1. How a primary care trust can support the employment and integration of HCAs into general practice Kate Moriarty Assistant Director of Nursing Southwark Primary Care Trust

2. Where are we in Southwark? ‘It allowed the whole running of the surgery to be very efficient…I think the nurses saw more patients and saw more appropriate patients.’ (Practice Manager) HCA local enhanced service (Unit 6) 32 out of 50 practices employ HCAs HCAs working across managed and contracted services Framework in place to support the education and development of HCAs

3. How did we get there? ‘Working in primary care gave me more insight into patient care and made me feel like getting on with my nurse training.’ (HCA) Review of nursing skill mix across PCG –Predominately G/H grade nurses –Capacity to take on complex care/management –Issues around the long-term recruitment and retention of nurses HCA pilot – 6 HCAs employed via PCT and placed in general practice

4. How did we get there? Pilot evaluated after 12 months –All practices agreed to continue with HCA posts and meet 70/30 funding split –4 of the original 6 HCAs have started nurse training – all posts have been re-recruited Extension of pilot – creation of 14 additional posts using PMS funding –2 nurses have rejoined the NHS as HCAs following long career beaks –4 HCAs are working across practice and district nursing teams HCA local enhanced service

5. Challenges ‘No one quite knew what I ought to be doing.’ (HCA) More awareness of the role needed within the existing practice team, by the HCA and by the patients Protocols and guidelines Competencies for the role and their scope Local training needed more structure

6. Support to meet these challenges Awareness of the role –Job analysis tool (Unit 2) – purpose, essential functions, job setting, qualifications –Generic job descriptions and person specifications (Unit 2) –HCA induction timetable (Unit 2; Ridge Medical Practice) –Patient feedback tool (Unit 9; East Leeds PCT) –Clinical supervision (Unit 6) –HCA forum (Unit 6; Richmond & Twickenham PCT)

7. Support to meet these challenges Protocols and guidelines –Development of generic protocols by the PCT, eg blood pressure measurement and recording, urinalysis, new patient health checks, blood glucose testing, peak flow and spirometry measurement, pregnancy testing –Websites for generic protocols and guidelines (Unit 3 tools)

8. Support to meet these challenges Competencies for the role and their scope –Suitably qualified nurse as mentor for the role Training for mentors – higher education providers –Understanding re accountability and delegation for the role Unit 3 – examples of competency framework, skills assessment and self-assessment tools PCT professional accountability and liability guidance for nurses, therapists, assistant practitioners and health care assistants

9. How can a PCT support general practice? It’s been marvellous, it takes away a lot of the routine work and I’m able to concentrate more on chronic illness like CHD and diabetes. I’m able to see more patients, for example, we have recalled all the hypertensives.’ (Practice Nurse) Promoting the benefits of employing an HCA –skill mix – skill-mix audit template –releasing capacity –recruitment and retention –improved access for patients –financial rewards, ie achieving QOF points eg smoking status, spirometry/peak flow testing, blood pressure measurement and recording, blood tests – HbA1c

10. How can a PCT support general practice? Funding –Skill mix – not always replacing like for like –Identifying opportunities for HCAs to work across managed and contracted services –Using local enhanced service funding to support the role of HCAs into primary care (Unit 6 LES specification)

11. How can a PCT support general practice? Commissioning of training and education –locally developed training courses providing, for example: roles and responsibilities confidentiality and record keeping health and safety health promotion phlebotomy (theory and practical) consequences of lifestyle infectious diseases routine tests (BP, urine etc) awareness of long-term conditions evaluation and projects CPR and anaphylaxis introduction to clinical supervision smoking cessation training

12. How can a PCT support general practice? Bradford distance learning course (Unit 5) National Vocational Qualifications (NVQs) –Richmond & Twickenham PCT – all employed HCAs are required to undertake NVQ level 3 training and practice nurses are encouraged to train as assessors (Unit 5) –Working with local providers offering NVQ training to reflect issues in primary care Workforce Development Confederation influencing work-based training strategies, ie cadet programmes, primary care assistant practitioner (PCAP) foundation degrees

13. What impact has employing an HCA made to general practice? ‘I think I saw more patients and more patients with identified health problems. I wouldn’t take another post without an HCA.’ (Practice Nurse) ‘A huge difference. Its having an additional resource, its somebody who is working across the board rather than just doing nursing duties, we couldn’t run the baby clinic without an HCA now. We have used the HCA to help meet our access targets, it gives us extra capacity by cascading the workload down from the doctors and nurses.’ (Practice Manager)