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
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 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
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 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 Strategic development of HCAs in Primary Care