04 / 05 / 2010
What we did and why
How we did it
Results and the next steps
Further information and contacts
Cornwall and Isles of Scilly Primary Care Trust was established on 1 October 2006 and brought together the three former Primary Care Trusts that provided services for the residents of Cornwall and the Isles of Scilly. These organisations were Central Cornwall Primary Care Trust, North and East Cornwall Primary Care Trust and West of Cornwall Primary Care Trust. This formed part of a national reorganisation of primary care aimed at improving the way healthcare is delivered.
Cornwall and Isles of Scilly Primary Care Trust initiated a preceptorship programme in 2000 and has seen it develop in line with today’s national preceptorship framework for nursing, midwives and allied health professionals. The trust used the introduction of the Skills for Health Framework in 2005 as a catalyst for change. Workforce development and planning for band five nurses is core to the trust’ s delivery of excellence in patient care.
The trust believes in ensuring that staff skills are fully developed to provide high quality and safe patient-centred services, whilst making best use of available resources and systems. That means nurses being ‘fit for purpose’ and having the confidence to work in a dynamic health environment. The Trust’s preceptorship programme is therefore aligned with core values of care.
In 2000 when the preceptorship programme was initiated at the trust, there was a greater focus on developing practical skills, rather than following a theoretical framework. The trust was already working with the University of Plymouth to prepare nursing students once they became ‘live’ in a health environment. The trust worked with peers and students at the University of Plymouth to discuss student nurses’ career aspirations, whether for primary care or district nursing and how they could be prepared for a nursing career and achieve the required core competencies.
In 2005, the Skills for Health framework introduced a new set of core competencies that aimed to standardise preceptorship programmes across strategic health authorities. This brought about a shift towards a 50/50 split between practice and theory, with direct links to annual personal development plans. The trust has embraced the Skills for Health competencies that are now embedded within the workforce development plans.
The trust believes that each and every workforce is a key element in enabling it to deliver against organisational objectives. When designing a workforce, there are therefore a number of considerations including the number of staff you need and whether they have the relevant skills and competencies to provide the service required. There also needs to be a strategy in place to secure a developed and competent workforce today and in the future.
The trust’s preceptorship programme is designed to support band five nurses through their first twelve months by giving them clear guidance on what their team/leader and their service expects from them and the standards they should be achieving. It is very much viewed as a partnership with their mentor. They prepare a learning agreement that will enable them to structure a development pathway. All staff nurses are normally expected to complete the full programme within twelve months.
The enriched preceptorship programme covers a total of 100 days that help the newly qualified staff to gain on-the-job development, build their confidence and to work autonomously, each having the support of a mentor. They need to be accountable, once they are qualified.
Much of the programme is based on work-based learning, referring to the knowledge, skills and understanding that will be gained during the course of normal duties. Some of the learning is gained through study days or other formal training events, but most learning takes place as the newly qualified staff go about their job, talking to and working with patients, carers, colleagues and other professionals.
The first six months are geared towards the development of clinical skills and gaining expertise in dealing with patients and preparing care plans, risk assessments and other written documents. Preceptees also participate in team meetings and clinical supervision sessions, work with other health professionals and read and research in their own time.
During the preceptorship programme, the staff are tasked with building up a portfolio that illustrates evidence of learning, with samples of written documents, for example, care plans, reflective notes on practice sessions and short written assignments and records of assessments of competencies achieved in specified areas.
Each preceptee is allocated a mentor who will work closely with them throughout the programme. Some assessments are, however, carried out by specialist nurses or other colleagues.
The preparation of mentors, or preceptors, is viewed with equal importance as preceptees at the Trust. They also need structured learning contracts and demonstrate competencies as trainers and make a commitment to the newly qualified staff. The Trust believes that this is an area that may need more investment in the future to ensure the right level of support available to newly qualified staff.
The preceptorship programme is viewed as the start to lifelong learning at the Trust. Its professionals are involved in the writing of academic modules for the course and have close links with local higher educational institutions. The theory underpins the practical lessons learnt on the job. The course is therefore academically driven.
By working in partnership across the South West Peninsula Cornwall PCT, Plymouth PCT and Torbay Care Trust, a competency framework has been developed. It strives to standardise education, competencies and documentation to develop and enhance the future of community nursing care. The Skills for Health competency framework has been used to support this educational model.
The framework is divided into three sections:
Section 1 – Preceptorship/Induction: For those registered nurses new into community care. It includes two academic degree modules delivered by the University of Plymouth and achieves the Children’s Directorate Core competencies.
Section 2 – Maintaining Competence: For community registered nurses to demonstrate that they are maintaining and updating their knowledge and competencies.
Section 3 – Band 5+ Developmental Role: Use of a career pathway to document competencies and skills in order to achieve a band six post.
Results and next steps
The preceptorship programme at the trust doesn’t stand still. It constantly evolves and is often re-evaluated to ensure that it is offering the very best outcome for newly qualified nurses. An education and training forum is held on a monthly basis, when lead practitioners share their main concerns and successes. Specific skills are discussed for clinical areas, for example, dementia.
It is also an opportunity to discuss changes in relation to the Prime Minister's Commission on the Future of Nursing and Midwifery in England and the nursing profession. Shared learning is essential amongst community healthcare, mental health, acute and primary community professionals.
What works particularly well with the preceptorship programme at NHS Cornwall and Isles of Scilly, is the strong links to local universities. It means there is always the chance to assess the competencies of the undergraduates before they qualify and match them to opportunities in the region. The current local economic situation is also discussed, as it varies according to region. Workforce and succession planning is an essential part of the process.
Some funding from the strategic health authority has meant that the trust has been able to employ a preceptorship project manager for a two-year period to help relieve the workload that such a programme brings. This has been of enormous benefit to the trust and has helped to bring about further developments.
Managing the change to the preceptorship programme has been key over recent years. Some people find it difficult to adapt. It’s not something that can be achieved overnight, rather integrated into workforce planning. Efficient leadership and management are integral to change. At the trust, there is more of a business focus and a close eye kept on sustainability.
Although a cost-benefit analysis has not been undertaken as yet, early signs indicate that the preceptorship model is working. One of the key benefits has been staff retention. None of the 21 newly qualified staff that have completed the programme have left their posts except for one nurse, due to personal relocation needs. This is a positive reflection of early success of the project.
The trust’s top tips for making things run smoothly across a preceptorship programme include:
- ensuring there is a passionate lead that is keen to embed the core competencies into the workforce for both newly qualified nurses and those that are new to the organisation.
- ensuring that the preceptors are fully equipped with the appropriate mentoring skills.
- having strong links with the universities, preferably dedicating that responsibility to a professional within the trust. They can promote the programme to students early on.
- use tools that have already been developed to eliminate duplication of effort and strive for transferability across organisations.
NHS Cornwall and Isles of Scilly