A range of skills will be necessary to ensure success in the education and training indicators which will benefit both staff and patients, says Dr Russell Steele

Education and training form one of the five sections of the organisational domain of the new GMS contract. Within the section are nine indicators (Table 1, below), which together offer a maximum of 29 points of the 184 achievable under the organisational indicators.1

Table 1: Education and training indicators
Indicator Points
Education 1
There is a record of all practice-employed clinical staff having attended training/updating in basic life-support skills in the preceding 18 months
4
Education 2
The practice has undertaken a minimum of six significant event reviews in the past 3 years
4
Education 3
All practice-employed nurses have an annual appraisal
2
Education 4
All new staff receive induction training
3
Education 5
There is a record of all practice-employed staff having attended training/updating in basic life support skills in the preceding 36 months
3
Education 6
The practice conducts an annual review of patient complaints and suggestions to ascertain general learning points which are shared with the team
3
Education 7
The practice has undertaken a minimum of 12 significant event reviews in the past 3 years which include (if these have occurred):
  • any death occurring in the practice premises
  • two new cancer diagnoses
  • two deaths where terminal care has taken place at home
  • one patient complaint
  • one suicide
  • one section under the Mental Health Act
  • 4
    Education 8
    All practice-employed nurses have personal learning plans which have been reviewed at annual appraisal
    3
    Education 9
    All practice-employed non-clinical team members have an annual appraisal
    3

    There is a degree of overlap in the subject areas of some indicators in the education and training section, and a review reveals that the competencies, or skills, needed to succeed fall into six different categories. Box 1 (below) shows the areas in which the practice has to be competent to gain points.

    Box 1: Main areas of competency required
    Competency needed Indicator
    Life support skills - training and updating
    Significant event analysis
    Appraisal
    Induction training for new staff
    Review of patient complaints
    Personal learning plan review

    1 and 5
    2 and 7
    3 and 9
    4
    6
    8

    Having reduced the list by a third, further scrutiny shows that there is still some overlap between indicators. For example, it would be unusual if a review of personal learning plans were not included in the appraisal procedure.

    Learning as an adult

    Whenever adults learn together in a small group it is important that they all feel comfortable. Most will be concerned about not looking stupid in front of their work colleagues, partners or employers, and this can be minimised if the facilitators/teachers are aware of the issues, and use their skills appropriately.2

    Involving participants in the learning process and stimulating their enthusiasm involves a set of conditions such as recognising that previous experience is useful as a resource, that adults learn better if they have a good reason to learn and that they learn in order to solve a problem or complete a task.3

    There are some basic principles that can help adults learning together in a group. These have been summarised as follows.4

    Participants should be encouraged to:

    • identify their own learning needs
    • define their own aims
    • plan their own learning
    • assess their own learning.

    Not all staff and partners will have the same knowledge gaps. Obviously, partners will have more clinical experience and ability. However, with a mixed group it is important to make sure that the least knowledgeable member learns what is necessary and that the session does not assume knowledge that the participants do not have. This involves carrying out a learning needs analysis.

    Although this sounds complex, it is no more than finding out what participants already know, comparing this with what they need to know and thereby discovering their knowledge gap.5

    Following these ideas and principles will enhance the chances of success for any educational session.

    Life support skills training (indicators 1 and 5)

    The effort involved is the same for each of these two indicators, but as Table 1 shows, the timing and participants are different. However, there is no reason why non-clinical staff should not join the clinical staff sessions and there is nothing like a little healthy competition to stimulate learning!6

    It is a good idea to carry out a learning needs analysis before a planned session to find out what your team needs to learn. This enables you to brief the presenter you choose to run the session to concentrate on the areas where people are uncertain.

    Your next task is to find someone to run a life-support session. Those with the most experience are usually either local paramedics or friendly hospital anaesthetists. Paramedics are usually willing to help and will bring plenty of teaching material and equipment with them.

    Significant event review (indicators 2 and 7)

    This has been called critical incident analysis in the past, and has also been referred to as significant event auditing. Whatever the name, the essentials are the same – an incident, which may be positive or negative, is identified and discussed.

    Such incidents can be clinical or managerial, but to enable them to be discussed there has to be a system of recording them. Therefore, the first step in gaining these points is to set up a system to record incidents that reflects the way the practice works.

    Such events might be recorded because they are believed to be important to the practice team or because discussion may help to improve the quality of service provided. 7 Recording these incidents involves no more than filling in a simple form, which notes the date and time of the event, a description of the event and its outcome, and the names of those involved.

    It is a good idea to have regular meetings to discuss significant events, and one member of the team should be appointed to chair these meetings.

    One of the most important things about a significant event analysis meeting is that it should be seen to be positive and supportive. It should not be seen as an opportunity to ‘have a go’ at a team member!

