Preceptorships

Definition and background to preceptorships

Preceptorships are designed to be a structured period of support to enable clinical staff who are new to an area of practice to support their transition from a novice to their new status as a qualified and fully accountable professional (NHS England and Improvement,2022). The challenges of adapting to a new role are highlighted in the literature for a range of different clinical professional groups (Kim & Shin; 2020, Thompson; 2015), including for speech and language therapists (Brumfitt & Hoben, 2014). These challenges are both professional and personal, with wellbeing being an important factor in the experience of newly qualified clinicians.

Preceptorships have been recommended for newly qualified professionals for some time, however, the benefits of preceptorships have now been highlighted for people experiencing a broader range of scenarios beyond initial qualification, including following a career break or period of extended leave, for international recruitment and for a significant change in clinical practice (e.g. HCPC, 2022).

Preceptorships have been defined by The Health and Care Professions Council (2022) as:
“…a period of structured support and development during periods of career transition, during which a preceptee is supported by a preceptor to develop their confidence as an autonomous and accountable professional… preceptorship should welcome and integrate the preceptee into a new role and encourage a culture in which individuals are supported to continue on their journey of career-long learning and development.” (HCPC, 2002, p5).

In 2023, The Health and Care Professions Council and NHS England (NHSE) published guidance and principles to support employers with the development and delivery of preceptorship programmes for Allied Health Professionals. In line with HCPC and NHSE, The Royal College of Speech and Language Therapists recommends that employers offer a period of preceptorship for clinicians who are either new to practice, or who are embarking on a new role which constitutes a significant change in their professional and clinical experience.

The benefits of preceptorship have been consistently documented across the literature. NHS England (2022) highlight the key benefits as:

• increased job satisfaction
• enhanced confidence
• improved recruitment and retention
• feeling valued
• enhanced future careers aspirations.

Across the literature, the themes of supporting transition, developing confidence and establishing autonomy and encouraging career or lifelong learning are core elements of preceptorship.

It is:

• structured and
• provided over time

to receive new therapists into an organisation.

For speech and language therapists, this may include opportunities to meet with and shadow other professionals and therapists, participate in mentorship, training on organisational values as well as building on the foundational therapy skills acquired in preregistration training. It may include guided self-directed as well as in person learning opportunities. Whilst preceptorship is different from the statutory and mandatory training or learning about standard operational processes expected of a new employee, it could take place alongside these elements of onboarding into a new role. It is noteworthy that preceptorship does not seek to replicate the pre-registration clinical training that clinicians have undertaken but that it should develop a wider skillset that spans across disciplines and professional groups. For this reason, many employers choose to develop multi-professional preceptorship programmes.

The role of preceptor, preceptee and employer in preceptorships

A preceptorship programme supports a preceptee, who is the newly appointed clinician receiving support and guidance. They are supported by a preceptor, who is the person responsible for providing and facilitating this support.

Preceptees should have a named preceptor for the duration of their preceptorship award (e.g. HCPC, 2022; NMC 2022; Health Education England, 2017). Current guidance indicates that, while a preceptor should be a registered clinician, they do not have to come from the same profession as the preceptee. Multi-professional preceptorships can introduce and strengthen integrated working at an early stage, highlight shared experiences, standards and learning and development opportunities across professional groups and support wider learning experiences.

There are also benefits to uni-professional support within preceptorships for speech and language therapists. Preceptees who learn alongside other speech and language therapists and / or who are supported by a speech and language therapist as their preceptor, may be able to draw on a broader range of shared experiences and share clinical and professional skills specific to speech and language therapists.

Employers are encouraged to consider the environment receiving the preceptee when determining the professional background of preceptors. Where preceptors are not speech and language therapists, links with the speech and language therapy professional leads should be established, to ensure joint working, so that preceptees receive the support they need to develop their full potential within their professional scope of practice as speech and language therapists.

Regardless of the professional background of the preceptor, support roles should be clarified with managers and other clinical supervisors who may also be supporting preceptees. For speech and language therapists, this is particularly relevant in situations where ongoing post-registration training is delivered (for example, for eating, drinking and swallowing).

