Cindy Carlson, Director, describes the work of the Learning and Development team of the Public Health Resource Unit

The Public Health Resource Unit (PHRU) was established in 1997 to provide support for public health developments, including programme planning and evaluation, in Berkshire, Buckinghamshire, Northamptonshire and Oxfordshire. It also took on the management of the Critical Appraisal Skills Programme (CASP). The PHRU is now hosted by Milton Keynes PCT.

The Learning and Development team was set up in 2000 to coordinate and consolidate the PHRU’s expanding education portfolio. By the end of 2001 the team was supporting training programmes in CASP and patient and public involvement, running ‘action learning sets’ for primary care and public health, and expanding its training delivery into the area of e-learning.

In early 2002 the National Primary Care Facilitation Programme team was integrated into the Learning and Development team, further increasing the range of learning support.

PHRU’s learning activities were awarded Beacon status in 1999, 2001 and 2002.

Today the Learning and Development team works with PCTs and other NHS trusts to promote health improvement by developing the capacity and skills of the health and social care workforce.


It accomplishes this through three main programmes:

  • CASP and other evidence-based activities
  • The Patient and Public Involvement Programme
  • The Advancing Learning in Practice Programme.

Critical Appraisal Skills Programme (CASP)

CASP was set up in 1993 to support clinicians and managers who wished to ensure that their practice was based on solid evidence.

The programme’s three key themes are:

  • Finding the evidence
  • Appraising the evidence
  • Acting on the evidence.

Workshops and open learning programmes have been developed on these themes and hundreds have been run throughout the country.

The overarching principle is that CASP workshops and open learning resources employ evidence-based learning methods while maintaining a very simple structure. This has proved successful for two main reasons:

  • The skills learnt can be passed on to other health and social care workers. Our ‘Training the Trainer’ programme trains and supports previous workshop delegates to enable them to deliver CASP workshops to their own organisations and local partners.
  • CASP can teach skills through the medium of a specific research area appropriate to the client organisation or according to identified local objectives.

CASP has helped people gain the skills to search systematically, and appraise, health and social care literature according to their professional needs in qualitative research, economic analyses, systematic review and randomised controlled trials.

In the past 18 months there has been much interest from primary care in CASP workshops on managing and measuring the change needed to put evidence into practice. A range of primary care professionals who have taken part have indicated that it was a good use of their time and they will put what they have learnt into practice.

Patient and Public Involvement Programme

The Patient and Public Involvement Programme aims to foster progressive evidence-based practices in patient and public involvement. It does this by supporting and evaluating activities that enable participants to take a lead in healthcare decision-making.

We work with mixed groups of lay participants and health and social care professionals. Key learning areas include:

  • Structure of the NHS – especially support for patient and public involvement
  • Valuing patient-centred evidence
  • Involvement in health research throughout the process
  • Understanding and using various forms of evidence
  • Communication, influencing and decision-making skills
  • Working in groups and meetings
  • Evaluating and producing quality health information for users
  • Tools and techniques for patient and public involvement.

One of the most popular workshops offered is IMPACT. This is a two-day workshop designed to support professionals and lay participants in working together in healthcare decision making and policy development.

Participants work on skills and principles through practical activities and in facilitated groups. They identify barriers to change and consider ways to address them. As skills are developed, they are practised through roleplay of a meeting where a ‘change scenario’ identified by the group is negotiated.

Both health professionals and lay people set their own objectives for the implementation of partnership working in their own areas.

Understanding research and evidence is also a component of IMPACT, providing an accessible introduction to the role of evidence in NHS decision-making.

Advancing Learning in Practice

The Advancing Learning in Practice programme uses innovative methods to make learning and development relevant to staff in their workplace while supporting larger organisational development objectives.

The PHRU runs action learning sets, usually on pre-determined themes suggested by the participants or their organisations. Examples of learning sets we have run in primary care include:

  • Medicines management for GPs, community nurses, and pharmacists
  • Multi-disciplinary public health for primary healthcare teams
  • Public health skills and change management for health visitors and school nurses.

We also offer facilitation skills training derived from that developed by the National Primary Care Facilitation Programme. This aims to bring together a multi-disciplinary mix of primary care staff for one-, two- or three-day workshops. Participants learn how to facilitate greater communication, problem solving and conflict resolution, as well as other skills needed to promote change in the workplace.

The staff working on facilitation skills training are currently involved in developing a postgraduate level -module in advanced facilitation skills at Oxford Brookes University.

The Advanced Learning in Practice programme also runs a mentoring scheme targeting mid- to senior level managers and clinical leads in the Thames Valley area who are managing change processes in their own organisations. This programme is proving popular with primary care managers and clinicians.

Another key area of our work is public health skills development, which builds on the knowledge and expertise of public health specialists working in the PHRU. Over the years we have created interactive workshops to develop skills in epidemiology and understanding statistics, as well as games designed to aid learning about social capital, clinical governance and homelessness.

Success stories

The popularity of the CASP approach has led to the development of an international network of CASP enthusiasts. Evidence-based training in Spain and Hungary has taken place through this network.

Here in the UK, CASP is celebrating its tenth anniversary and is due to launch a web-based interactive CASP training course in May.

An example of successful patient and professional partnership development is our work with the Child and Adolescent Mental Health Services (CAMHS) in Plymouth. Using our IMPACT training experience, we worked with CAMHS Plymouth to improve the confidence and skills of a group of young people. Two of these then joined the management group of the service. Work is continuing to establish mechanisms to spread good practice and build a sustainable training programme to support the needs of this group.

Action learning sets have been proven to be an effective mechanism for helping primary care staff to change practice and develop skills. A recent learning set run with health visitors and school nurses from two PCTs culminated in the group looking at how they could take more responsibility for public health practice in their PCTs.

The Learning and Development team’s way of working is now being more fully integrated into the approach of certain PCTs. In Buckinghamshire, for example, the five PCTs in the county are contributing towards the salary and support costs of one member of the Learning and Development team to work with them in developing their programmes for public health and public involvement.

The future

The focus of the Learning and Development team’s work will continue to be facilitating learning in evidence-based practice, patient and public involvement, public health skills and change management. At the same time we aim to be ready to take on new areas of learning as they arise within the NHS.

The learning and development team, phru

Set up

Objectives To promote health improvement by developing the capacity and skills of the health and social care workforce
Funding Sources include the NHS, Department of Health and voluntary agencies. Most workshops are provided on a commissioned basis
Key personnel: Director:

Cindy Carlson

CASP Programme Manager:
Jon West
PPI Programme Manager:
Linsey Hovard
ALP Programme Manager:
Andi Mabhala
Buckinghamshire Training Lead:
Julie Burge
Contact details: Address:

Public Health Resource Unit
Institute of Health Sciences
Old Road
Oxford OX3 7LF

Tel: 01865 226968
Fax: 01865 226959

Guidelines in Practice, April 2003, Volume 6(4)
© 2003 MGP Ltd
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