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The benefits of e-learning – results from a piloted development course

1 September 2007

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Jill is the former Associate Director of the Clinical Governance Support Team, where she worked for four years – 18 months of her time there was spent working on the Primary Care Management Development Programme, as Programme Lead. Jill has a great interest in clinical governance and quality improvement. She now works for the Health Foundation as Programme Manager

The NHS Clinical Governance Support Team’s (NCGST) aim was to design a programme specifically to meet the needs of managers working in primary care – particularly practice managers – following the publication of the practice managers’ competency framework as part of the new General Medical Services (GMS) contract in 2004.(1) The following year, the Standards for Better Health framework was released, requiring all NHS trusts to work towards complying with a series of core and developmental standards.(2)
The NCGST’s aim is to support all NHS organisations develop clinical governance and quality of their services to patients. In its work with primary care organisations, the NCGST had come to recognise that there was no one training programme that catered specifically and comprehensively for the developing needs of managers.
Additionally, the burgeoning healthcare quality and improvement agenda, with much additional responsibility being placed on primary care managers, served to underline that the time was right for the launch of a new educational programme for primary care managers.
The NCGST subsequently worked with the NHS Alliance and educational experts to develop and deliver the programme over a period of two years. The programme was supported by the Working in Partnership programme (WiPP).

Programme design
A blended learning approach
Module materials and documentation were made available online (the e-learning element), with support from an experienced local facilitator through action learning sets, one-to-one discussions, and telephone and email advice. Additional learning opportunities were made available through three optional “masterclasses”.

Facilitators’ experience and skills were key in ensuring that the participants were fully supported. The facilitators were recruited and managed by the NHS Alliance, and care was taken to select facilitators who were experienced in primary care, but also had the aptitude to provide support to the learning sets groups as well as to individuals. To develop their facilitation skills and knowledge of the programme, bespoke training sessions were provided prior to, and at regular intervals throughout, the programme.

How the programme works
Nine learning modules were produced (see Box 1), and, as each module was developed, selected primary care professionals were asked to comment on the text to ensure the materials were both accurate and current. The aim of this was to achieve a robust programme that catered for the ever-changing needs of primary care managers.
The completed modules were then uploaded onto a dedicated programme website, which was accessible only by programme participants and their facilitators.  The website allowed participants to contact each other, their facilitators and  programme leaders through the message centre and via a forum.
The purpose of the forum was to provide a mechanism whereby participants could post questions or start debates on issues connected with the programme.  The website also housed a wealth of support information – for example, presentations from masterclasses and copies of the programme newsletters.
Participants worked through the modules at their own pace, and had the opportunity to network with a group of fellow managers and their facilitators during regular action learning sets, via the message centre and forum.
Competency was determined by the facilitator through assessment of one piece of work for each module, which consisted of a piece of reflective writing, supported with evidence collected during learning.  An example of how the programme works is described in Box 2.

Academic accreditation
Participants were offered the opportunity of gaining academic accreditation with one of two universities under schemes developed by the NCGST. Accreditation provided the possibility for participants to gain formal academic recognition and credence for their completed work.

An evaluation of pre- and postprogramme attitudes, expectations and experience of participants was undertaken by the Collingham Healthcare Education Centre, with additional data collected and analysed by the NCGST. Two questionnaires were developed. Participants were asked to complete a questionnaire in November 2005 at the start of the course, and were then invited in November 2006 to complete a second, similar questionnaire at the end of the course.

Pilot programme results
Response to questionnaires
At the time of the precourse questionnaire, 302 people were registered on the course. We received 106 responses – a response rate of 35.1%. Of the 166 participants still registered on the course in November 2006, 50 (30%) responded to the postcourse questionnaire. Twenty-four course participants answered both the pre- and postcourse questionnaires.

Profile of participants
The participants in the pilot had spent a varying amount of time working in the NHS, and in primary care. The mean amount of time spent working in the health service was just over 11 years.  Additionally, the mean amount of time spent working in primary care was more than eight years; the longest primary care service was over 33 years.
At the time of enrolment, 170 (56%) were practice managers; 48 (16%) were other frontline primary care managers working in general practice, 67 (22%) were primary care trust (PCT) managers, four (1%) were dental practice managers, and 15 (5%) were in other roles.

Value of the programme
More than two-thirds (68%) of those completing the postcourse questionnaire regarded the course as either “excellent” or “good”.
When asked about the various components of the programme, the course materials were highest-rated by respondents, with 84% rating the materials as either “excellent” or “good”. The competency of the facilitators was also highly rated.

Programme outcomes
Participants were asked to rate their perceptions of a number of characteristics relating to their job role. Participants’ ratings improved dramatically in all areas after following the course:
•    Job satisfaction went up from 75% positive to 89%.
•    Control over work increased from 66% to 88%.
•    Good relationships with colleagues went up from 87% to 100%.
•    Team-working went from 80% to 98%.
•    Communications with colleagues increased from 81% to 98%.
Another set of questions asked the course participants to rate their overall opinion of the course. The outcome here was that 92% felt, on the whole, that the course met their development expectations, and 91% would recommend the course to others – however, 36% would do so with reservations. Participant’s understanding of how clinical governance could be applied at work had also improved in 89% of responses. Encouragingly, for the PCOs whose staff completed the course, 87% of respondents said they had made changes in their workplace as
a consequence.
Many examples were included in the participant’s submissions, detailing such improvements made by managers. Commonly, participants cited improvements in policies and procedures, but also in ways that more directly impacted on patient care. Some examples are included in the sample materials that are freely available on the Working in Partnership Programme (WiPP) website (see Resource).

The evaluation results are extremely positive. There have been clear benefits for those who participated. The materials and facilitator support were highly rated by participants. The comment quoted in Box 4, which demonstrates the impact on one participant, is typical of those received.
The pilot has not been without its difficulties. As with any new, major educational resource, the programme needed time to bed down, and for format and organisational issues to be ironed out. It is now ready to be further developed.
Currently, programme leaders are discussing, with several academic institutions, the possibility of hosting and developing the programme into a formal, accredited learning opportunity, in partnership with the NHS.

The author would like to thank Professor M Pringle and team at the Collingham Healthcare Education Centre for their contribution to the evaluation of the pilot programme.

1. Department of Health. Investing in general practice: New General Medical Services Contract. London: DH; 2003. Available from:
2. Department of Health. Standards for better health. London: HMSO; 2004.

Primary Care Management
Development Programme