 

The role of the preceptee:

The HCPC principles of preceptorship highlights empowerment of the preceptee as a core principle (Principle 3). Preceptees are encouraged to be active partners with their preceptors in the development of their learning and transition. They will bring a range of background experiences and skills to their new roles and are encouraged to reflect how their existing strengths can be utilised as well as what support they need for their ongoing development. As with all supervision and development, the preceptee is responsible for completing their preceptorship with guidance and support from their organisation, actively taking the opportunities for timetabled and self-directed learning provided and evidencing completion of their preceptorship with their preceptor. Preceptees should be supported by managers to attend learning and development identified in a preceptorship and given time in their roles to do this. Employers are encouraged to consider the time given to preceptees in line with the overall provision of time and support for learning and development; as set out in the Royal College of Speech and Language Therapists’ Principles of Lifelong Learning.

 

The role of the preceptor:

Preceptors are registered clinicians who are trained and supported to carry out their preceptor role. They act as professional role models and provide regular support to their preceptee, which would include opportunities for the preceptee to reflect on their experiences, identify learning needs, enable access to learning opportunities and supporting preceptee’s health and wellbeing during this period of transition. Preceptors support preceptees in their empowerment (HCPC, 2022). They should have protected time to meet regularly with the preceptee as part of the preceptorship as well as training and support for them to deliver their role, and to support their own health and wellbeing.

Frameworks and principles of preceptorships

Preceptorships and foundation support

NHS England have identified preceptorship as one element of their Allied Health Professions Preceptorship and Foundation Support Framework (NHS England, 2022). This framework demonstrates that transition of newly qualified practitioners, specifically, begins before qualification and continues beyond their first year of practice.

They highlight 3 phases as:

1. Pre-preceptorship
2. Preceptorship and
3. Foundation support.

Employers of speech and language therapists are encouraged to work collaboratively with Higher Education Institutions offering registrant courses in Speech and Language Therapy to support the progression though the pre-preceptorship stage to the preceptorship phase for newly qualified therapists, and beyond to foundational support. This may be facilitated in part at the pre-preceptorship to preceptorship stage through practice educator roles and in combination with the management of support for preregistration clinical placements.  At the preceptorship to foundation support stage, employers are encouraged to develop a range of ongoing learning and development opportunities across the 4 pillars of professional practice, and for preceptees to have opportunities to build on the learning within their preceptorship as part of this.

A Framework of Principles for Preceptorship

The Health and Care Professions Council have developed a Principles for Preceptorship framework in collaboration with NHS England. This outlines 5 core principles for preceptorships with guiding statements under the following themes:

1. Organisational culture and preceptorship
2. Quality and oversight of preceptorship
3. Preceptee empowerment
4. Preceptor role
5. Delivering preceptorship programmes.

 

These principles bring the Allied Health Professions in line with the principles currently outlined by the Nursing and Midwifery Council (NMC, 2022) and build on the guidance previously developed by the Department of Health (2010).

The Principles for Preceptorship Framework offers multi-professional guidance on the core elements and principles that should be embedded within any preceptorship programme. They are not specific to an individual professional group. Elements of the principles however, do highlight profession specific considerations. These include:

Principle 2, b: Under Quality and oversight of preceptorship, employers are guided to consider that processes are in place to support ‘an appropriate mix of profession specific and multi-profession learning and development’.

Principle 4, d: Under Preceptor role, preceptors are guided to ‘support preceptees to engage with their wider profession’

Principle 5, c: Under Delivering preceptorship programmes, employers are guided to ‘have flexibility to deliver common themes of preceptorship in a multi-professional way while ensuring profession specific elements are provided where necessary’.

 

Guidance specific to speech and language therapists.

In order to ensure that the profession-specific needs of speech and language therapists are accommodated within preceptorship programmes, the following is recommended:

