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10 years on – Evaluation of the Non Medical Consultants role in the North West September 2010

10 years on – Evaluation of the Non Medical Consultants role in the North West September 2010. Chris Mullen MBE and Ann Gavin-Daley “Working Together Consultancy”. Aims – Presentation of Findings. Part one To outline the background to the project To outline the NMC profile

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10 years on – Evaluation of the Non Medical Consultants role in the North West September 2010

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  1. 10 years on – Evaluation of the Non Medical Consultants role in the North West September 2010 Chris Mullen MBE and Ann Gavin-Daley “Working Together Consultancy” Working Together Consultancy

  2. Aims – Presentation of Findings Part one • To outline the background to the project • To outline the NMC profile • To outline what the NMCs do Part two • To provide an overview of the impact findings • To review the influencing factors and sustainability • To share & discuss some of the recommendations for the future Working Together Consultancy

  3. Background to the Project • To complete the first NW wide evaluation of the NMC role – to include Nurses, Midwives, Health Visitors, Allied Health Professionals and Pharmacists • To provide some recommendations from the lessons learnt Working Together Consultancy

  4. Literature review – The Studies and Their Characteristics • Initial focus on the NMCs perceptions & limited supporting data • Small number of studies between 2000 -2004 • Increased number of studies between 2005 -2009 • Low numbers of NMCs in most of the studies • Self evaluations by individual NMCs own area of work • Profession and or service specific • Ranged from a sample of 5 to one that had over 400 • Lack of cost benefit analysis Working Together Consultancy

  5. Literature review • Manley:- • NMCs impact influenced by organisational culture – transformational • To develop others NMCs need to have a transformational leadership style • Found role ambiguity, overload, and conflict • Advocated the need for support to prevent burnout Working Together Consultancy

  6. Literature review – key areas explored Types of studies:- • Specific clinical areas (8) • Organisational culture and influences on role achievement (4) • Review of the role over time (8) • NMC characteristics and achievement (4) • Patient outcomes (3) • Research capacity (3) • Establishment of the NMC role (3) • Addressing the 4 core functions (3) • Perceptions and experiences of the NMC (3) • Clinical Practice (2) • Contribution to service development, research & evaluation (2) • NMC Leadership development (2) • Education role (1) • Clinical Negligence (1) Working Together Consultancy

  7. Some of the Main Findings from Previous Studies • Guest 2000-2004:- • Found NMCs saw leadership as the highest impact area • NMCs had impact through development of staff rather than direct patient care • Achievement in role was associated with NMCs who had a higher level qualification (masters) • Lack of managerial authority was impacting on the NMC effectiveness • Called for succession planning • Reported high satisfaction levels • NMCs did not regard their role as comparable to medical consultants and as the pinnacle of their career • Research was weakest area of activity • Lack of infrastructure support e.g. offices, secretarial support Working Together Consultancy

  8. Findings… • Woodward:- • Identified key characteristics of ‘NMC achievers’ – most experienced practitioners, prior knowledge & experience of four core functions • Personal characteristics – history of innovation, determination, assertive, leadership qualities & empowering skills • NMCs were becoming involved in management • Found NMCs optimistic about future research funding • All 10 NMCs had a contract with the universities • Lack of understanding from the medical staff • Hogg:- • Demonstrated NMCs need LQF leadership qualities • Highlighted personal accountability in relation to autonomous practice – personal negligence claim in radiology • Highlighted the need for education, support and career pathway Working Together Consultancy

  9. Findings… • Richardson 2008:- • Illustrated the complexity and variety of the role • Found where there was more overlap of 4 core functions there was a greater impact • Waters 2007:- • Looked at NMC role in children & young people & found ‘the NMC research role became explicit as a practice research role’ Working Together Consultancy

  10. Some local Findings… • Pidd & Tinston 2009 - • scoped the non medical staff in the North West about research activity and found:- • Wealth of research by AHPs & nursing, particularly physiotherapists • Lost opportunities – accessing research grants, using knowledge professionals with masters and or PHDs • Mula 2002 – • advocated regular performance management, regular reviews, support and access to Director/Board level • Shapiro 2009 – • evaluation of the advanced practitioner role in the NW and the link to NMC’s of the future Working Together Consultancy

  11. Literature Review – How it was used The literature review informed the methodology adopted and key themes to focus on:- • The focus on preparation for the role, • The impact on services both direct & indirect, • The application of leadership across all functions, • The scope of activity in the context of previous experience and educational qualifications, • Attempt to identify tangible evidence particularly related to QIPP • The link between organisational culture and impact of the educational element • Explore the evidence of the NMC engagement in R &D particularly in relation to how it is shared and used across communities Working Together Consultancy

  12. Methodology • Started in November 2009 – 8 months • Desk top literature review • Comprehensive questionnaire to NW known NMCs • An NMC fact finding focus group in January 2010 • Focus groups and meetings with key stakeholders:- • Director of Nursing NW forum • Pharmacy NW workforce leads forum • AHP NW workforce leads forum • Electronic questionnaire to identified representatives of the NW key stakeholders and sponsors Working Together Consultancy

