Understanding delegation, capability and emerging roles among AHP support workers in community and Intermediate Care – PhD Health Sciences Ref: 5885

Supervisors

Dr Abi Hall - University of Exeter - Faculty of Health and Life Sciences

Dr Jo Day - University of Exeter - Faculty of Health and Life Sciences

Professor Richard Griffin - https://www.kcl.ac.uk/people/richard-griffin - King’s College London

NIHR Applied Research Collaboration(ARC) South West is inviting applications for a PhD studentship to commence on 21 September 2026 or as soon as possible thereafter.  For eligible students the studentship will cover Home tuition fees plus an annual tax-free stipend of at least £21,805 for 3 years full-time. We welcome applicants who wish to study less than full-time, provided they complete their studies before March 2031.  The student would be based in the ARC South West in the Faculty of Health and Life Sciences at St Luke’s Campus in Exeter. A training and development budget will also be provided to support the activity of the student.

1.       Background

Community rehabilitation and intermediate care services play a central role in supporting older people and adults with multiple long-term conditions to remain independent, improve quality of life and avoid unnecessary hospital admission (1,2) . These services are increasingly expected to deliver proactive, personalised care closer to home, reflecting national policy and pressures on healthcare services (1,3). NHS England has identified community-based care and workforce transformation as critical to the delivery of the NHS Long Term Workforce Plan, including optimising numbers and skills of staff and expanding the contribution of the non-registered workforce (4). Within this context, Allied Health Profession (AHP) support workers are an essential and growing part of community rehabilitation teams (5). While national guidelines outline expected skills they need and career development opportunities, there is emerging evidence (6) that some services are developing new roles that operate beyond traditional boundaries. However, there is currently no clear national picture of how widespread these roles are, how they are safely managed, or how they contribute to staffing levels, quality, and patient experience 6,7). Addressing this gap is important to ensure workforce innovation aligns with national priorities for safety, sustainability, and equity (4).

2. Problem or issue to be investigated. 

Community and Intermediate Care services rely heavily on AHP support workers, yet there is a limited evidence base to inform how these roles are defined, supported, and developed in practice. Current uncertainties around role boundaries, delegation and supervision, capability development, and the emergence of more advanced roles create challenges for designing workforce models that are safe, effective, and sustainable. Addressing these gaps is essential to support delivery of the Ageing Well agenda and aligns directly with the Department of Health and Social Care’s Areas of Research Interest, which identify skill mix, role development, and workforce sustainability in community settings as key research priorities.

3. Research questions/aims and objectives. 

Research questions

• How do AHP support workers understand their roles and boundaries when supporting older adults in community and Intermediate Care rehabilitation, including where responsibilities extend beyond formal role descriptions?
• How are delegation, supervision and accountability negotiated in everyday practice, particularly in relation to more complex or extended tasks?
• What organisational, relational and contextual factors shape support worker capability, confidence and professional identity?
• How do emerging advanced or enhanced support worker roles develop, and how are they experienced by support workers, AHPs and managers?

Aim - To understand how AHP support workers enact delegated rehabilitation work in community and Intermediate Care settings, including emerging advanced roles, and to use these insights to inform evidence-based workforce development.

4. Proposed methodology and methods - A qualitative, multi-site study conducted over four phases.

Phase 1: Documentary and workforce analysis (3–6 months)

Analysis of national and local policy documents, professional guidance, ICS workforce strategies, job descriptions and supervision frameworks. This phase will map how support worker roles — including any advanced or enhanced positions — are formally described and governed, and identify gaps between policy and practice.

Phase 2: Multi-site observational study (9–12 months)

Observation and shadowing within 2–3 community or Intermediate Care teams supporting older adults. Fieldwork will explore how delegated rehabilitation tasks are enacted in practice, how support workers learn and develop capability, and how role boundaries and extended responsibilities are negotiated within teams.

Phase 3: In-depth interviews (6–9 months)

Semi-structured interviews with AHP support workers, registered AHPs and service managers. Interviews will explore experiences of delegation, supervision, confidence, role identity, perceptions of advanced practice, and views on risk, responsibility and career development.

Phase 4: Consensus process (6–9 months)

Phase 4 would use a structured consensus approach, informed by implementation science, to identify and agree priorities for practical workforce tools or guidance grounded in the findings from Phases 1–3. This  phase would focus on defining what would be most useful and feasible to produce, rather than developing or testing full interventions, and would provide a clear platform for future post-doctoral work.

5. Dissemination and impact plans. 

The study will generate findings directly relevant to workforce planning and service delivery, including:

• Recommendations for what evidence-informed guidance is needed on delegation and supervision underpinning safe and effective care
• Principles to support capability development and extended practice
• Recommendations for ICS workforce strategies
• Insights into optimal utilisation of support staff
• Peer-reviewed publications and conference presentations

These outputs will support safer, more consistent rehabilitation services for older people and contribute to national conversations about the future community rehabilitation workforce. The outputs will provide NHS England with evidence to guide policy decisions on role standardisation, delegation, and career development pathways for the support workforce, supporting implementation of national workforce strategies and improving capacity, continuity, and quality of care for people receiving community rehabilitation.

