Community and Primary Care Workforce Development

Community and Primary Care Workforce Development

Consultation Document

1Introduction

Health Education South West has recently undertaken a tendering process to award a contract for new workforce development for the community and primary care non-medical workforce in the South West. This paper forms part of the consultation process to ensure that the education commissioned is fit for purpose and meets the needs of service commissioners and employers. You are invited to respond to the consultation questions contained within this paper and provide any other salient comments you may have regarding this development. Please could you ensure that all comments are returned to Ian Bramley, Innovation and Development Manager by 15 April 2015.

The purpose of this development is to:

Support the current community and primary care workforce to transform community and primary care services to deliver integrated, personalised care to individuals and populations whilst ensuring that the service continues to be delivered safely and with high quality;

Develop a future community and primary care workforce that can work in this newly transformed health and social care context.

1.1Overview of Tendering Process

A competitive tendering exercise was undertaken during the latter part of 2014 to secure provision for this new workforce development for three years from April 2015 with an option to renew for two further years – a five year education contract. The University of the West of England was successful in bidding to provide this education for Bristol, North Somerset, Somerset, Bath, Gloucestershire, South Gloucestershire, Swindon and Wiltshire; and Plymouth University was successful in bidding to provide for Devon, Cornwall and the Isles of Scilly.

1.2Principles

The tender is underpinned with the following principles which will drive the development of the education provided by the two universities:

• Any education developed must be flexible and responsive to service commissioners and providers strategic plans;
• Education must be as accessible as practicable minimising learner travel and disruption to service;
• Any education must be developmental building year on year as the service develops in response to the ‘transformation’ agenda;
• Wherever possible education must be interprofessional allowing different professionals to learn with and from each other to support a common understanding and integration of services.

1.3Content

There are four components to this tender:

• A multiprofessional Common Foundation Programme;
• Condition Specific Modules which include Academic Partnership Modules;
• Continuing Professional Development Masterclasses, Action Learning Sets and Work-based Learning;
• Clinical and Professional Leadership.

These are further described in sections 2 to 5 below

1.4Consultation Process

The consultation process is described in the table below:

Date / Activity / Outcome
February to October 2014 / Consultation with Clinical Commissioning Groups, NHS England Area Teams, Community Providers; Community and Practice Nurse Forums; LMC and GP Representatives; Professional Leaders / The development of Health Education South West’s Community and Primary care Workforce Development Strategy which informed the Tender Specification
October to December 2014 / Tendering process which was assessed by representatives from Service Commissioners and Employers / The award of the tender.
22 January 2015 / Communication Launch: Workshop with Service Commissioners and Employers and the successful universities / Service Commissioners and Employers were formally informed of the outcome of the tendering exercise and the consultation process was designed and finalised
10 February 2015 / Consultation Event: to consult on the content of the programmes / Provided the consultation content and questions found in sections 2 to 5 of this paper
3 March 2015 / Consultation Event: to consult on the management, accessibility, reporting requirements and quality assurance of the programmes / Provided the consultation content and questions found in section 6 of this paper
4 March 2015 / This paper circulated to Clinical Commissioning Groups, NHS England Area Teams, Community Providers; Community and Practice Nurse Forums; LMC and GP Representatives; Professional Leaders.
15 April 2015 / Consultation Ends
30 April 2015 / A common set of agreed outcomes will be developed by the universities.
5 May 2015 / Details of new programmes for 2015/16 delivery will be published
Sept. 2015 / New programme delivery commences

2Multiprofessional Common Foundation Programme

2.1Overview

This programme is for health care professionals who are currently working in community and primary care as well as those working in these settings for the first time. It is intended to provide the foundational knowledge, skills and competence for practitioners to work safely and effectively outside of hospital settings whilst engaging with the transformation of services.

2.2Indicative Content

The content below is the output of a stakeholder workshop which took place on 10 February 2015. It is not meant to be exhaustive or complete but forms the basis of the current consultation exercise. Stakeholders were working to prioritise and identify the indicative content of this programme.