• There should be a nominated speech and language therapist within organisations or wider networks to represent the profession on the development and delivery of preceptorships.
• Speech and language therapists undertaking a preceptorship should have access to mentoring support from a qualified speech and language therapist. This may be within the preceptor role or complimentary to (but linked with) the preceptorship programme. Where there are no speech and language therapists available within an organisation, a suitable external mentor should be sought.
• There should be good communication links between providers of preceptorship programmes and speech and language therapy leads within an organisation or wider network. A process for feedback or escalation should be agreed to support preceptees concerning matters specific to their profession.
• The specific clinical and professional developmental needs of any speech and language therapist roles should be incorporated into any preceptorship programme. Preceptors should be made aware of these and enabled to support preceptees’ access to learning and development opportunities, including clinical supervision, where needed to support autonomous practice within a given role.
• Speech and language therapists should be encouraged to link with professional and clinical networks in their area of practice to support their confidence as autonomous practitioners. Examples of these networks include the clinical excellence networks hosted by the Royal College of Speech and Language Therapists.
• Preceptors and employers should refer to the RCSLT’s resources available to support practitioners new to roles, including the guidance for Newly Qualified Speech and Language Therapists. In addition guidance is being developed for International Recruitment as well as guidance on new roles through the Workforce reform programme.
• Speech and language therapy preceptees should be encouraged to give feedback on multi-professional programmes to support their voice in future development.

Other guidance on preceptorships

Preceptorships are recommended for speech and language therapists regardless of the nature or region of employment, however specific guidance can be found for employers in specific categories as follows:

National Guidance:

England: Health Education England have produced guidance in association with the Health and Care Professions Council. In addition, they have produced a number of training programmes and resources as follows:

• Training on preceptorships on their e-learning for health platform.
• A Framework for preceptorships for AHPs based in London has been developed, known as CapitalAHP Preceptorship | Health Education England (hee.nhs.uk)
• NHS England are also developing a national AHP Implementation Framework and are seeing involvement from AHPs with experience of a range of different transitions into the workplace.

Scotland: In addition to the HCPC guidance highlighted above, NHS Scotland have produced information and support for preceptorships, which include the NHS Flying Start programme as well as other more general resources to support AHP supervision.

Wales:  While no specific guidance is given for preceptorships for allied health professions, the following resources may be useful: NHS Wales guidance for Allied Health Professions, and the All Wales Preceptorship Guidelines for newly appointed ward sisters/ charge nurses. Although the second reference is related to the nursing profession, there are many similarities for preceptorships between Nursing and Allied Health Professions.

Northern Ireland: As for Wales, there is no specific guidance for preceptorships for allied health professions, however the Northern Ireland Practice and Education Council for Nursing and Midwifery have produced guidance on preceptorships.

 

Guidance for NHS Employers:

The NHS employers provides guidance on preceptorships for newly qualified staff.

The NHS Terms and Conditions of Service Handbook also refers to a period of preceptorship for the first 12 months of a clinician employed at the bottom of Band 5 on the Agenda for Change payscale. This banding applies to newly qualified speech and language therapists. Please see Part 2, section 1.8– Pay,  for more information.

Guidance for employers from other sectors and for Speech and Language Therapists in Independent Practice: Whilst there is no specific guidance for employers from other sectors, the RCSLT recommends that any speech and language therapist new to practice is supported through a preceptorship in line with the HCPC principles and the additional guidance given here.

Concerning independent practice, The Association of Speech and Language Therapists in Independent practice provides guidance on membership which highlights minimum standards expected of members. This includes successful completion of at least one post graduate year of practice (referred to as a ‘probationary’ year). In addition, full membership is only granted to therapist who have two recent and consecutive years of post-graduate practice (ASLTIP, 2023).

Case study 1: The experience of a newly qualified speech and language therapist working in a large NHS community and mental health trust in England (Children and Families Services)

What was going through your mind when you started your new role?

Being in the pandemic, that was in the forefront of my mind. I had trained and had my placements pre-COVID and having to come into something different, I was trepidatious about what the service was going to look like. Also starting a new job when everyone was wearing masks etc… so what was going through my mind was fear. I know I was excited about starting. I had had a change in thinking during my training, had originally wanted to work with adults but because of my placements with (the employer) I changed my mind. Knowing the environment from my placement still helped. So mixed feelings, excitement, and fear.

How was the preceptorship introduced to you? Who was with you on that journey?

There was a bit of a gap after starting but I first found out about the preceptorship from other therapists who had started the preceptorship a few months before me. But they didn’t really explain it very well, they’d said it was a bit like another set of competencies, and that wasn’t really the right description. I then mentioned to my line manager about it, who had to chase the team to get me put on the programme. They did this and then I was contacted by the programme lead. I was given a choice of cohorts to start. When I first found out then that I had to do the preceptorship I wasn’t happy, because of the long gap before the programme, but I am actually still really glad I did it.

Tell us about the preceptorship and how it worked?

