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

2. Where did the Delivering the Workforce Programme come from? GMWDC (now GMSHA) in September 2001 developed a 3 year project in response to growth in the health and social care sector GMWDC (now GMSHA) in September 2001 developed a 3 year project in response to growth in the health and social care sector The plan - to increase workforce in Greater Manchester by 2000 extra staff by 2005 The plan - to increase workforce in Greater Manchester by 2000 extra staff by 2005 Service user groups identifying need for more holistic care from one, rather than several practitioners Service user groups identifying need for more holistic care from one, rather than several practitioners

3. Driving Forces Existing workforce demographics Existing workforce demographics Changing population demographics Changing population demographics National Modernisation Agenda National Modernisation Agenda Service re-design Service re-design Need to build capacity/capability of workforce Need to build capacity/capability of workforce Workload pressures Workload pressures Access targets to higher education Access targets to higher education Local employment targets Local employment targets

4. Infrastructure for Development in Salford PCT Project manager – SHA Project manager – SHA Sponsor – PCT (board level) Sponsor – PCT (board level) Champion – leads and develops programme within organisation Champion – leads and develops programme within organisation Steering group - PCT Steering group - PCT Mapping days for new developments Mapping days for new developments Educational forums Educational forums

5. Definition of an Assistant Practitioner Band 4 (AfC) practitioners with the knowledge, skills and competencies to deliver holistic care utilising a range of care, therapeutic and health promotion activities in domains previously only within the remit of registered professionals

6. Assistant Practitioners in General Practice 28 qualified Assistant Practitioners 28 qualified Assistant Practitioners 6 Trainee Assistant Practitioners 6 Trainee Assistant Practitioners 47 GP practices have an AP 47 GP practices have an AP 14 practices have not developed an AP 14 practices have not developed an AP Lack of space Lack of space No available mentor No available mentor Lack of understanding of the role and its potential Lack of understanding of the role and its potential Changes to original funding Changes to original funding

7. Education: Widening Participation WORK EARN & LEARN WORK EARN & LEARN No exclusion criteria No exclusion criteria Wide variety of backgrounds Wide variety of backgrounds Wide age range – 21-50 years Wide age range – 21-50 years Wide variation in prior educational attainment Wide variation in prior educational attainment Diagnostic educational assessment made on commencement of course – support provided Diagnostic educational assessment made on commencement of course – support provided

8. Education:Foundation Degree in Health and Social Care 2 year modular Foundation Degree (diploma level programme) at MMU 2 year modular Foundation Degree (diploma level 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 based Work based learning – competency based Link tutor and module tutor support Link tutor and module tutor support Practice mentor(s) Practice mentor(s) Access to Salford PCT training programmes Access to Salford PCT training programmes AP specific training programmes AP specific training programmes Practice Trainer Practice Trainer

9. Specific Issues for General Practice Medical Indemnity Medical Indemnity Practice Protocols Practice Protocols Patient specific direction Patient specific direction Assessment of competence - acceptance of accountability by TAP - delegation Assessment of competence - acceptance of accountability by TAP - delegation

10. Examples of Skills and Competencies Developed by Assistant Practitioners Administration of immunisations and other injection Administration of immunisations and other injection Tissue viability/wound care Tissue viability/wound care Monitoring of long term conditions – BP, venepuncture, urine testing, spirometry Monitoring of long term conditions – BP, venepuncture, urine testing, spirometry Health promotion – smoking cessation, weight management, inhaler technique, telephone triage of asthma management in non-attenders Health promotion – smoking cessation, weight management, inhaler technique, telephone triage of asthma management in non-attenders Continence advice and referral Continence advice and referral

11. Areas Where Trainee Assistant Practitioners Have Challenged Practice Infection control – decontamination Infection control – decontamination Health and safety Health and safety Ethical practice Ethical practice Manual handling Manual handling Skill mix and “letting go” Skill mix and “letting go” Care planning Care planning Registered practitioner accountability Registered practitioner accountability Roles of other learners on placement Roles of other learners on placement Service delivery Service delivery Workforce Planning Workforce Planning

12. Challenges Faced in Embedding Role in Practice Understanding and acceptance of role /role protectiveness Understanding and acceptance of role /role protectiveness Understanding of political drivers Understanding of political drivers Development of competencies to move on from HCA role Development of competencies to move on from HCA role NVQ infrastructure NVQ infrastructure Employee/learner tensions Employee/learner tensions Workforce Planning Workforce Planning

13. Benefits of Assistant Practitioners Improved access for service users Improved access for service users Development opportunities for other practitioners Development opportunities for other practitioners Achievement of national health targets – QOF!! Achievement of national health targets – QOF!! Foundation for service modernisation Foundation for service modernisation Health and social care approach Health and social care approach Achievement of access to HEI targets Achievement of access to HEI targets Increase in capacity and capability of workforce Increase in capacity and capability of workforce

14. Evaluation Steering group – ongoing monitoring Steering group – ongoing monitoring Formal 3 year evaluation by an independent Formal 3 year evaluation by an independentorganisation Low attrition rates in general practice Low attrition rates in general practice

15. Lessons Learned So Far Workforce planning required Workforce planning required Planning – new developments to include practitioners prior to implementation Planning – new developments to include practitioners prior to implementation Recruitment and selection to include a DtW team member at each stage Recruitment and selection to include a DtW team member at each stage Practice Trainer role key to development of Assistant Practitioners Practice Trainer role key to development of Assistant Practitioners Effective mentorship and support essential Effective mentorship and support essential (Benson 2005)

16. Summary The Developing the Workforce programme is an integral part of the Modernisation Agenda which is driving changes in service design and delivery to meet health targets for long term conditions The Developing the Workforce programme is an integral part of the Modernisation Agenda which is driving changes in service design and delivery to meet health targets for long term conditions Planning is key to effective implementation Planning is key to effective implementation A strong foundation of supportive and governance mechanisms is essential to its success A strong foundation of supportive and governance mechanisms is essential to its success The AP role meets the needs of General Practice The AP role meets the needs of General Practice