6. Patient and public involvement and engagement

Patient and public involvement (PPI) will play a focused and proportionate role in this study, ensuring that the research remains grounded in what matters to older people receiving community and Intermediate Care rehabilitation. While the primary participants are AHP support workers and professionals, the way these roles are enacted has direct implications for older adults’ experience, confidence and outcomes. A small advisory group of older adults and carers with recent experience of community or Intermediate Care rehabilitation will be established at the outset of the project. This group will contribute to the by:

1. Shaping the research focus
2. Informing interpretation of findings
3. Contributing to co-design activities
4. Supporting accessible dissemination

PPI involvement will be supported through accessible materials, flexible meeting formats and appropriate reimbursement in line with national guidance. This approach ensures that the study remains focused on the experience of older people, while maintaining methodological coherence with a workforce-focused qualitative design.

7. Research inclusion

The study will include support workers from a range of backgrounds, bands and professions across different community and IC services, ensuring diversity of experience and context. Sites will be chosen to reflect varied populations, including rural, coastal and more deprived areas, to capture different patterns of service delivery. Participation will be supported through flexible scheduling and clear, accessible study materials. Older adults involved in PPI will be drawn from diverse backgrounds, and adapted approaches will be used where needed to support inclusion of people with communication or cognitive difficulties. Representation will be monitored throughout to ensure the study reflects the breadth of the workforce and the communities they serve.

References

1.        NHS England (2019) The NHS Long Term Plan. London: NHS England.

2.        World Health Organization (2017) Rehabilitation 2030: A Call for Action. Geneva: WHO.

3.        Department of Health and Social Care (2019) The NHS Long Term Plan. London: DHSC.

4.        NHS England (2023) NHS Long Term Workforce Plan. London: NHS England.

5.        Health Education England (2021) Allied Health Professions Support Worker Competency, Education and Career Development Framework. London: HEE.

6.       Skills for Health (2022) Developing the Clinical Support Workforce. Bristol: Skills for Health.

7.       Griffin, R. Hall, A, and Kessler J (2023) The Cavendish Review: Ten Years On. London: Cavendish Coalition.

“The studentship will be awarded on the basis of academic merit. Students who pay international tuition fees are eligible to apply. However, these candidates should note the following:

• The award covers only part of the international tuition fee, approximately £27,000.
• It does not include a stipend for living expenses.
• International applicants will need to cover additional costs, including:
• Student visa fees
• Immigration Health Surcharge
• Relocation expenses associated with moving to the UK to undertake a PhD.

International fee-paying applicants should ensure they have sufficient funds to meet these costs before applying.

The conditions for eligibility of home fees status are complex and you will need to seek advice if you have moved to or from the UK (or Republic of Ireland) within the past 3 years or have applied for settled status under the EU Settlement Scheme.”

Entry requirements

Applicants for this studentship must have obtained, or be about to obtain, a First or Upper Second Class UK Honours degree, or the equivalent qualifications gained outside the UK, in an appropriate area of health or healthcare research.

If English is not your first language you will need to meet the English language requirements and provide proof of proficiency. Click here for more information.

Doctoral Award Person Specification

Essential

·         Hold a 1st or 2:1 bachelor’s degree, or equivalent If not, you will usually need to have a relevant master’s degree

·         Have prior research experience or training to prepare for a PhD

·         Not already hold a relevant PhD or equivalent

·         Show strong academic and professional skills needed to complete a PhD

Desirable

·         Demonstrate originality and independent critical thinking in proposing research with real-world benefits for patients, the public, and the health and social care system

·         Knowledge of the priorities in the area of research interest

·         Demonstrate an alignment with NIHR strategic priorities, where applicable.

Successful applicants will become members of the NIHR Academy, and further information about this can be found here https://www.nihr.ac.uk/career-development/research-career-funding-programmes/supporting-career-development/opportunities-infrastructure.

How to apply

Apply now

To apply, please click the ‘Apply Now’ button above. In the application process you will be asked to upload several documents

•             CV

•             Letter of application (outlining your academic interests, prior research experience and reasons for wishing to undertake the project).

•             Transcript(s) giving full details of subjects studied and grades/marks obtained (this should be an interim transcript if you are still studying)

•             Two references from referees familiar with your academic work. If your referees prefer, they can email the reference direct to PGRApplicants@exeter.ac.uk quoting the studentship reference number.

•             If you are not a national of a majority English-speaking country you will need to submit evidence of your proficiency in English.

The closing date for applications is midnight on 28th July 2026.  Interviews will be held virtually in August.

All application documents must be submitted in English. Certified translated copies of academic qualifications must also be provided.

Please quote reference 5885 on your application and in any correspondence about this studentship.

NIHR are committed to equality, diversity and inclusion in everything we do. Diverse people and communities shape our research, and we strive to make opportunities to participate in research an integral part of everyone’s experience of health and social care services. We develop researchers from multiple disciplines, specialisms, geographies and backgrounds, and work to address barriers to career progression arising from characteristics such as sex, race or disability. Please let us know if you need any reasonable adjustments made to the application process and we will be happy to explore whether this is possible. 

Potential applicants working in community, social care and public health are welcome to contact us to explore their suitability.

For general information about this studentship and the application process, please contact PGRApplicants@exeter.ac.uk. Project specific queries should be directed to the main supervisor A.Hall4@exeter.ac.uk. Queries about the award itself can be directed to arcsouthwest@exeter.ac.uk

Summary