We had monthly meetings; the programme lead gave us an outline of the programme with an overview schedule. We had quite a bit of information to start with about the purpose of the preceptorship. Initially we’d have a presentation in the morning, with a chat afterwards and then another presentation in the afternoon. Later on in the preceptorship period, we had the afternoons set aside for our Quality Improvement (QI) projects. Some of the monthly meetings were guided learning and were focussed on things like developing your leadership skills. There was also information on coaching, being a coach. For me, because I got a leadership development post at the beginning of the preceptorship, that was really helpful.

We got to choose whether our QI projects could be solo, or in teams. We were supported by the Trust QI team and this was really helpful. Because there weren’t any other Speech and Language therapists on the preceptorship, I decided to do a sole project. I had already thought about my project before I started, and this was based on my experience of parents having difficulties with the stage of discharge from our service. This was the topic of my preceptorship project and led to the development of an information leaflet about the service. There were a few things about the project that I couldn’t do as much of as I would have liked, due to the timing of the project, like the parental involvement, but I did get a little bit. As far of the project was concerned it was hugely important to me to have parental involvement, and through the feedback I did get some really valuable information about what was important on the leaflet. Through doing this project I am always aware now for other projects about the importance of parent involvement.

What was helpful about the preceptorship?

The QI project. Although at the time I didn’t realise how important it would be, I’ve now been asked to be part of another QI project, so I felt really prepared to be able to do this. Also, the coaching has been really helpful. I am about to take on my first student, so having that is a good preparation. And in time I will be expected to line manage. I don’t know when that will be but again that will be a good preparation.

 

What wasn’t helpful?

The monthly meetings were on a virtual platform. I realise that one of the aims of this type of preceptorship is to meet people outside of your team and form connections, but that didn’t really work on a virtual platform. Face to face would have been much better.

 

Did you have a preceptor? Who were they?

I didn’t have a named preceptor, but the preceptorship lead was available to us all on the programme.

 

Were there any other speech and language therapists or members of your own team?

No there weren’t any other speech and language therapists. There was another children’s therapist (occupational therapist). The vast majority of the team were nurses, and it did feel quite nurse heavy and there was lots of reference back to the NMC guidelines, so we were having to fit in to that model. I suppose it would be helpful for the course leader just to be a bit more aware and mentioning the other guidelines (e.g. RCSLT or HCPC guidelines).

There wasn’t really any link to the local team. It’s quite a new thing so there aren’t many people to talk to about the programme. To have that local support would be really useful. I’m not sure anyone else on the team has done the preceptorship apart from one other person. It would be helpful to make sure that people aren’t missed, as it took a while to get me on the programme.

 

Case study 2: The perspective of a preceptor

What were your hopes/ fears when starting your new role?

I remember feeling a mixture of excitement and anxiety when starting my first role as an SLT so I acknowledged this may be the case for (preceptee’s name). I hoped that (preceptee’s name) would fit into the team and I feared that she may not feel welcomed and supported as I had when I joined the team. (preceptee’s name) is very conscientious and approaches uncertainty with pragmatic curiosity, and will share her thoughts openly in supervision sessions, so I trust she will share her hopes and fears explicitly as and when she needs to.

 

How was the preceptorship introduced to you?

I am unsure how exactly the preceptorship was first introduced to (preceptee’s name) as I was not her original preceptor however I am aware she received information from the Trust. I was aware of the preceptorship process from my first role. (Preceptee’s name) made me aware of her preceptorship through informal discussion and then by me becoming her preceptor.

 

Tell us about the preceptorship and how it worked?

I am new to being a preceptor and am still evaluating how helpful and accessible it might be for all new starters, however (preceptee’s name) is proactive with providing evidence and using the framework to identify gaps in her knowledge.

 

Who was with you on your journey?

(Preceptee’s name) has been working incredibly well with her SLT colleagues and the MDT, who have supported her through joint visits and case discussions. (Preceptee’s name) and I have had informal supervision sessions as well as preceptorship meetings which I feel has been beneficial for both of us.

 

Did you have an identified preceptor? Who were they? Where were they based?

(preceptee’s name) has recently switched preceptors due to team caseload demands. Her preceptor is now myself, a Band 6 SLT within the same team. My base is the same location as (preceptee’s name).

 

What was your experience of the preceptorship and how did it help?

