Developing the role of assistant practitioners

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06 / 04 / 2011

The organisation

North Bristol NHS Trust (NBT) provides hospital and community healthcare to the residents of Bristol, South Gloucestershire and North Somerset. The Trust is one of the largest teaching trusts within the South West with links to the University of Bristol, University of Bath and the University of the West of England and local further education (FE) colleges and has 9,000 staff delivering healthcare across Frenchay and Southmead Hospitals.

They treat over 200,000 patients a year and deliver over 6,000 births.
NBT provide award winning services and receive a significant number of referrals from other trusts for their wide range of specialist services.

What we did and why

North Bristol NHS Trust has 15 years experience providing vocational and continuing professional development (CPD) training for staff.

In 2005 North Bristol NHS Trust was approached by their strategic health authority to develop the assistant practitioner’s role and were asked to participate in a pilot scheme using a newly approved Foundation Science Degree in health and social care practice from University of the West of England. Eight trainee assistant practitioners were recruited into medicine and surgery for the first cohort.

An assistant practitioner implementation strategy was created which identified a number of key objectives. They included:

  • Workforce plans that identified the assistant practitioner role
  • Trust policies and guidelines amended to incorporate the assistant practitioner role
  • Clear roles and responsibilities identified for Bands 2, 3 and 4 with job descriptions and knowledge and skills framework (KSF) outlines
  • Stakeholder and staff engagement to aid the change process and introduction of the role
  • Code of practice for assistant practitioners to support accountability and appropriate delegation by registered practitioners
  • Continued recruitment annually of a minimum of 20 trainee assistant practitioners per year.

How we did it

North Bristol NHS Trust had little time to prepare for the introduction of the role before the commencement of the pilot scheme. The SHA offered some funding to this initiative to encourage the uptake and development of the role. North Bristol NHS Trust did not want to miss the opportunity of financial backing and went ahead with appointing a small number into the pilot scheme.

The trust then initiated the following implementation steps:

Engagement with Stakeholders

  • Senior team members visited the North West pilot site in Manchester to gain information on developing the role
  • A series of briefing sessions were held with HR, general managers and heads of nursing to promote the benefits of developing this role. This was carried out in line with the main drivers such as working time directive, reduction in doctors working hours, demographic trends and NHS modernisation plans
  • A generic job description and leaflet explaining the role was developed and used to support the awareness of the role within the nursing teams
  • An assistant practitioner coordinator was appointed to support the trainees in practice and clinical matrons. The matrons had been established as ‘champions’ within their directorates who would support the development of the role within their teams
  • Accountability was an issue that was repeatedly raised by the registered practitioners who thought they would be still accountable for the task even though they had appropriately delegated to the assistant practitioner. A NBT code of practice was written to provide support for registered practitioners and assistant practitioners relating to the appropriate delegation of roles to unregistered assistants.

Planning the implementation

  • Staff and mentors were provided with information regarding the academic and competency based training to ensure skills are appropriately delegated to the assistant practitioners.
  • A strategic workforce development manager was appointed to develop a three and five year workforce plan with all directorates. It provides detailed information of the number of assistant practitioners required in preparation for the new ways of working in the new hospital to be opened 2014.
  • Information advice and guidance is offered to health care assistants during vocational training to ensure they have the required entry requirements to lead them onto the Foundation Degree. This also included careers advice for young people whilst they are at school using their partnership links with local schools and colleges.
  • Further development of roles and responsibilities for assistant practitioners and clear boundary definitions between Bands 2, 3, 4 and 5.
  • Annual recruitment of trainees onto Foundation degree courses plus in-house Higher Professional Diploma courses (provided by the trust from 2007-2010) to ensure key target numbers reached each year.

Using the national assistant practitioner coordinators network as a resource for development.

In 2008 an assistant practitioner coordinators network was established by three trust coordinators who were attempting to find support and information from other organisations about how they were implementing the role. The network has been invaluable to the trust in ensuring it receives information from other organizations, including Skills for Health that can support the development of the role when barriers to implementation has prevented or impeded this process.

The network is a powerful ‘national voice’ influencing the development of the role. It currently has over 50 members who meet three times a year. It consists of a wide representation of staff and also utilises email as a medium to pose questions and seek support. Information is collected relating to numbers of assistant practitioners, skills identified for the role plus problem solving and sharing of good practice.

The network is currently working on a national code of conduct for England. If you would like to join, please contact sue.crew@nbt.nhs.uk   

Results and next steps

North Bristol NHS Trust has 41 qualified assistant practitioners working in the trust, plus 57 in training. Training has been provided using the (UWE) Foundation Degree or the in-house, Higher Professional Diploma level 4 from City and Guilds.

In addition to these figures a number of qualified assistant practitioners have progressed in their careers and are currently working towards registration as a nurse. The attrition rate of the course was initially very high but the rate is now below the 13 per cent attrition rate set for undergraduate courses.

North Bristol NHS Trust works in partnership and has supported the training by providing one of the modules from the Foundation Degree plus its own in-house course.

Other key progress areas are:

  • Job descriptions and code of practice in place
  • Support for mentors and line managers to assist with identification of the role
  • The majority of areas  have assistant practitioners either qualified or in training within medicine, medical admissions units, respiratory, stroke, dementia, renal unit, neuroscience, surgery, endoscopy, urology, burns, vascular, ENT, gynaecology, radiology nurses, ITU, HDU, outpatients, pr-op assessment , musculoskeletal, recovery and learning and development
  • New areas include the children’s ward, neonatal intensive care, adult intensive care unit and theatre scrubbing for operations
  • Work with stakeholders, staff engagement and workforce planning developing bands 2 and 3 are to take place in both maternity and allied health professions
  • Trust clinical policies are being changed to ensure assistant practitioners are included where appropriate
  • Preceptorship programme in place for newly qualified assistant practitioners
  • Pilot fast-track programme underway for student nurses who have been competent health care workers but have not been successful in their final module at university having completed three years of nurse training.

North Bristol NHS Trust is now in the process of recruiting trainees for January 2012 and are planning for the introduction of higher apprenticeships in 2012/2013.

Tips for other trusts

  • Take time to plan the introduction of the role before you commence training
  • Identify roles and responsibilities for Bands 2, 3, 4 and 5 to ensure clear role profiles are established
  • Stakeholder and staff engagement is key to successful implementation
  • Identify ‘champions’ in senior positions to support the implementation of the role
  • Have workforce plans, which identify the implementation of the role
  • Once established in your organisation use assistant practitioners as ambassadors of the role.

Contact details

Sue Crew
Assistant Practitioner coordinator
Teaching and learning in Practice Team Leader
sue.crew@nbt.nhs.uk

Jane Hadfield
Assistant director HR&D
Head of learning & development
jane.hadfield@nbt.nhs.uk 

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