2.2.1Interprofessional Learning

• Wherever possible all professions learning together,
• Nurses, midwives, allied health professions, paramedics, pharmacists,
• Understanding each other’s roles and how to best access specialist knowledge,
• Need to consider how we include and learn from social care.

2.2.2Competencies

• Common assessment process, including holistic assessment and care planning.
• Clinical decision making,
• Motivational interviewing, shared decision making and enabling self-care,
• Clinical risk management (including knowing own limitations and when to refer),
• Signposting,
• Motivational interviewing
• Health promotion and prevention,
• Mental Health, learning disabilities and parity of esteem.

2.2.3Managing Self

• Lone working,
• Communication and managing relationships
• Using technology including remote consultation skills,
• Time management,
• Case load management,
• Ensuring quality of care.

2.2.4Patient Safety

• Safeguarding (Mental Capacity Act and Deprivation of Liberty),
• Ethics of Patient Centred Care,
• Root Cause Analysis,
• Overview of Service Improvement principles and change management.

2.2.5Context of Community and Primary Care

• The Care Act, The Five Year Forward View and other political drivers,
• Understanding the health and social care system (including an overview of commissioning),
• Personalisation (including personal health budgets),
• Communication across the system,
• Understanding social care – nursing and residential homes,
• Understanding the patient’s experience of transition between services,
• Working with patients, families, carers, the voluntary sector and communities.

2.3Consultation Questions Multi Professional Common Foundation Programme

2.3.1Does the indicative content above meet the aim to equip practitioners new to community and primary care with the knowledge, skills and competencies they require?

2.3.2Is there anything superfluous in the Indicative Content?

2.3.3Is there anything missing from the Indicative Content?

2.3.4Should practical clinical skills (such as ear irrigation and travel vaccination) be included in the programme or provided separately?

2.3.5Any other comments

3Condition Specific Modules Including Partnership Modules

3.1Overview

These are short modules to give practitioners working in community and primary care enhanced skills in the leadership and management of patients living with specific clinical conditions outside of hospital settings. These will include modules that are developed and delivered in partnership with service.

3.2Content Required

Stakeholders were asked to produce a prioritised list and to identify principles for delivery of these modules. It was identified that there is a need for a module to enable practitioners to support people living with multiple long-term conditions as a priority. Stakeholders were asked to list the indicative content for such a module.

3.2.1Prioritised List

This list is an amalgamated consensus view taken from the participants in the workshop held on February 10th 2015:

• Living with multiple long-term conditions,
• Living with Dementia,
• Living with Frailty,
• End of life care,
• Diabetes; Asthma; COPD;Stroke;Tissue Viability,
• Depression; Continence; Chronic Heart Disease; Chronic Kidney Disease; Parkinson’s; Sexual Health; Health Promotion; Nutrition and Hydration; Personality Disorder; Psychosis; Child and Adolescent Development; managing Self-harm; Cognitive Behaviour Therapy; psycho-social interventions; Immunisations and Travel Health; Cervical Screening.

3.2.2Principles for Condition Specific Modules

• Patient-centred (focussing on ‘living with…’),
• Work-based wherever possible using case study,
• Should be able toamalgamate modules for identified academic awards (this should include partnership modules),
• Could build to an academic qualification,
• Modules should have flexible delivery allowing for staff to attend or have remote access,
• Rather than having a large menu of modules would it be better to have a published three-year rolling programme.

3.2.3Indicative Content of Multiple Long Term Conditions Module

• Living well principles and self-management (the focus of this module should not be disorder specific),
• Motivational interviewing
• Managing complexity,
• Holistic assessment, frailty recognition and co-morbidity,
• Learning disabilities, mental health as well as physical health,
• Polypharmacy.

3.3Consultation Questions

3.3.1Do you agree with the prioritised list (what should be added, reprioritised or removed)?

3.3.2Are the principles correct?

