisals and training advice for their ongoing development.
  • Defining the HCA role - including the competencies they should have.
  • Evaluating the HCA role - including templates and tools to help assess how the role is fitting in with the practice.

This support has been established with Department of Health funding and developed by a partnership of HCAs, practice nurses, GPs, professional bodies, PCTs and DH representation. It reflects the growing importance of the HCA role and prevents the problem of practices developing in isolation, reinventing the wheel as they encounter the same hurdles such as competencies, litigation and accountability. Visit the site at

In my experience, HCAs are enthusiastic to take on new roles. They are cost-effective, become a real asset to the surgery team, and are able to take on administrative roles as well as expanding the clinical workforce. HCAs are destined to grow in numbers and competencies. But not everyone agrees with me: some feel that HCAs, especially with a recognised qualification (eg, NVQ) may be employed in place of a practice nurse.

Although some practice nurses and GPs are presently cautious of this new development, practice nurses have a vital role to play in planning and shaping future nursing services. Nurses can and should ensure that key safeguards are in place to support HCAs and protect patients. For me, ensuring the HCA has the competencies for the role is fundamental and within our brief.  We have an NMC code of responsibilities for safe practice. Nurses should recognise that HCAs actually enhance our role and support safe patient services.