ANNE CRANDLES
MBA
Practice Management Adviser
Boroughloch Medical Practice, Edinburgh
Anne has worked in general practice since 1985, and in practice management since the last “new contract”. Over this time she has picked up an AMSPAR Diploma, an MBA and the Prince 2 foundation course in project management. Outside of work, Anne goes to the gym and attends a weekly French class. She has two grown-up daughters, who act as her own personal Trinny and Susannah
For as long as I can remember, NHS Lothian’s training department has offered courses specifically for practice staff and nurses. Training is delivered by experienced practice managers with an interest in training, and by practice nurses with a qualification in a specific subject.
How we learn in Lothian
Trainers are offered the opportunity to undertake “train the trainer” courses and to attend update sessions. They are also encouraged to sit in on one another’s training events. The department hosts regular formal meetings and the trainers provide each other with ongoing peer support.
Some of the practice nurse modules are accredited through a local university and are part of NHS Lothian’s Continuous Professional Development Framework. The latest module aims to provide professional and clinical preparation to nurses planning or undertaking a practice nurse role, and is designed to meet the NHS Education for Scotland (NES) requirements for practice nurse orientation.
Administrative and clerical (A&C) staff training varies from short workshops with a mixture of presentations and interactive group work to nationally recognised and accredited courses, learning sets and IT sessions in computer suites.
For some time, the trainers – including myself – had felt that certain national course materials required revision to reflect recent changes in general practice. Additionally, as primary care has become more differentiated in each of the home countries, course texts were no longer always relevant to Scotland. This was corroborated by the feedback from course attendees and a drop in numbers applying for places on courses.
Concerns grew that the current national training sessions were starting to fall short of meeting the needs of Lothian’s practice staff, and that this could damage the training department’s good reputation.
Addressing our training needs
During 2009, the trainers – with the backing of the training department – agreed that a series of short (either a half-day or, at most, a full day) one-off training sessions should be offered instead, and that these would be designed in such a way that each could stand alone but be able to “dovetail” into one another.
This would provide a responsive, comprehensive training programme meeting the requirements of the novice receptionist, the established secretary and the newly appointed or promoted senior staff members. The programme was named “Learning in Lothian”.
In order to cover this wide range of experience, topics would be offered at different levels: basic, intermediate and advanced.
A letter was sent to practices explaining what was happening, the reasons for this and asking for comments, suggestions etc.
The trainers discussed the initiative with local peers and gathered further ideas. This feedback, combined with the trainers’ own thoughts, resulted in a long list of possible topics.
As a group, the trainers prioritised which of these should be developed into courses, and allocated trainers to subjects based on interests and experience. We picked over previous presentations and materials, keeping the good bits – no point reinventing wheels – and shared draft outlines for the “new, improved” versions.
A “buddy” trainer was identified for each topic. This person was to work with the designated trainer so as to be able to take over the delivery of the session if need be. Additionally, copies of the presentations and course materials were sent to the training department, ensuring the course would always go ahead.
Topics include:
- Introduction to General Practice – explains general practice finance, the background to the NHS, the new contract, and communicating and dealing with people.
- How Can I Help? – considers approaches to ensure a smooth patient journey and the effectiveness of the practice, looking at patient experience, integrated team working and telephone and listening skills.
- Ethics – provides an overview of ethical standards in general practice, covering duties and dilemmas, chaperoning, certification and confidentiality.
- Audit and Significant Event Analysis – how to undertake an audit, what it is, what it involves, key components and why these are carried out.
Sessions are interactive, using participants’ own experience to explore topics. Creative, brain-friendly training methods that accommodate all learning styles are used wherever possible.
Courses will regularly be reviewed and revised to keep them fresh and relevant or, where necessary, deleted and replaced. This is fundamental to training and development – what is the point in continuing to talk about filing records when the vast majority of practices are paperlite?
A certificate of attendance is awarded at the end of each course. These can be built up into a portfolio of evidenced learning, relevant to general practice in Lothian.
Finance and marketing
Costs are kept to a minimum, as the training department subsidises course fees by 70%. In order to discourage “no shows”, practices are charged for late cancellations on a sliding scale depending on how close to the date the cancellation is made.
Trainers introduced the new training programme to their colleagues at local practice manager meetings throughout Lothian. A Networking and Learning (Lothian) Roadshow – a practice manager training and development event – provided us with an opportunity to encourage managers to support the courses.
This “advertising” created huge interest in our new courses. We have waiting lists for each course, ensuring the programme will run throughout 2010. People are applying for multiple courses to build up their portfolios.
Evaluation
Although it’s early days, evaluation is positive, with staff saying that they will go back to work able to apply new learning, recommending courses to peers. The number of staff applying for further courses is heartening.
We acknowledge that this training may not be recognised outside of Lothian. However, we would argue that the learning is generic and the skills and knowledge could be easily transferred to another practice in another area if a member of staff moves elsewhere. Furthermore, a portfolio of learning demonstrates a person’s willingness to attend training, to learn and to develop.
While we maintain there is no substitute for firsthand knowledge and experience, delivered in a friendly and empathetic way, there is a place for other courses – and commercial companies.
We see “Learning in Lothian” as part of a larger lifelong learning journey for staff – something people can dip in and out of as they grow. We anticipate our programme paving the way for further learning – for example, those who have attended the advanced courses may choose to go on to undertake NHS Education for Scotland/Networking and Learning’s General Practice Managers’ Vocational Training Scheme (GPMVTS) or other management qualifications.
Conclusions/recommendations
There are two key factors in this new training programme – and two clear outcomes.
NHS Lothian’s training department’s support of practice staff learning is invaluable. Crucially, this includes an ongoing willingness to listen and to implement change.
The trainers’ cohesive approach to training has meant that skills and knowledge were pooled to develop not only courses but also a sustainable training service for GP staff.
The combination of these factors has given us vibrant new courses and a training team, rather than a group of trainers. The drivers for change that made Lothian managers review training may not be present in other areas of the country but, hopefully, the benefits that can be derived from doing so may just tempt managers to take another look at local courses.
