Government policy across the four nations of the UK emphasises the importance of developing public health workforce capacity to meet the challenges of the 21st century – non-communicable diseases such as diabetes and heart disease, and continuing health inequalities. Public health practitioners make up an important part of the workforce, but are not well defined and currently are not required to be registered with a regulator. There is widespread agreement that registration is valuable in principle in protecting the public and upholding professional standards. The UK Public Health Register (UKPHR) provides voluntary registration but as of 2020 only a small proportion of the practitioner workforce was registered. Research suggests that only a minority of practitioner job descriptions include registration as an essential or desirable criterion. The aim of this study was to understand the attitudes, policy and practice of employers towards UKPHR practitioner registration across London and South East England.
This was a qualitative study utilising semi-structured interviews conducted between September 2020 and April 2021. A maximum diversity sample of employers of public health practitioners in London and the South East of England was sought seeking diversity on three criteria: geography, type of employer and level of management. Participants were recruited through e-bulletins, Health Education England networks and direct email approaches to line managers of advertised practitioner posts. Data were recorded and transcribed. Thematic analysis was undertaken with both deductive (themes derived from the research questions) and inductive (themes emerging from the data) dimensions.
Thirty-one line managers from public health employers were interviewed, mainly from local authorities and Public Health England. Eight key themes and ten sub-themes were identified from the data, largely shaped by the research questions but some new areas of interest emerging from the data. The eight themes were: the importance of practitioner professional development; individual pathways to development; the value of registration versus the MSc; gap in registration for senior practitioners; need for stepped career pathways; welcome for apprenticeships. The value of registration was further broken down into seven sub-themes: essential; desirable; optional; not valued; difficult to assess; hidden value; need to promote. Registration versus the MSc was broken down into three sub-themes: MSc more valuable; registration more valuable; judge candidates in the round.
Practitioner registration is valued by many employers, though there is a range of attitudes from enthusiasts to sceptics. Registration as either an essential or desirable criterion only appears in a minority of practitioner job adverts. Employers also value registration in ‘hidden’ aspects of recruitment, in particular seeing it as evidence of competency and continuing CPD even when not formally included as a criteria. Registration is not included in practitioner job descriptions for a variety of reasons including inertia, concerns for inclusivity and equity and the desire for specific expertise. There is a significant group of senior practitioners/principals who do not feel current registration categories meet their needs. There is a continuing need to promote registration to both employers and practitioners, and improving the evidence base on the value of practitioner registration would assist with reaching out to those not currently engaged. Limitations of the study included that it was carried out during the COVID-19 pandemic when employer workloads were intense and did not recruit as many participants as intended, particularly directors of public health and employers from the NHS, private and third sectors.
Evans, D. (2021). Employer attitudes policies and practice towards public health practitioner registration - Final report. Bristol: Health Education England