04 / 05 / 2010
What we did and why
How we did it
Results and next steps
Further information and contacts
NHS Direct was the health advice and information service provided by the National Health Service, established in March 1998. It was an NHS trust. It was discontinued in March 2014, and many of its functions are now being carried out by NHS Choices.
The principles contained in this case study about the preceptorship programme for new staff at NHS Direct are still applicable, and can be referred to as shared learning for other trusts wishing to implement a preceptorship programme for their newly qualified staff.
Since it was founded, there was always a preceptorship programme for new staff at NHS Direct which developed over time to become more formal and structured. Having originally delivered different models of preceptorship to meet the operational needs of individual regions prior to becoming a national body, NHS Direct developed a national model to support new staff starting with the organisation and offering a formal career development framework for existing staff.
NHS Direct believed the period of preceptorship was a formative one in which the knowledge, skills and attitudes acquired during the role preparation can be applied to practice. It is a period where the staff member, although competent in the minimum level of safety, is in need of guidance and support from more experienced practitioners.
The preceptorship programme at NHS Direct was designed for all new frontline staff including nurse advisers, health advisers, health information advisers, dental nurse advisers and care managers. It also included those practitioners who were re-entering NHS Direct following an extended period of absence, a secondment or career break.
The programme aimed to provide the right levels of support and guidance to enable new registrants to make the transition from student to accountable practitioner. At NHS Direct, the preceptor model tended to be used for the transitory period between a specific clinical role to working in a multi-channel healthcare environment. Newly qualified practitioners would then go on to participate in clinical supervision as part of a supportive framework.
The preceptorship programme covered standards for conduct, performance and ethics and aims to develop confidence in competent nursing and to support our non clinical staff to work in the e-health environment whilst developing their knowledge and skills.
Any preceptorship programme needs to adapt in line with the evolving NHS. INHS Direct’s preceptorship model was important as most pre-registration nursing courses at the time did not include patient telephone consultation modules and placements for students.
The existing preceptorship model within NHS Direct was therefore reviewed by the organisation’s learning and development team to ensure that it was fit for purpose. A period of intense preceptorship was strongly recommended to support the transitional period to this unique clinical service.
The review considered a number of areas. Preceptorship needed to take place for new front line staff during the indirect supervision phase of the role preparation where new staff work independently caring for patients over the telephone but with added support mechanisms and as required for those members of staff returning to work. It was acknowledged that where large groups of new staff were recruited, say for groups of 20 or more, preceptors may be required to give more support through direct supervision.
The new or returning member of staff would need to meet and demonstrate evidence to perform at a competent practitioner level within their specific role. They would need to be supported and participate in call reviews and meetings with their line manager and preceptor.
Additionally, the majority of non-nursing front-line staff predominantly came from commercial call centre backgrounds, so require a period of preceptorship to support them. This was particularly important, given the wide variety of patient symptoms and enquiries managed on a daily basis.
NHS Direct held the role of the preceptor in high esteem. Preceptors are pivotal to the success of any preceptorship model, so at NHS Direct, all preceptors had the opportunity to be developed as mentors through the personal appraisal and development review process. Quarterly preceptorship workshops for new preceptors and refresher programmes for existing preceptors were facilitated within the development plan strategy.
As a minimum, preceptors needed to demonstrate an interest in the education and development of others, have experience and expertise in practice, work independently and as part of a team and consistently achieve high clinical and performance targets. They needed to have evidence of good communication skills, the ability to adapt to individual learning styles and be good organisers. Predominantly this role was undertaken by the nurses working at Band 6 but was open to all staff groups.
Practitioners were brought into the role of preceptors to support the ongoing development of their peers. The preceptor's role was to support the learning through the transition period in partnership with other designated clinical support and operational staff that help during live calls. The subsequent call performance reviews covered a range of live and retrospective calls.
At NHS Direct, the newly qualified member’s learning time was protected in their first year of qualified practice. They were given access to a preceptor with whom regular one to one meetings were held. The preceptor would be offline for the duration of the shift in order to offer support, guidance and manage call reviews for the new or returning member of staff.
All newly qualified NHS Direct staff were assigned a preceptor during the initial intense 12-week induction period. New nursing advisers tended to have access to preceptors for their shifts up to week twelve and health advisers up to week eight, depending on the level of experience and competence. The core objective was to support staff during the transition period, equipping them with enough knowledge and confidence to manage telephone patient calls autonomously, safely and effectively.
The recommended ratio of preceptor to preceptee in the first two weeks of the programme was 1:1, until ten safe and consecutive telephone assessments were achieved. Then the ratio tended to be 1:3 or 5. Following the period of preceptorship, band five nurses still had access to support on a daily basis for at least their first year.
On average it would take six to eight weeks for newly qualified staff to feel confident enough to take calls without assistance. Clinical supervision was offered thereafter. Preceptees are offered the safety net of further support from the preceptor and senior operational staff, as and when required.
The ability to offer a comprehensive preceptorship programme could be dependent upon the group size. Larger groups were more difficult to resource operationally and anecdotal evidence indicated that large cohorts are likely to have higher attrition rates.
A reflective diary was introduced for all new staff to enable them to record and discuss any critical incidents at their regular meetings with preceptors. The staff side union supported this initiative. The diary also offered the organisation a set of rich data for analysis and helped to identify areas for development.
One of the key issues facing those front-line staff taking patient calls was the restriction on the time available for training; considering that the organisation took over five million calls each year. This was managed through an effective workforce planning strategy that enabled staff to be trained first and foremost, in their core role, focusing on patient care and quality as their priority.
NHS Direct believed that the key to success for any preceptorship framework is gaining sponsorship at Board level. At NHS Direct, the preceptorship programme was supported well by the clinical directorate. With the essential buy-in from operational management teams too, preceptors were released from some of their duties to commit quality training time to newly qualified staff.
NHS Direct ensured that that the whole organisation had a good understanding of the benefits of the preceptorship programme and how it fitted into workforce planning. An appropriate level of resource needed to be allocated in advance of a cohort of newly qualified nurses starting their training.
As the organisation introduced new roles such as the Assistant Practitioner and allied health professionals, the preceptorship was developed.
Having a national formalised preceptorship programme provided job enrichment for existing experienced staff whilst retaining new staff who may previously have left as they felt unsupported.
At NHS Direct, the change in the way the preceptorship programme was managed was accepted well across the organisation. Preceptors were keen to share their knowledge and experiences and became ambassadors for the programme. Ultimately, a high quality preceptorship experience supports the achievement of safe and competent patient care.