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Assistant Practitioners in Primary Care The Skills Escalator in Practice

Assistant Practitioners in Primary Care The Skills Escalator in Practice. Barbara Jackson & Rachel Shears Salford Primary Care trust. Where did the Delivering the Workforce Programme come from?.

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Assistant Practitioners in Primary Care The Skills Escalator in Practice

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  1. Assistant Practitioners in Primary CareThe 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 • 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

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

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

  5. 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 Definition of an Assistant Practitioner

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

  7. Education:Widening Participation • WORK EARN & LEARN • No exclusion criteria • Wide variety of backgrounds • Wide age range – 21-50 years • Wide variation in prior educational attainment • 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 • Level 3 NVQ (Jan 06 onwards mapped to NOS) • Work based learning – competency based • Link tutor and module tutor support • Practice mentor(s) • Access to Salford PCT training programmes • AP specific training programmes • Practice Trainer

  9. Specific Issues for General Practice • Medical Indemnity • Practice Protocols • Patient specific direction • 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 • Tissue viability/wound care • 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 • Continence advice and referral

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

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

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

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

  15. Lessons Learned So Far • Workforce planning required • Planning – new developments to include practitioners prior to implementation • Recruitment and selection to include a DtW team member at each stage • Practice Trainer role key to development of Assistant Practitioners • 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 • Planning is key to effective implementation • A strong foundation of supportive and governance mechanisms is essential to its success • The AP role meets the needs of General Practice

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