3.3.3Is the indicative content for the Multiple Long Term Conditions Module correct?

3.3.4Should there be a module ‘Living Well in Older Age’?

This was suggested by one of the stakeholder groups as being more relevant than a module for multiple long term conditions

3.3.5Any other comments

4Continuing Professional Development

4.1Overview

This is an opportunity for the education providers to respond to needs identified through appraisal, training needs analysis or organisational development needs by providing masterclasses, action learning sets or work-based learning opportunities.

4.2Definitions

4.2.1Masterclasses

are sessions of tuition in specific subjects delivered by experts in that field

4.2.2Action Learning

is a process which involves working on real challenges, using the knowledge and skills of a small group of people combined with skilled questioning, to re-interpret old and familiar concepts and produce fresh ideas

4.2.3Work-based Learning

is learning which usually takes place in the workplace and accredits or extends the workplace knowledge, skills and abilities of learners.

4.3Proposed Process

Stake holders were asked to identify a process for identifying and prioritising the development of any masterclasses, action learning sets or work-based learning. They also suggested some content for such learning opportunities.

4.3.1Process for identifying need

• Use existing groups to discuss and identify need,
• Develop a timeline for identifying masterclasses, action learning sets or work-based learning (Eg: Academic year September to July and delivery can be within this time period) ,
• Annual review involving employers of whole programme,
• Could masterclasses be discrete parts of Condition Specific Modules for those people who do not need to do the whole module?

4.3.2Suggested content

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• Assessment of others in practice,
• Learning specific to organisational need,
• Advanced care planning,
• Breaking bad news,
• Tissue viability,
• Self-harm,
• Learning Disability awareness,
• Mental health assessment ‘first aid’,
• Transition from child to adult,
• First aid for prisons,
• Motivational interviewing,
• Immunisation updates,
• Cervical screening,
• Condition specific updates.

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4.4Consultation Questions

4.4.1Do you agree with the proposal for identifying need? Can you suggest any improvements?

4.4.2Are there any high-priority needs that could be met through CPD that are not listed above?

4.4.3Any other comments

5Professional Leadership

5.1Overview

Leadership is integral to all the development in this programme of work and leadership skills will be developed in all of the above programme. This section is specifically to develop the leadership skills required to work across the whole of the patient’s pathway and also to be a system leader providing professional leadership across a local area to a group of professionals.

5.2Indicative Content

Stakeholders identified some leadership development that was required and some principles that should govern the development of any leadership programmes. It was noted in this exercise that there is a need to scope current leadership provision to ensure there is no duplication.

5.2.1Leadership Development Required

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• Strategic thinking,
• Understanding and engaging with health and social policy (including business case and report writing),
• Locality profiling, audits.
• How to lead across professions (building relationships),
• Understanding professional boundaries,
• Clinical supervision,
• Patient Safety,
• NHS Leadership behaviours,
• Self-awareness and emotional intelligence,
• Managing change,
• Managing others, (including performance and absence)
• Resilience,
• Communication,
• Team dynamics,
• Networking skills,
• Interprofessional working and professional awareness,
• Ethics.

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5.2.2Principles

• Needs to be aligned to other leadership programmes (no duplication) – should map existing provision,
• Action learning sets and local delivery,
• Bespoke to organisations/employers,
• Should support transition between roles.

5.3Consultation Questions

5.3.1Do you agree with the description of leadership development required above? (What should be added or removed?)

5.3.2Do you have any further suggestions for the principles for leadership development listed above?

5.3.3Any other comments

6Programme Management

The purpose of this section of the document is to gain an employer perspective on the accessibility, recruitment, reporting and quality assurance requirements for these courses. It is important to remember the diversity of employers and employment models that exist across community and primary care when considering these issues. The sections below provide summaries of the main points highlighted by stakeholders at a workshop on 3rd March.

