Developing the role of an HCA in general practice: A case study

1. Developing the role of an HCA in general practice: A case study Dr Nalini Modha Thistlemoor Medical Centre

2. Background • Starting point was 4 years ago - HCA, BP and N/P medicals • Where we are now? • List size 7,100 patients • Open access • 2.5 doctors, 3 NP, 2 PN, 9 HCAs • All staff on a skills-escalator and constantly developing new skills. As staff move up the escalator, work is delegated down the escalator • continuum of tasks performed

3. Motivation to change • Difficulty in recruiting • Trying to achieve infinite tasks with finite resources • Changed pattern of presentations, computerisation changed roles • Our belief • Massive underdeveloped potential within the NHS waiting to be released • Traditional work patterns waste scarce resources. • Our vision – achieving excellence with a team delivering care by the most appropriate person. • Our opportunity – nGMS contract

4. Our challenges • Changing and updating mental models – personal challange • Challenge concept of ‘I am my job!’ • Developing a multi-tasking and multi-skilled team that can anticipate, adapt, respond to change and thrive to use it to their advantage.

5. Requirements from management • Clearly defined and understood team goals and objectives • Learning and development planned to achieve the objectives of the organisation • All staff given equality of opportunity to develop • Staff encouraged and rewarded to take ownership and responsibility by being involved in decision making and performance related pay, which helps them to learn and develop effectively • Clearly defined individual roles/shared tasks • Regular internal, formal and informal communication – 2 meetings a week • Feedback to individuals and team • The contribution of HCAs to the organisation is recognised and valued • Investing in people improves the performance of the organisation.

6. Our model • Balancing between skill matching vs. reinforcing loop of Pygmalion • Training and delegating at individual’s pace • Clinical supervision from named nurse and doctors at all times • Teams within the team with hierarchy of management and team leaders as first point of contact • ‘Learning to learn’ - individuals know own skills and those of others within other teams to improve work processes • Training, teaching for whole clinical team, transfer of tacit knowledge and apprenticeship.

7. Team working and team building • Mandatory attendance - 2 meetings a week • Clinical meeting content: • medication • reflective learning from case studies • significant events • teaching sessions on medical terminology • anatomy • physiology • systems and management of common diseases and conditions • minor illness. • Staff meeting – collective decision on protocols and policies.

8. Training provided • Protocols, templates and online guidelines • Ownership of learning via annual appraisals for PDP and CPD • Work shadowing, apprenticeship, transfer of tacit knowledge (‘we all know more than we can tell’) • External study days – spirometry, phlebotomy, COPD/asthma, ECG • Annual updates on H&S, basic CPR, infection control, fire protocol.

9. Duties of an HCA Ethics and law Confidentiality Communicating with patients Medical terminology Patient education Record keeping and performing administrative duties Risk management Medical asepsis and infection control Anthropometric measurements and vital signs Assisting with physical examinations and chaperoning Assisting with minor surgery Introduction to the clinical laboratory Microbiology Urinalysis. Basic training

10. Systems study • Systemic studies including HCA’s role in each speciality and commonly presenting problems in each speciality • Dermatology – eczema, nappy rash, steroid use • Ophthalmology and ENT- red eye, conjunctivitis, FB detection, cataracts, glaucoma • ENT- ear examinations, taking ear, nose and throat swabs, tonsillitis, phryngitis, sinusitis • Respiratory system – lower resp. tract infections, pneumonia, asthma, COPD • Cardiology – hypertension, angina, myocardial infarction, • Gastroenterology – gastroenteritis, hernias, IBS, mouth ulcers, appendicitis • Neurology terminology, TIA, CVA etc • Urology – terminology, common procedures, renal colic, kidney stones, etc • Obstetrics & gynaecology – procedures, terminology, PMT, menopause, fibroids, prolapse • Paediatrics and geriatrics – terminology, croup, chest infections, UTI in children, abdominal pain in children, application of U-bag, etc.

11. Route of the patient in an open access surgery OPEN ACCESS MORNING SURGERY 60-100 patients, 2-2.5 hours’ duration, 5-15 minutes average waiting HCA 3 and 4 with practice nurses / CP rooms: Chaperoning, documenting, Booked appointments- Smears, coils, intimate examinations, minor operations, dressings, injections, phlebotomy HCAs 3 & 4 share patients HCA 1 for: Health screen updates, Smoking cessation, NP medical, Language line, Chaperoning (Ext. 292) Reception 3 Doctors and 3 Nurses HCA 5 for: Urgent ECG, processing EDI Supervising patient flow, Admission, referral & C&B (ext 228) HCA 2 for: Chaperoning, documenting, Assisting with minor operations, Photographs, Opportunistic and booked breast / joint/ abdomen examinations HCAs 1 & 2 share patients (Ext 227 except Thurs-242) HCA 6: Phlebotomy booked appointments after 10.45 am

12. Route of the patient in an afternoon surgery AFTERNOON SURGERY (PRE-BOOKED APPOINTMENTS) Doctor Or Nurse HCA 1 & 2 Booked appointments for obesity monitoring, Hypothyroidism, Epilepsy, hypertension, Asthma step 1, pill checks, ECGs, Spirometry, Doppler (Ext 292) HCA 3 & PN: Chaperoning, assisting PN with clinical procedures, Photographs, N/P medicals, Health screen, Pill checks New patient medical, Language line (Opportunistic) (Ext 229) Other HCAs: Audio typing Summarising, Processing Insurance medicals Data entry, scanning