    The indicators show that a minimum of six reviews in the previous 3 years is necessary to achieve four points, and for a further four points, 12 significant event reviews should have taken place covering the areas shown in Table 1.

    Some very useful guidance for running a significant incident review can be found on the internet on the Plymouth GP tutors website.8

    Annual appraisals (indicators 3 and 9)

    The appraisal system is now in place for all principals,and most nurses will be aware of the principles of appraisal. It is essentially a supportive exercise, and should not be confused with performance management. Performance management is about reviewing whether targets have been met. Appraisal, on the other hand, is about discussing and planning how an individual can be helped in their professional development, and it should be carried out in an atmosphere of mutual respect.

    Although there is plenty of advice on the Department of Health website, more useful and relevant information for this particular exercise can be found in a short book entitled The Perfect Appraisal.9

    Ensuring that all staff, including nurses, have an annual appraisal means that maximum points for these two indicators can be gained. Appraisals do not necessarily have to be done by a partner and as long as both parties are in agreement they can be done by any suitably skilled team member.

    Induction training for new staff (indicator 4)

    Induction training is something that falls within the responsibility of your practice manager. Each post in the practice should have a job description, which will have been drawn up by the practice manager in discussion with the partners. Your practice manager is well qualified to carry out this induction, and will probably use other members of the primary healthcare team, as appropriate, to do this.

    In the same way that a learning needs analysis can be carried out for educational sessions, this approach can be used for new staff members. In this way the time spent on induction training can be more efficiently used.

    A useful guide for induction for new staff members can be found in the book Introduction to Management. 10

    Review of patient complaints (indicator 6)

    Practices are now expected to have a complaints procedure, and most PCTs will have agreed this with the practices in their area. This principle is therefore not a new one.

    The interesting thing about this indicator is that it could also form part of your significant event review. Patient complaints will usually be significant incidents, and the most important thing here is to be sure that there is a system in place to record complaints and discuss them regularly. Once again, this is something that your practice manager will be able to organise.

    Personal learning plan review (practice nurses; indicator 8)

    This indicator overlaps with indicator 3 as it is quite possible that a personal learning plan will be part of the annual appraisal system. Sometimes this can be called a personal development plan although it is useful to regard a personal development plan as a broad plan whereas a learning plan is more specific.

    The Plymouth GP tutors’ website has good advice on personal learning plans. Developing a personal learning plan involves identifying what your practice nurse wishes to do or learn in the next 12 months, identifying how she might do this, identifying the resources needed and agreeing how she will know when she has been successful.11

    For example, the practice nurse may wish to learn how to run an asthma clinic. This will initially involve a learning needs analysis so that she knows exactly what she needs to learn. The next step involves identifying courses or other learning resources that suit her learning style.12 The resources needed will include both time and finance. Finally, the criteria for success will include the competencies needed to run a good asthma clinic in the practice.

    Planning

    As with all the domains in the new contract, the essential thing is to be sure that a system is in place to cover all the indicators, and that there is a timetable to guide the practice. This is where your practice manager is invaluable in making the full plan and in encouraging everyone to meet the requirements and the deadlines.

    References

    1. Watson N. Making the contract work: patient records and information. Guidelines in Practice 2003; 6(9): 52-6.
    2. McEvoy P. Educating the Future GP (2nd edn). Oxford: Radcliffe Medical Press, 1998.
    3. Knowles MS. Andragogy revisited. Adult Education 1979; 3: 52-3.
    4. Fabb WE. Learning in adults. In: Fabb WE, Hefferman MW, Phillips WA, Stone P (eds). Focus on Learning in Family Practice. Melbourne: Royal Australian College of General Practitioners, 1976.
    5. Grant J. Learning needs assessment: assessing the need. Br Med J 2002; 324: 156-9.
    6. Jaques D. Learning in Groups. Dover: Croom Helm, 1984.
    7. Pringle M, Bradley C. Significant event auditing: a user’s guide. Audit Trends 1994; 2: 20-4.
    8. Plymouth GP tutors’website. Significant Incident Reviews. http://www.plymouthgptutors.org/SI_information.htm retrieved September 2003.
    9. Hudson H. The Perfect Appraisal. London: Century Business, 1992.
    10. Pettinger R. Introduction to Management (2nd edn). Basingstoke: Macmillan Press, 1997.
    11. Charlton R. Personal Development Plans (PDPs). Br Med J 2002; 325: S36-7.
    12. Honey P, Mumford A. The Manual of Learning Styles. Maidenhead: Peter Honey, 1992.

    Guidelines in Practice, October 2003, Volume 6(10)
    © 2003 MGP Ltd
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