  13. Methodology – The NMC Focus Group • 16 NMCs • Questionnaire was comprehensive, tested out with NMCs Focus Group, adjusted and agreed (105 q) • As a consequence of the NMC Focus Group the core functions of the role for the purposes of the questionnaire were expanded to include:- • Expert practice – to be split to identify direct and indirect care • Service Development was identified in its own right • Partnership working, networking and empowering others was explored separately • Exploration of the evidence would include reviewing how the NMC contributed to QIPP Working Together Consultancy

  14. The NMC Interactive Impact Framework Areas explored in the NMC role were:- • Leadership & Consultancy • Partnership working • Expert clinical practice – direct & indirect • Service development • Education, Training & Development • Research, audit and evaluation The NMC Interactive Impact Framework Working Together Consultancy

  15. Response Rate • NW register used • 130 NMCs identified • 95 responded = 73% response rate • Who responded by profession:- • 73 nurses 72% response rate • 5 midwives 45% response rate • 11 AHPs 86% response rate • 5 pharmacists 100% response rate Working Together Consultancy

  16. Methodology – Rationale and limitations • Adjusted the methodology to ensure timely completion and to gain the best output • Time scale was short particularly in the light of previous studies • Accuracy of the NW register was problematic • Not all questions were answered by all responders • Sponsor meetings (4) limited but did provide some opportunity to triangulate the data • Sponsors questionnaire response rate was low • These limitations are acknowledged Working Together Consultancy

  17. The NMC post and Lessons Learnt • The NMCs are a very experienced group of clinical professionals • The NMCs work in all four sectors of service provision. • NMCs in the North West are fulfilling the four core functions of the role, albeit to different levels of complexity. • The NMC role has the potential to make a significant contribution to supporting the delivery of the NHS plan. • The NMC role has made a considerable impact both directly and indirectly in improving service and quality. • The NMC role has made considerable impact on the education, training and development of the current and future clinical workforce. Working Together Consultancy

  18. The NMC post and Lessons Learnt • The research function of the NMC role can create added value through income generating research proposals, supporting innovation and sharing of best practice • The NMC role is not being embraced and or utilised to its full potential by organisations in the North West. • The impact of the role needs to be shared more widely to enable current and future sponsors to understand the full potential of the role. • Cultural issues are continuing to have a negative impact on the effectiveness of the role in several organisations. • Organisations need to ensure NMCs are actively, competently engaged in strategic issues and have access to executive level support. Working Together Consultancy

  19. The NMC post and Lessons Learnt • Realistic planning, organisational awareness, understandingand support for the NMC role are critical to the effectiveness of the NMC. • The most effective NMC needs to function at the highest level, combining expert practice with strategic insight and influence. • Organisations need to be clear regarding the requirement and expectation of the job to be done to ensure the NMC role is appropriate, and that the NMC is enabled to function at the required level. Working Together Consultancy

  20. Presentation of FindingsThe NW Position Working Together Consultancy

  21. NW Organisational Findings Number of NMCs in Organisations • 30 organisations had between 1-3 NMCs (48%) • 10 organisations had between 4-8 NMCs (16%) • 4 organisations had between 9-12 NMCs (6%) • 19 organisations had no NMCs (30%) Number of NMCs in the Sectors • 54 NMCs in acute sector (57%) • 20 NMCs in PCTs (21%) • 15 NMCs in mental health (16%) • 6 NMCs in specialist services (6%) Professions – NMHVs work in all sectors, AHPs work in acute & PC, and Pharmacy work in acute & specialist services Working Together Consultancy

  22. Workforce – NMC Development and Movements – Findings • New posts per year ranged from:- • A low of 7 • A high of 12 • Average number per year = 9.8 • Turnover – approximately 1.5% per year • Retention – 53% (n50) intend to stay 4-5 years • 28% (27) intend to move on in the next 1 to 2 years Working Together Consultancy

  23. Some Workforce and Performance Management Recommendations Recommendation 5 No formal record is maintained of NMC turnover. Consideration should be given to the need for maintaining accessible data for future monitoring of turnover. Section 2.1 Key Stakeholders: NHS North West/ Organisations Recommendation 14 NHS North West should review the impact of the dissemination of the evaluation report on future workforce plans for 2011. Sections 2.1/2.3Key Stakeholders:NHS North West/Panel Working Together Consultancy

  24. NMCs ProfilesGeneral background • Age – 65% were between 40 – 50 years of age • Gender - 80% female/20% male • Ethnicity - 93% British, 1% from an ethnic background (Recommendation 4) • Years qualified – 75% between 20 – 40 years since qualified • Previous experience • Previous posts - 79% from direct clinical posts • 21% from indirect roles • 9% manager roles • Number of years in NMC post – 52% (n49) had 6 years or more in an NMC post Working Together Consultancy

  25. NMC Profile – Educational Background Qualifications held by the NMCs • All responders had a first degree • 92% had a masters degree • 8% had a PHD • Other courses such as prescribing, post grad certificate etc • Leadership courses – local, regional, national and in 3 cases international Working Together Consultancy

