One of the ambitions of the NHS Long Term Plan is to develop sustainable growth in the NHS workforce and scale up the number of people in learning. If employers are to meet this ambition and support the recruitment drive for roles in nursing, midwifery and the allied health professions, then placement capacity will need to increase, while maintaining the required quality and level of educational support.
Clinical placements are a pivotal element of healthcare education and from our discussions with employers, the ambition and motivation to meet the proposed increase in students is clear, however there is some apprehension about how additional capacity for placements can be generated.
Historically, the ability to take on learners for whom practice-based learning is a requirement of their programme has been limited by two main factors, the number of placements available to host them and having experienced staff who can teach and assess.
This page looks at ideas for employers to explore and links to resources that can help to increase their placement capacity.
The Nursing and Midwifery Council (NMC) standards for nurses implemented in January 2019 include the standards for student supervision and assessment, which provides an opportunity for employers to review the supervision models used for their students.
A significant change is the move away from the traditional method of mentoring to one that separates out the supervisor and assessor roles, where students can be supervised by an NMC registered nurse, midwife, nursing associate, or any other registered health and social care professional.
Increasing placement capacity cannot be achieved by employers alone. All stakeholders involved in the development of professionals need to work together to find ways of overcoming the barriers to expanding capacity. Having a group that includes employers, the higher education sector, local health and care providers and national bodies that comes together and shares preferences for how programmes are delivered, is more likely to come up with solutions that work for everyone.
At an employer level, managers also need to be involved. It is not enough to raise awareness about the necessity to increase capacity, managers need time to explore options that work for them and their teams, and identify what can be changed to overcome barriers and resistance.
Through partnerships with local Universities, Northumberland, Tyne and Wear NHS Foundation Trust has increased student numbers, in particular for their mental health and learning disabilities nursing programmes. To manage the increase in clinical placements and mentor support, the trust introduced a central mentor database aligned to ESR. This feeds into a dashboard that has enabled the trust to strengthen its governance of mandatory training, identify mentors that are no longer active and target areas for development. The trust also created two new roles; a practice educator support nurse and practice placement support co-ordinator, who support individual learners and help embed the programmes.
Solutions to explore:
- Improve processes such as better co-ordination between Higher Education Institutes (HEIs) and placement providers
- Determine how programmes are organised and structured
- Explore the use of staggered placement starts for different cohorts and programmes. Evening out the intake of students can help placement providers to manage demand and reduce ‘bottle necks’ in the system
- Redesign placement models and the approach to how education is delivered
- Be open to expansion into the private, voluntary, and independent sectors and different ways of delivering placements
- Discuss in your STP/ICS about how you might use a system-wide approach to scale up capacity
- Take a local approach to attract and increase applications to courses, particularly for those professions that are under-subscribed.
Based on conversations with organisations who have grown their placement capacity we have set out a series questions and actions for employers in our Steps to expand placement capacity.
Diversity in placement options
To increase their capacity, some employers have begun to explore and change how, when and where placements are offered. For some organisations, this has required a change in organisational culture and staff mindsets.
Ideas to consider:
- Use a ‘hub and spoke’ model where students work on a base ward and rotate from there, spending time in different settings and coming back to the base in between. For example, could your Operating Department Practitioners rotate around theatres, wards and critical care?
This model not only broadens the experience of the learner, but it also enables good practice to be taken into other the teams and knowledge shared from a different perspective. For example, learners can bring back ways of working from inpatient or community settings to their base, which helps to provide a better ‘journey’ for the patient.
- Consider and develop links with clinical areas and community settings that are not routinely used for student learning, such as primary care, GP practices and care homes. This can provide a ‘spoke’ placement or a specialist placement for senior students.
Agreements can be put in place for reciprocal placements with partners including social care or primary care, either locally or across the ICS to provide further opportunities.
- Provide placements on a weekend within services that operate over seven-days. Register students onto e-rostering systems to enable you to view the distribution of learners and help to ensure that placements are evenly distributed across settings and shift patterns.
This can avoid overburdening certain areas and ensures that students receive the required training hours, spend time on shift with their practice supervisor and are given exposure to a range of settings. Imperial College Healthcare NHS Trust offers 10 start dates throughout the year for their nursing associate apprenticeship programme as part of their partnership agreement with a local university. By evening out the intake of students in this way, it helps the trust to manage student placements and has reduced ‘bottle necks’ in the system.
- Use your resources effectively to ensure that you have an enhanced amount of supervision available to extend placement capacity.