6.1Access to Learning

Stakeholders were asked to identify how to ensure that the timing, location and delivery methods would enable:

• Accessibility across the geography
• Delivery with minimal disruption to service delivery
• Accessibility to all relevant staff and professional groupings in the South West

6.1.1Delivery across the geography

The following proposals were discussed:

• The programme should make use of satellite sites or community hospital sites across the geography,
• A mixture of local ‘satellite site’ learning and bigger learning opportunities that bring everyone on a programme together,
• Learners to have access to on-line learning platform to allow remote learning.

6.1.2Delivery with minimal disruption to service delivery:

The following proposals for minimising disruption to service delivery were discussed:

• Avoiding delivery during the winter months (December and January),
• Delivery to be 50% face-to-face and 50% remote (other percentage splits were also suggested),
• Should programmes be delivered in a block of 5 days over one week; one day a week; one day a month or in some other pattern? Stakeholders had a variety of opinions about which would be easier to manage in terms of service delivery,
• Flexibility regarding the timing of assessments.

6.1.3Accessibility to all relevant staff

It was felt that if the requirements above were met that all relevant staff would be able to access these programmes so long as they had the support from their employer to attend.

6.2Learner Recruitment

It has been proposed that Health Education South West allocate the value of the contract to each county being served by the contract. This would then enable community and primary care employers to work together to agree their county delivery according to local health and social care priorities.

Stakeholders were asked to describe an employer-led process for managing the recruitment of learners to these programmes.

The following proposals were made:

• Potential learners should be identified through appraisal which should be aligned to personal and service needs,
• Sign off by line manager to say they will support them to be released for the programme,
• Applications should be reviewed by Trust Education Co-ordinator – it is clear this would not work for smaller organisations who do not have such a role (is this necessary and if so how can we ensure parity between employers?),
• Application form to be developed by universities and employers in partnership,
• Centralised booking system updated in real time to ensure that cancellations and place availability is visible,
• Who should mediate between organisations to ensure parity of access?

6.3Reporting Requirements

Stakeholders produced the following list of reporting requirements that the universities would produce for employers.

• Exception reports on:
• Uptake of places,
• Learner attendance,
• Learner engagement,
• Learner attrition,
• Number of successful and unsuccessful students,
• Submission and resubmission data regarding assignments.
• A report halfway through the course identifying any issues with students to prevent attrition,
• A final evaluation report that includes partnership working with employers to identify the impact of the learning on practice. This would include student feedback on learning and what they have taken back into practice.

6.4Quality Assurance

Stakeholders produced the following list of quality assurance requirements for the programmes. It should be noted that these are in addition to the contract monitoring processes that will be undertaken by Health Education South West.

• Identifying and sharing best practice which is meeting service needs,
• Improvements to service delivery to be measured as part of assessment process perhaps linked with student assignments,
• Evaluation of students’ experience feedback and responses to it,
• Sharing of learning contracts or action plans that students design at the beginning of the course – these should reflect students’ appraisal needs.

6.5Consultation Questions

6.5.1Do you agree with the proposals for delivery across the geography listed above? How local should the provision be (e.g. how far should learners be prepared to travel)?

6.5.2Please comment on the proposals for minimising disruption to service delivery? What would work best for your organisation?

6.5.3Is there anything additional in terms of accessibility to these programmes that your organisation would require to support attendance?

6.5.4Do you support the proposals for Learner Recruitment outlined in section 6.2 above? In your opinion who should mediate between organisations to ensure parity of access?

6.5.5Do you agree with the proposed reporting from universities to employers in section 6.3 above? What is missing should anything be removed?

6.5.6Do you agree with the proposed Quality Assurance measures for employers in Section 6.4 above?

7Your Contact Details

Name

E-mail Address

Organsiation

Thank you for your comments

Please return this document with your comments to Ian Bramley, Innovation and Development Manager by 15 April 2015

either by e-mail to

or post to:

Ian Bramley

Innovation and Development Manager

South West House,Blackbrook Park Avenue,Taunton,TA1 2PE

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