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Case Study – Dudley Group NHS Foundation Trust

Transferable roles transform services for orthopaedics, benefiting patients and the workforce workforce

Introducing advanced practitioners in its orthopaedic assessment service resulted in dramatic benefits for Dudley Group NHS Foundation Trust. has had a profound impact on the efficiency of services from primary to secondary care, improving the experience of patients and utilising system-wide workforces more effectively

The Primary Care Trust’s experience demonstrates clear evidence of the benefits of nationally transferable roles and shows their potential in other settings and for other healthcare professionals. The orthopaedic assessment service reduced orthopaedic referrals to secondary care from 100% to 30%.

Skills for Health has developed a range of role templates to support new ways of working, to create a more flexible workforce and reduce waiting times. These “Nationally Transferable Role” (NTR) templates provide a structured approach to developing relevant, transferable, and nationally endorsed roles across different locations and services, with the flexibility to add locally relevant competences where required.

Each template provides:

  • Competences required for the role
  • The career framework level descriptors
  • Indicative learning and development needs

The first 30 NTRs focused on improving access to key specialities and diagnostic services.

“These are highly skilled physiotherapy practitioners with master’s level additional qualifications. This is a totally community-based service, which has developed strong links with our orthopaedic consultants in our local hospital.”

Alison Matthews, Community physiotherapy services manager, Dudley PCT



  • Orthopaedic referrals to secondary care reduced from 100% to 30% – so more cost-effective services with quicker throughput and lower cost per contact
  • 70% of orthopaedic patients treated in community locations with improved patient experience and satisfaction
  • The consistent quality of care – standardised, transparent roles are comparable across the UK
  • Improved staff satisfaction. The orthopaedic practitioners are confident to lead and innovate
  • Transferability of skills, competences and qualifications leads to improved career opportunities without the need to repeat education and training.

Our team surveyed 150 acute and foundation trusts and strategic health authorities and collated sample roles of those involved partly or wholly in reducing waiting times. The survey produced ‘live examples’ of roles comprising job descriptions and, for some, their learning and development packages. There were clear similarities among the variety of posts.

From the examples, four categories of roles with national transferability features were identified:

  • advanced practitioner
  • assistant practitioner
  • administrator/clerical
  • cross-cutting roles

Core competences and the learning and development needs for each group were then developed as templates. These ‘clusters’ of competences can be replicated anywhere in the UK. Each role is made up of Career Framework level descriptors, with core and specialist national occupational standards (NOS) to which locally relevant NOS can also be added. The learning and development package is an integral element of each NTR.

Dudley PCT’s orthopaedic assessment service was set up in 2005 and is run by four whole-time equivalent orthopaedic practitioners (who combine the role with physiotherapy practice). As described in the NTR template, the advanced practitioners are experienced professionals who have developed their skills and knowledge to a very high level, showing leadership, innovation, and excellence within the role.

Referrals are triaged daily by one of the team. Only 30% of patients need a referral to secondary care for surgical intervention. Follow up care is undertaken by the same practitioner, ensuring continuity of care. Fast track access to epidural clinics and for shoulder manipulation with no need for preliminary consultant appointments means patients wait up to eight weeks less.

The other 70% of referrals are seen by the advanced practitioners at one of several community locations. They order and interpret diagnostic tests and treat with joint injections or specialist physiotherapy techniques.

As the Sector Skills Council for all health sector employers, we support NHS, independent and third sector. Since 2002 we’ve been working with employers to get the right people, with the right skills, in the right place at the right time. We are the authoritative voice on skills issues for the health sector and offer proven workforce solutions and tools – with the expertise and experience to use them effectively.