You could train newly qualified nurses and nursing associates to supervise first year students or ask your HEI partner to help raise awareness and train staff on the NMC’s standards for student supervision and assessment. Bradford District Care NHS Foundation Trust recently added a new supervisor support role that is offered to staff working in band 3 to 5 roles for those looking to progress onto a teaching or assessing role, including newly qualified nursing associates and nurses, who will supervise first-year students. An experienced educator is allocated to oversee them and registrants from other professions and disciplines will also offer formal practice supervision.
Using placement capacity funding
Have you explored different ways of using the funding available through the Placement Expansion Programme to increase placement capacity? For example, purchasing laptops that are then loaned out to the students to support a more flexible approach to placements, including some remote working.
Use of simulation and remote placement activity
The outbreak of COVID-19 saw a range of new approaches to placement activity that can be counted towards the programme delivery and still provide students with a rich experience. Given the benefits some of these ideas have brought, it is worth exploring whether they can be adopted permanently going forward.
There is also an increase in the development of blended learning programmes which incorporate a mix of training techniques. For example, delivered online either in a group or for individual to access when convenient. Some sessions could be ‘face to face’. Technology is also being explored that use virtual reality where students work through a series of tasks and skills tests.
Health Education England has published its National Strategic Vision for simulation and immersive technologies for use in health and care that explores how high-quality, simulation-based programmes can be applied to help address system-wide challenges faced within the health and care sector.
The University of Portsmouth introduced on-campus simulation activities that counted towards placement hours and avoided putting additional pressure onto an already complex system.
During the early phase of the COVID-19 outbreak, some students were deployed into non-patient areas such as small peer groups, where they worked on projects, policy and research with universities. Feedback from these groups stated that this provided them with a better understanding of the bigger picture around their profession, and gave them fresh ideas and skills to take into clinical settings.
For first-year students who were not able to complete their placements, some universities brought forward some of the theory work normally taught in the year two. Those practice hours will be made up during the second year as less time can be spent in academic study.
Technology Enabled Care Services (TECS) such as telehealth, telecare, and self-care apps all involve delivering patient care where the patient is not in the same room as the clinician. TEC services could host students, either in a clinic with a practice educator, or at home delivering care either via a virtual platform or over the telephone. Putting students in these settings will also give them exposure to digital skills.
Remote consultation - providing access to online consultations and group case discussions outside the clinic environment. These have been used for occupational health, physiotherapy, and advanced practice clinics.
Offering support sessions online for students out on placements can provide an opportunity to keep in touch and enable them to air any concerns or worries.
Different models of supervision
In a move away from the traditional mentoring model many trusts are exploring different approaches to how they support their students and learners.
Introducing a coaching style approach to student supervision has enabled many trusts to increase their capacity. Under this approach students are directly involved in hands-on patient care and empowered to take a greater level of responsibility for their own self-directed learning.
Under the model students from different year groups work together as a team with support from a practice educator, or coach who is available to observe and supervise and ask ‘coaching’ questions that encourage the students to explain their practice and identify the learning. The approach has been used in different areas including: outpatients, children’s mental health units, midwifery, children’s nursing and community settings.
Hear from staff at James Paget University Hospitals NHS Foundation Trust about how they have used the CLiP (Collaborative Learning in Practice) coaching model to increase placement capacity in this podcast.
This model involves one educator and multiple students (usually 2:1 but can be more) who offer peer support to each and can help develop different skill sets. These are commonly used within physiotherapy.
Split and shared models
A student is shared between two or more staff members in a team and co-ordinated by a lead educator. This can be ideal way to include part-time staff or to offer a placement across two different teams.
Non-traditional placements may involve settings where services are not provided on a regular basis, such as the voluntary and independent sectors, therefore they do not involve constant one-to-one supervision by a practice educator.
Students complete or lead a project aimed at addressing an identified need in the placement setting. Supervision can be provided on-site by a staff member (not necessarily from the same profession) with off-site supervision provided by a practice educator or registered professional.
There are further ideas explored by employers in our resource: Employer approaches to building placement capacity.
Join the National AHP Virtual Hub on the Future NHS Collaboration Platform where you can engage with other employers on placement capacity topics.
Watch this think placements differently webinar by Dorset Healthcare University NHS Foundation Trust which explores how to expand AHP clinical placement capacity.
Key points of the webinar include:
- 9 minutes - summary of alternative models of supervision and placement delivery
- 24 minutes - Split placement 2 days research, 3 days clinical
- 35 mins - virtual placements
- 41 minutes - role emerging placements, introduced this role for the first time into Mental Health and Social Care
- 51 minutes - increasing placement capacity ideas
- 61 minutes - engaging teams in increasing placement capacity
- 1:10 - working collaboratively to increase capacity
- 1:15 - Q&A