  26. Employment Practices • Single employer – the majority • Joint employer posts – 5 with universities, 2 with other providers • Role – ‘Part time NMC’ function:- • 5 worked in universities 0.1 – 1 day/week • 1 NMC 50% time as a Divisional Lead • 1 NMC 50% Clinical Director • 1 NMC part time Director with GPs • 1NMC part time in Business Unit • 83% have either formal or informal links to universities Working Together Consultancy

  27. NMC Level of Role • NMC grades • 77% (n73) NMCs at grade 8b • 4% (n4) NMCs grade 8a • 17%(16) NMCs 8c,8d,9, Working Together Consultancy

  28. Services & Sectors in which the NMC’s Work Working Together Consultancy

  29. Employment Practices – Job Title • 99% (94) have the word consultant in the title • Pharmacists, AHPs, and Midwives had a consistent approach – consultant first, followed by profession • Nursing had variations • 85% (80) had somewhere in the title the service/specialism in title Recommendation 13 The title of the non medical consultant role should be standardised to ensure consistency and clarity for the public and the service. As the majority of NMCs use consultant followed by the profession and then the service it is suggested that this format is adopted throughout the North West. Sections 2.1 Key stakeholders: NHS North West/Regional/Panel/Organisations/NMC NMC TITLE Working Together Consultancy

  30. What they do – Summary of Activities NMC’s Spent 15% or over on Working Together Consultancy

  31. What they do – Clinical Practice • Direct care – 64% (n61) spent over 20% of time in direct care • Indirect care – 48% (n46) spent over 20% time in direct care • Both direct & indirect – 65% (n62) spent over 40% of time in both direct and indirect ‘The time allocation above does vary from year to year depending on demands of service, availability of research grants and funding, audit requirements, teaching requirements etc which are factors that is external to my job’ • The original expectation of a commitment of 50% of time working directly with patients is not evident and has been seen in other studies Working Together Consultancy

  32. What they do – clinical practice • 88% (n84) were involved in the development of protocols, documentation systems, standards, policies and clinical guidelines • 81% (n77) worked where no precedents existed “The specialty I work in is probably the most legislated area of the NHS as it involves working with ionising radiation and the manufacture of sterile medicines. My role has involved the interpretation of this complex legislation (which is sometimes conflicting) both at a local and national level which has been put into guidelines, policies etc. My role has involved setting up a comprehensive quality management system, sops, documentation etc. which is required for licensing of the service by the MHRA and setting the standards for others to practise and operate in the specialty.” Working Together Consultancy

  33. What they do – Clinical Practice • 65% (n62) admit & discharge • 76% (n72) diagnose, treat & refer patients • 58% (n55) carry a caseload • 21 of the 55 (38%) record FCEs in their own name • 43% (n41) are prescribers • Professions analysis:- • 3 pharmacist NMCs • 3 AHPs • 35 nurses • No midwives Working Together Consultancy

  34. What they do - Leadership and Consultancy • 77% (n73) NMCs spent a minimum of 15% time undertaking this function – highest response • 100% (n95) rated this activity as their highest – provision of expert specialist advice to others • 78% (n74) said they were the professional or clinical lead for the service • 77% (73) provided supervision to other staff (16% of these mentioned supervising other professionals than their own e.g. medical staff) ‘I have been able to negotiate some very tricky therapeutic relationship safely and maintaining relationships’ Working Together Consultancy

  35. What they do – Research, Audit and Evaluation • 47% (n45)spent 15% time or over on RAE • 83%(n79) had undertaken some RAE • 63% [n60] worked in partnership with others e.g. universities and professional colleagues • Other Key findings:- • 46% (n44) had acted as lead or associate researcher • 49% (n47) had been co-researchers and or associates • 25% (n24) have been involved in audits • 32% (n30) had submitted research bids • 67% (n64) were involved in local or national research • 28% (n27) act as reviewers of journals • 32% had made bids for research grants Working Together Consultancy

  36. What they do – Education, Training and Development • 54% (N51) spend between 0.75 – 1 full day/week in this activity • Provision of advice was evident ranged from 37% to 55% depending upon the programme • Delivery of programmes was evident and ranged from 52% to 74% • This indicates a higher rate of activity in delivery of programmes Recommendation 9 Given the level of expertise of the experienced NMC and demands on their time it is recommended that the NMCs expertise is utilised and focused more on the provision of advice to higher education providers. Sections 2.1/2.2 Key Stakeholders:Organisations/NMC/Universities Working Together Consultancy

  37. What they do – Education, Training and Development Working Together Consultancy

  38. What they do – Management of Staff • 41% (N39) did not manage any staff • 35% (n33) managed between 1-6 • 8% (n8) managed between 7-9 • 14% (n13) managed between 10-16 • Time spent on this activity ranged from 46% (n44) less than 5% to 11% (n10) spending more than 20% time Working Together Consultancy

  39. That’s the background, who they are and what they do. Any questions? Working Together Consultancy

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