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Assistant Practitioners in Assistant Practitioners in Primary Care Primary Care The Skills Escalator in Practice The Skills Escalator in Practice Barbara Jackson & Rachel Shears Barbara Jackson & Rachel Shears Salford Primary Care trust Salford Primary Care trust

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Page 1: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

Assistant Practitioners in Primary CareAssistant Practitioners in Primary Care

The Skills Escalator in PracticeThe Skills Escalator in Practice

Barbara Jackson & Rachel ShearsBarbara Jackson & Rachel Shears

Salford Primary Care trustSalford Primary Care trust

Page 2: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

Where did the Delivering the Workforce Where did the Delivering the Workforce Programme come from?Programme come from?

• GMWDC (now GMSHA) in September 2001 developed a 3 GMWDC (now GMSHA) in September 2001 developed a 3 year project in response to growth in the health and year project in response to growth in the health and social care sectorsocial care sector

• The plan - to increase workforce in Greater Manchester The plan - to increase workforce in Greater Manchester by 2000 extra staff by 2005by 2000 extra staff by 2005

• Service user groups identifying need for more holistic Service user groups identifying need for more holistic care from one, rather than several practitionerscare from one, rather than several practitioners

Page 3: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

Driving ForcesDriving Forces

• Existing workforce demographicsExisting workforce demographics• Changing population demographicsChanging population demographics• National Modernisation AgendaNational Modernisation Agenda• Service re-designService re-design• Need to build capacity/capability of workforceNeed to build capacity/capability of workforce• Workload pressuresWorkload pressures• Access targets to higher educationAccess targets to higher education• Local employment targetsLocal employment targets

Page 4: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

Infrastructure for Development in Infrastructure for Development in Salford PCTSalford PCT

• Project manager – SHAProject manager – SHA• Sponsor – PCT (board level)Sponsor – PCT (board level)• Champion – leads and develops programme Champion – leads and develops programme

within organisationwithin organisation• Steering group - PCTSteering group - PCT• Mapping days for new developmentsMapping days for new developments• Educational forumsEducational forums

Page 5: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

Definition of an Assistant PractitionerDefinition of an Assistant Practitioner

Band 4 (AfC)Band 4 (AfC)

practitioners with thepractitioners with the

knowledge, skills andknowledge, skills and

competencies to delivercompetencies to deliver

holistic care utilising aholistic care utilising a

range of care, therapeuticrange of care, therapeutic

and health promotionand health promotion

activities in domains activities in domains

previously only within the previously only within the

remit of registered remit of registered

professionalsprofessionals

Page 6: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

Assistant Practitioners in Assistant Practitioners in General PracticeGeneral Practice

• 28 qualified Assistant Practitioners28 qualified Assistant Practitioners• 6 Trainee Assistant Practitioners6 Trainee Assistant Practitioners• 47 GP practices have an AP47 GP practices have an AP• 14 practices have not developed an AP14 practices have not developed an AP

• Lack of spaceLack of space• No available mentorNo available mentor• Lack of understanding of the role and its potentialLack of understanding of the role and its potential

• Changes to original fundingChanges to original funding

Page 7: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

Education:Education:Widening ParticipationWidening Participation

• WORK EARN & LEARNWORK EARN & LEARN• No exclusion criteriaNo exclusion criteria• Wide variety of backgroundsWide variety of backgrounds• Wide age range – 21-50 yearsWide age range – 21-50 years• Wide variation in prior educational attainmentWide variation in prior educational attainment• Diagnostic educational assessment made on Diagnostic educational assessment made on

commencement of course – support providedcommencement of course – support provided

Page 8: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

Education:Foundation Degree in Health Education:Foundation Degree in Health and Social Care and Social Care

• 2 year modular Foundation Degree (diploma 2 year modular Foundation Degree (diploma level programme) at MMUlevel programme) at MMU

• Level 3 NVQ (Jan 06 onwards mapped to NOS)Level 3 NVQ (Jan 06 onwards mapped to NOS)• Work based learning – competency basedWork based learning – competency based• Link tutor and module tutor supportLink tutor and module tutor support• Practice mentor(s)Practice mentor(s)• Access to Salford PCT training programmesAccess to Salford PCT training programmes• AP specific training programmesAP specific training programmes• Practice TrainerPractice Trainer

