Developing a standardised introductory course for HCA’s in General Practice - lessons learnt and future directions.

Introduction & background Growing number of HCAs in NHS

Wanless Report forecast 40% growth

Number of HCAs in Primary Care increasing General shift toward Primary Care provision New Contract for GPs 2005 NSF Frameworks for disease management Ongoing development of PN role

Training and support of HCAs of concern No national guidance Fragmented / inconsistent approach to HCA training Variations in content, structure and capacity of local training Little or no research for evidence base

HCA Foundation Course in North Central London NHS Sector Programme Aims

Develop agreed standards in HCA training and support Promote consistency and quality for training and support for

HCAs Provide more effective use of PN role Develop skill-mix Share learning, experience and develop support among

participating PCTs

Course Aims Develop HCA skill and knowledge base Develop greater HCA confidence in their role Develop quality of care to patients Develop role satisfaction, career opportunities of HCAs

Foundation HCA Training Course content

Week 1 Structure of the NHSStructure of General Practice

Week 2 Interpersonal communication in General PracticeAssertiveness skillsSkill mix and management of change

Week 3 Record KeepingConfidentiality issuesIntroduction to basic clinical skills (HT/WT/BMI & Urinalysis)

Week 4 Cold chainInfection Control

Week 5 Health Promotion in General PracticeClinical training: Blood pressure, Peak Flow recording

Week 6 Clinical skills: Blood glucose monitoringMaintaining effective liaison with other agencies (NHS, Social Services)

Week 7 Presentation of course projectsIdentification of future training needs

Evaluation Consulting with HCAs

Survey of HCAs completing the Foundation course Interviews with HCAs

Consulting with Course Tutors Interviews

PCT perspectives Interviews with PCT leads

Practice Nurse Development Learning & Development Manager

HCAs perception of the course Content and Structure

Study format accessible Study areas relevant, useful & practical (irrespective of how long

students been a HCA)

Course length Desire for longer course

to cover issues in greater detail Further development of clinical skills

Inter and post course support Good teaching support (as new to study & learning) Sharing and learning with other HCAs important – peer support Variability of PN mentoring during and after course Variability of Practice Support

Impact of the introductory HCA course Confidence in HCA role increased

Greater awareness of role and responsibilities Greater awareness of limitations of role (legal & delegation)

Development of interpersonal skills Important for role development Development of working relationships in General Practice

Increased job satisfaction More varied roles More specialised roles Greater patient contact Appreciated more within Practice

Impact on role of HCA in practice

63

100

58

92

61

90

61

82

53

71

55

69

37

53

5 11

0

10

20

30

40

50

60

70

80

90

100

Bpres. BMI Urinalysis NP Check Equip.steril.

Ordersupplies

Phlebotomy ECG

Figure 6 - Roles pre and post HCA training

Pre HCA Training After HCA Training

Impact on roles and responsibilities Role development

Increase in variety of roles undertaken Increase in speciality of roles undertaken

Role development not uniform Level of post course support and training by PN variable Level of post course support by wider Practice variable Interpersonal relationship with PN Dual admin/ HCA roles problematic

HCAs working to different levels of sophistication

HCAs working to different levels of supervision

HCA contribution to skill-mix, practice capacity and workloads

Further training and career development Training and career progression

Motivation high after course Confidence developed after course Introductory course clearly a ‘springboard’ to further training &

study Many already embarked on further training or further

qualification

Barriers to further training and career development Lack of defined training and development pathways Inconsistency of available courses relevant to HCA Lack of support from General Practice

Poor understanding of potential role of HCA Poor understanding of training needs of HCA –supervision /

development Resources Staffing flexibility – supervision in career progression

Further training

29

4040

45

45

45

53

58

58

63

63

66

71

0 10 20 30 40 50 60 70 80

%

Communication skills

Health promotion

Dealing w ith conflict

Smoking cessation

Weight Control

CHD

Asthma

First aid

IT skills

Wound management

Diabetes

Counselling skills

Nutrition

Figure 10 - Issues on which respondents desired more training.

Impact within the PCT - workforce Standardisation: establish minimum sector wide standards for the

training and development of HCAs in North Central London NHS Sector.

Greater awareness of the HCA role: Stimulated local debate about the nature and role of the HCA in Primary Care

Role redesign: through providing skilled and competent HCAs helped in the ‘professionalisation’ of the HCA workforce and helped to develop the role of the PN

Staff retention: the supply of skilled and competent HCAs was noted to have increased HCA job satisfaction and helped to reduce volatility in this area of the workforce.

Benefit realisation: helped to develop the capacity and contributed to more efficient working roles in General Practice.

Skills escalator: Instilled a personal sense of achievement, development and motivation within the HCA workforce.

Course development – key findings Post Course Support

Help in establishing of HCA role Maintain peer support mechanisms HCA Forum (for support/ training/ update)

PN Mentoring / Supervision Develop minimum standards in mentoring /supervision Further training for PN mentors

General Practice Development Further develop awareness of HCA role and potential

contribution to General Practice Expectation of HCA training and commitment

Training and development pathways Clear presentation of options and opportunities for HCAs

Strategic development of HCAs in Primary Care Strategic Lead for HCA

development Responsibility for leading

reform, change and development

Funding of further vocational qualification NVQ Cost of course, supervision

staff release

Further exploration of sector wide commissioning Maintenance of introductory

course Provision of post introductory

course training National Guidance

Registration Employment guidelines

Further research Impact on PN role and

responsibility Contribution to practice

workloads Impact / perceptions of patient

care