I am still working through the preceptorship with (preceptee’s name) but it is providing dedicated time for us to look at (preceptee’s name)’s skills in detail. I believe that (preceptee’s name) is finding it useful to have a framework by which to gauge her level of confidence with the expectations of the role.

 

What do SLTs need specifically which can be included in a preceptorship programme?

I feel that there could be a means of evidencing that the preceptee has had sufficient supervision opportunities and quality of supervision to feel confident going forward.

 

Case study 3: The experiences of a preceptee working in a Learning Disability team

What were your hopes/ fears when starting your new role?

My hopes were to put my theory from Uni into practise as well as to learn new clinical skills and gain perspectives of working with people with LD and the people around them. My fear initially was not being confident enough to express my clinical decisions.

 

How was the preceptorship introduced to you?

SLT colleague, who had previously completed it told us about it. He explained the purpose as well as what to do/what goes on in a preceptorship.

 

Tell us about the preceptorship and how it worked?

My preceptorship involved monthly meet-ups and discussion about cases. I would gather my own cases from my caseload that I would like to discuss as well as using the provided NQP goal list as a guide to ensure we cover the topics/themes.

 

What was helpful about the preceptorship?

My manager and also, band 6 colleague. I also have to say that our team is open to discussions so if I’m in need of advice or guidance, the rest of the team is very keen to help and provide feedback.

 

Did you have a preceptor? Who were they?

Yes, it was (preceptor’s name) but now, (new preceptor’s name) (band 6) is about to take over as she handles more communication cases. They are based in the same office and cover similar areas in Essex.

 

What was your experience of the preceptorship and how did it help?

It definitely helped build my confidence in terms of making clinical decisions. My preceptors have always made sure it was a safe space for me to discuss and learn as I approach clients with various needs. We would find ways to go about complex clients and also getting other AHPs involved to ensure we provide a holistic care towards our clients.

 

What do SLTs need specifically which can be included in a preceptorship programme?

A band 5 buddy would be nice to have.

References and external links

The Association of Speech and Language Therapists in Independent Practice (2023) Member benefits obtained online 6 March 2023

Brumfitt, S. & Hoben, K. (2004) The transition from speech and language therapy student to newly qualified professional IN Brumfitt S (Ed) Innovations in Professional Education for Speech and Language Therapy, London, Whurr

Cox, D. (2022) ‘Good preceptorship positively impacts staff recruitment and retention’ | Nursing Times February 2022; obtained online 5^th January 2023

Department of Health (2010) Preceptorship Framework for Newly Registered Nurses, Midwives and Allied Health Professionals London DoH

Health Education England (2017) Capital Nurse Preceptorship Framework September 2017, obtained online 13 February 2023

NHS England (2022) National AHP Preceptorship and Foundation Support obtained online 13 February 2023

Health & Care Professions Council (2022) Consultation document: Consultation on principles for preceptorship, London HCPC

Irwin, C.; Blis, J. & Poole, K. (2018) Does preceptorship improve confidence and competence in Newly Qualified Nurses: A systematic literature review

Kim, J. & Shin, H. (2020) Exploring barriers and facilitators for successful transition in new graduate nurses: A mixed method study Journal of Professional Nursing 36 (6) pp 560 568

NHS Employers (2022) Preceptorships for Newly Qualified Staff June 2022, obtained online 13 February 2023

NHS England and Improvement (2022) National Preceptorship Framework for Nursing October 2022, obtained online 13 February 2023

Nursing and Midwifery council (2022) Principles of preceptorship November 2022; obtained online 13 February 2023

Royal College of Nursing (2022) NMC: Preceptorship May 2022. Obtained online 13 February 2023

Thompson, S. (2015) The perceived concerns of newly qualified paramedics commencing their careers: a pilot study Journal of paramedic practice https://doi.org/10.12968/jpar.2015.7.2.74

Contributors

• Clare Smith (Lead Author)
• Lauren Leigh-Doyle (Supporting Author)
• Eleanor Harris (Supporting Author)
• Danielle Neshiri
• Christine Ward
• Laura Pickering-Payne
• Claire Bradshaw
• Laura Lennox
• Eleanor Burris
• Kristy Cross
• Jackie Kindell
• Catherine Fisher
• Ciara Fearon
• Sian Jones
• Heidi Cox