Redesigning and enhancing practice learning opportunities as a response to policy change Ria Baker, senior lecturer in practice learning   In conjunction with Paramedic Science Programme team at Canterbury Christ church university, South Kent Coast CCG, Ashford CCG, Canterbury & Coastal CCG, and THANET CCG.  

Changes to pre-registration education and training: Background & Context. Changes to pre-registration education and training: - Changing face of pre-registration education and training - Evolving roles of professional practitioners

What review and transformation reports have been set out?: Background & Context. What review and transformation reports have been set out?: - Transformation of Ambulance Services within Taking Healthcare to the Patient (Department of Health, 2005) - Association of Ambulance Chiefs (2011)

How do we make practice education meaningful and relevant? Background & Context. How do we make practice education meaningful and relevant? - Ensure that it adds to the body of knowledge required - Ensure that it supports our students to make safe effective decisions for patients that will be in their care

Aim. The aim of this piece of work was to examine the development and implementation of practice opportunities within primary health services, mirroring the ‘Taking Healthcare to the Patient’ review (2011), which sets out a vision for the ambulance services to provide an increase of primary care services.

Vision. The collective vision for the project was that it would allow our Paramedic Science students to enhance their knowledge of the primary care sector, and begin to examine the interface with their role as a paramedic upon qualification.

The themes that the project was based on: Understanding the impact and influence of health and care policy on pre-registration education Understanding the need for a flexible programme that will enable response to the changes in health and care policies The importance of professional working relationship with stakeholders to allow students to access primary care placements, in line with changes in policy and practice

Consultation The consultation began with collaboration between the Primary Care Workforce Tutors at each CCG and the pilot team at Canterbury Christ Church University. The following questions led us to a structure for our pilot placements: How long should this practice experience be? Who in practice should facilitate their learning? What should a mock timetable of their week look like? What do we need to do to prepare our students? What do we need to do to prepare our practice areas? What do we want our students to learn?

Preparing students & the practice areas. Example timetable, week 1. Monday Tuesday Wednesday Thursday Friday   Meet Practice Manager or Designated Lead Orientation to the Practice. To include HR, Processes, Health & Safety and Governance Meet Reception Staff and observe function of Receptionist. Observation of GPs Role 12:00 – 13:00 – Potential to attend Home visits/ Care Home visits Observe Triage Clinician/GP/ANP.    Observe Receptionist Triage Observation of Health Care Assistants role Observation of Chronic Disease Management Clinics (e.g. Asthma, COPD, CHD & Diabetes) Management Clinics (e.g. Asthma, COPD, CHD & Diabetes) Observation of ANP/ AHP role 12:00 – 13:00 – Potential to attend Home visits/ Care Home visits

Preparing students & the practice areas cont. In order to prepare our students for placement, the pilot team: - Included learning objectives in the Practice Assessment Documentation - Created a Primary Care placement handbook that contained Key mentor details, and details for the Primary Care Workforce Tutors Induction information Student responsibilities Clinical skills guidance In order to prepare our practice areas for the placement, the pilot team: Created a list of responsibilities for the practice area Created an induction checklist Gave the option of a visit from the Paramedic Science Practice Lead Gave the learning objectives to the practice area

Implementation It was agreed that the students should spend two weeks (75 hours) in Primary Care services Student information: 22 undergraduate, pre-registration paramedic science students The placement took place towards the end of their second year The placement was spread over an 8 week period from January- March 2017 Three Clinical Commissioning Groups took part in this pilot, Ashford CCG, Canterbury & Coastal CCG, South Kent Coast CCG, and Thanet CCG.

Evaluating the pilot- students. Once all 22 students had completed their placement they were asked to evaluate the pilot in three ways: Attendance at a focus group session, facilitated by the university and the CCG An evaluation form designed to elicit quantitative responses [42 questions] An evaluation form designed to elicit qualitative responses [7 questions]

Evaluating the pilot- practitioners . After the practice experience had been completed, members of staff that supported the students also had an opportunity to comment on the placement by completing: An evaluation form designed to elicit qualitative responses

Results. 80.4% of students agreed that they had a range of learning experiences that involved services users, were able to use feedback from service users to develop, and these experiences helped them better develop person centred practice. 86.6% of students agreed that all learning was recognised, and used to enhance practice, service, workforce and educational development. 90.4% of students agreed that there is sharing of information, and best practice by all 79.3% agreed that there was open and honest communication and effective collaboration between individuals and organisations. 87.9% of students agreed that active learning activities are were taking place 70.9% of students agreed that standards are used to support and quality assure practice learning and assessment.

Results cont. Some of the responses from the qualitative questions were: Theme, referrals: “I am now happy to refer to a GP”, “I was able to work with several practitioners to see many referral pathways”, “Really did improve our knowledge of referral services” Theme, preconceived ideas & roles within primary care: “understanding of increased demand, pressure on the services”, “Didn’t realise they [primary care] covered so much, i.e. ultrasound, asthma clinics, diabetes clinics”, “didn’t realise some of the things nurses did; ear irrigation, heart monitors and leg bandages”. Theme, increased knowledge and benefits “increased collaborative work”, “Understand each others roles a bit more”, “they understand a bit more about the ambulance service”, “My mentor taught me how to do a phone handover to a GP. This should improve collaborative practice”.

Feedback from practitioners Results. Feedback from practitioners “It was a very good two weeks and we managed to make sure our student linked in with the doctors, nurses and engaged with home visits. Also, sitting in with specialist clinics, ENT, minor surgery. I think it has given them a clearer idea of what Primary Care does and how it integrates with their role.” “The Clinicians were impressed with the knowledge and the appropriateness of the questions asked by both the paramedics we had with us.” “They were both surprised by the reality of General Practice and also the different roles within the organisation.  They did not expect the level of Chronic Disease Management in general practice and the vast range of things Nurse Practitioners can do.  They were also surprised by the abuse that reception staff can receive in general practice.” “I believe having Paramedic students in Primary Care will have huge benefits for Interprofessional working, in understanding each others roles and how we can work better together in future for the benefit of our patients.”

Next steps. Following the completion of the pilot study, we are now rolling the practice experiences out for all students on either the BSc Paramedic Science or BSc Paramedic Practice degree. Practice areas will be across the county, and not restricted to the four East Kent CCG’s, Dartford Gravesham and Swanley CCG, Swale CCG, and Medway CCG will now all offer placements. Where to improve: - Placement preparation: needs to be completed in a face to face session, in conjunction with a member of the CCG. - Increased understanding of learning objectives, by both the students and the staff. - Undertaking of pre placement visits by students

Any questions?

References. Department of Health (2005). Taking Healthcare to the Patient: Transforming NHS Ambulance Services. London: Department of Health.   Association of Ambulance Chief Executives (2011). A review of 6 years’ progress and recommendations for the future. London: Association of Ambulance Chief Executives. National Ambulance Service Medical Directors (2014). Future National Clinical Priorities for Ambulance Services in England. NHS England (2015). Transforming urgent and emergency care services in England. London: NHS England.