A practice manager contacted the MDU for advice on employing an HCA. The practice was considering taking on an HCA to help with the practice nurse's increasing workload. At a practice meeting, a question arose about what training the HCA should receive.

Such queries are common. Between January 2010 and December 2013, we received on average 30 calls a year from members regarding employing HCAs. More than half raised queries about the role of HCAs, what tasks they can perform and their training requirements.

As the workload of GP surgeries increases, the role of HCAs is expanding and developing. Surveys indicate that the number of HCAs in general practice is rising while the number of registered nurses is declining.

Of course with greater responsibility comes greater risk. Proper training is vital to ensure safe and effective practice. In addition, employers can be vicariously liable for the acts or omissions of their HCAs, which reinforces the importance of providing appropriate training.

At present, HCAs already in practice are not required to have any formal qualifications, but must be 'competent to take on the task' (for example, in the administration of flu vaccines). From April 2015, all new starters must attain at least the minimum standard required by the Certificate of Fundamental Care, introduced in March, to practise as an HCA. The onus is on the HCA's employer to provide training in 15 standards, specified on the NHS Employers' website. Training must be completed within 12 weeks and employers are responsible for the certification.

Proper training is vital to ensure safe and effective practice

Background to the new training

The 2013 Cavendish Review, commissioned by Jeremy Hunt, Secretary of State for Health, in the wake of the Francis Inquiry, set out 18 recommendations for changes to how HCAs are recruited, trained, managed and supported to more clearly define the parameters of the HCA's role. The Report called for HCA training to be standardised, with all HCAs receiving the same basic training based on existing best practice and linked to the nursing curriculum.

On completion of training, HCAs would receive a Certificate of Fundamental Care, which would permit them to see patients unsupervised.

The Government response to the Cavendish Review was included in its formal response to the Francis Report, issued in November 2013. In it, the Government ruled out regulation of HCAs, but did confirm that the care certificate would be developed by Health Education England (HEE). The certificate is based around the Skills for Health documents - the Code of Conduct and the National Minimum Training Standards.

Other resources

Another useful resource for HCAs is the Royal College of Nursing First Steps competence checklist (2014). This is a self-assessment tool which provides an HCA training framework based upon the National Minimum Training Standards and Core Competences from Skills for Health.


This article was correct at publication on 21/04/2015. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Dr Ellie Mein

Medico-legal adviser

MB ChB MRCOphth GDL LLM

Ellie joined the MDU as a medico-legal adviser in 2013. Prior to this she worked as an ophthalmologist before completing her Graduate Diploma in Law in Birmingham.

See more by Dr Ellie Mein

Dr Sissy Frank

Medico-legal adviser

Sissy trained in law in the US, graduating from Stanford University in 1990. She then changed careers and trained in medicine, obtaining an MD from Harvard Medical School in 1998 and completing her residency in paediatrics in 2001. She came to England in 2001 and completed further training in general practice, receiving her MRCGP in 2006. Before becoming an MLA, she worked as a GP partner in Kent.

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