Page 9: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

Specific Issues for General PracticeSpecific Issues for General Practice

• Medical IndemnityMedical Indemnity

• Practice ProtocolsPractice Protocols

• Patient specific directionPatient specific direction

• Assessment of competence - acceptance of accountability by TAP - delegation Assessment of competence - acceptance of accountability by TAP - delegation

Page 10: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

Examples of Skills and Competencies Examples of Skills and Competencies Developed by Assistant PractitionersDeveloped by Assistant Practitioners

• Administration of immunisations and other Administration of immunisations and other injectioninjection

• Tissue viability/wound careTissue viability/wound care• Monitoring of long term conditions – BP, Monitoring of long term conditions – BP,

venepuncture, urine testing, spirometryvenepuncture, urine testing, spirometry• Health promotion – smoking cessation, weight Health promotion – smoking cessation, weight

management, inhaler technique, telephone management, inhaler technique, telephone triage of asthma management in non-attenderstriage of asthma management in non-attenders

• Continence advice and referralContinence advice and referral

Page 11: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

Areas Where Trainee Assistant Areas Where Trainee Assistant Practitioners Have Challenged PracticePractitioners Have Challenged Practice

• Infection control – decontaminationInfection control – decontamination• Health and safetyHealth and safety• Ethical practiceEthical practice• Manual handlingManual handling• Skill mix and “letting go”Skill mix and “letting go”• Care planningCare planning• Registered practitioner accountabilityRegistered practitioner accountability• Roles of other learners on placementRoles of other learners on placement• Service deliveryService delivery• Workforce PlanningWorkforce Planning

Page 12: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

Challenges Faced in Embedding Challenges Faced in Embedding Role in PracticeRole in Practice

• Understanding and Understanding and acceptance of role /role acceptance of role /role protectivenessprotectiveness

• Understanding of political Understanding of political driversdrivers

• Development of Development of competencies to move on competencies to move on from HCA rolefrom HCA role

• NVQ infrastructureNVQ infrastructure• Employee/learner tensionsEmployee/learner tensions• Workforce PlanningWorkforce Planning

Page 13: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

Benefits of Assistant PractitionersBenefits of Assistant Practitioners

• Improved access for service usersImproved access for service users• Development opportunities for other Development opportunities for other

practitionerspractitioners• Achievement of national health targets – QOF!!Achievement of national health targets – QOF!!• Foundation for service modernisationFoundation for service modernisation• Health and social care approach Health and social care approach • Achievement of access to HEI targetsAchievement of access to HEI targets• Increase in capacity and capability of workforceIncrease in capacity and capability of workforce

Page 14: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

EvaluationEvaluation

• Steering group – ongoing monitoringSteering group – ongoing monitoring

• Formal 3 year evaluation by an independent Formal 3 year evaluation by an independent

organisationorganisation

• Low attrition rates in general practiceLow attrition rates in general practice

Page 15: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

Lessons Learned So FarLessons Learned So Far

• Workforce planning requiredWorkforce planning required• Planning – new developments to include Planning – new developments to include

practitioners prior to implementationpractitioners prior to implementation• Recruitment and selection to include a DtW Recruitment and selection to include a DtW

team member at each stageteam member at each stage• Practice Trainer role key to development of Practice Trainer role key to development of

Assistant Practitioners Assistant Practitioners • Effective mentorship and support essentialEffective mentorship and support essential

(Benson 2005)(Benson 2005)

Page 16: Assistant Practitioners in Primary Care The Skills Escalator in Practice Barbara Jackson & Rachel Shears Salford Primary Care trust

SummarySummary

• The Developing the Workforce programme is an The Developing the Workforce programme is an integral part of the Modernisation Agenda which integral part of the Modernisation Agenda which is driving changes in service design and delivery is driving changes in service design and delivery to meet health targets for long term conditionsto meet health targets for long term conditions

• Planning is key to effective implementationPlanning is key to effective implementation

• A strong foundation of supportive and A strong foundation of supportive and governance mechanisms is essential to its governance mechanisms is essential to its successsuccess

• The AP role meets the needs of General PracticeThe AP role meets the needs of General Practice


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