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Education & training (c)

Summary of Indicators

  C. Education and training
Education 1
4 points
There is a record of all practice-employed clinical staff having attended
Training/updating in basic life support skills in the preceding 18 months
Education 2
4 points
The practice has undertaken a minimum of six significant event reviews in the past 3 years
Education 3
2 points
All practice-employed nurses have an annual appraisal
Education 4
3 points
All new staff receive induction training
Education 5
3 points
There is a record of all practice-employed staff having attended training/updating in basic life support skills in the preceding 36 months
Education 6
3 points
The practice conducts an annual review of patient complaints and suggestions to ascertain general learning points which are shared with the team
Education 7
4 points
The practice has undertaken a minimum of twelve significant event reviews in the past 3 years which include (if these have occurred):

Any death occurring in the practice premises
Two new cancer diagnoses
Two deaths where terminal care has taken place at home
One patient complaint
One suicide
One section under the Mental Health Act
Education 8
3 points
All practice-employed nurses have personal learning plans which have been reviewed at annual appraisal
Education 9
3 points
All practice-employed non-clinical team members have an annual appraisal

Education Indicator 1

There is a record of all practice-employed clinical staff having attended training/updating in basic life support skills in the preceding 18 months

Education 1.1 Practice guidance
The primary care team members deal with cardio-pulmonary collapse relatively rarely, but require to have up-to-date skills to deal with an emergency. This is best undertaken at regular intervals through practical skills-based training sessions, as it is known that these skills diminish after a relatively short time. The timescale has been set pragmatically at 18 months, although many practices offer training on a more frequent basis.

This training may be available from a variety of providers including your local Accident and Emergency Department, BASICS, the PCO or out-of-hours co-operative, Red Cross, St John's Ambulance or equivalent. It may be sufficient for one individual in the team to attend for external training and then cascade this within the team.

Education 1.2 Written evidence
Attendance at CPR training should be listed. (Grade B)

Education 1.3 Assessment visit
Staff should be questioned on the date of their last CPR training.

Education 1.4 Assessors' guidance
Assessors should confirm by checking the CPR attendance list that practice-employed clinical staff have attended.

Education Indicator 2

The practice has undertaken a minimum of six significant event reviews in the past 3 years

Education 2.1 Practice guidance
Significant event review is a recognised methodology for reflecting on important events within a practice and is an accepted process as evidence for GMC revalidation.

Significant event analysis is not new, although its terminology may have changed. It was first known as critical event monitoring. It provides structure to an activity which anyway happens informally between health care professionals. It is the discussion of cases and events and the learning obtained through reflection. Due to its reflective nature, it can be viewed as an extension of audit activity. Discussion of specific events can provoke emotions that can be harnessed to achieve change. For it to be effective, it needs to be practised in a culture that avoids blame allocation and involves all disciplines within the practice.

The following steps are useful in introducing significant event analysis to a practice:

1. A multidisciplinary meeting to explain the concept.

2. Consideration of events which should be important to the practice but need not imply criticism of the practice. The practice can construct a core list as a basis to stimulate discussion or it can use the one published in the RCGP Occasional Paper (see reference at end of this section). Some of the examples from this are below.
Preventative care:
Measles
Unplanned pregnancy
Non-accidental injury
Squint diagnosed by an ophthalmologist

Acute care:
Sudden unexpected death
Death occurring on the practice premises
Suicide or suicide attempt
All new cancer diagnoses
Myocardial Infarction
Terminal care death at home
Section under Mental Health Act

Chronic disease:
Diabetic hypoglycaemia
Leg ulcer or amputation
Asthma - hospitalisation
Epilepsy - status epilepticus

Organisation:
Investigation received but not acted upon
Breach of confidentiality
Any patient complaints
Upsetting of staff

3. Mechanism for identification of events. A logbook kept at reception may be helpful or an electronic logbook held on the practice computer system. Any mechanism should allow all team members to contribute.

4. Significant events meetings. These are generally multidisciplinary and chaired, and notes should be taken. Each attendee should be encouraged to take along at least one significant event. The meeting can choose which to discuss first and anybody can have the right to veto if that area is considered too sensitive.

The events are then discussed, first highlighting the aspects of high standard and then those standards that can be improved. A decision about the case needs to be reached.

This can be:

- celebration of excellent care
- no change
- audit required
- Immediate change required.

Follow-up of these decisions should be arranged and this may occur at the next significant event analysis meeting.

These reports should be laid out in a form consistent with either of the two following suggested formats:

A.
- Description of event. This should be brief and can be in note form.
- Learning outcome. This should describe the aspects which were of high standard and those which could be improved. Where appropriate it should include why the event occurred.
- Action plan. The decision(s) taken need to be contained in the report. The reasons for these decisions should be described together with any other lessons learned from the discussion.

B.
- What happened?
- Why did it happen?
- Was insight demonstrated?
- Was change implemented?

Reference:
Royal College of General Practitioners. Significant Event Auditing: Occasional Paper 70. London: RCGP, 1995.

A description of significant event audit is also available in: Robinson LA, Stacy R, Spencer JA, Bhopal RS. How To Do It: Use facilitated case discussions for significant event auditing. BMJ 1995; 311: 315-318.

Education 2.2 Written evidence
Each case report must consist of a short commentary setting out the relevant history, the circumstances of the episode and an analysis of the conclusions to be drawn. Evidence should be presented of any clinical and organisational changes resulting from the analysis of these cases. (Grade A)

Education 2.3 Assessment visit
The reviews should be discussed.

Education 2.4 Assessors' guidance
The practice should report their analyses in a form consistent with either of the two following methods:

A. Statement of the problem or event, learning outcome and action plan or
B. What happened? Why did it happen? Was insight demonstrated? Was change implemented?

The practice should involve all team members who were stakeholders in the event in the case discussion.

Education Indicator 3

All practice-employed nurses have an annual appraisal

Education 3.1 Practice guidance
Appraisal is a constructive opportunity to review performance objectives, progress and skills and identify learning needs in a protected environment. The learning needs identified may be personal to the appraisee and/or organisational learning needs which the appraisee has agreed to fulfil. The outcome of the appraisal should be a written action plan agreed between appraiser and appraisee which could include a personal learning plan for the appraisee.

Practices which have established appraisal schemes for the nursing team use varying professionals as appraisers. The agreed structure of the scheme should include identification of which individual(s) will take on the role of appraiser. It is important that all team members who are appraisers are adequately trained in appraisal techniques.

Some further guidance on appraisal can be found on the ACAS website (www.acas.org.uk) and in the ACAS advisory booklet: Employee Appraisal. http://www.acas.org.uk/publications/B07.html

The practice could draw on the professional practice and appraisal skills of a lead nurse in the PCO.

Education 3.2 Written evidence
The appraisal system should be described. (Grade C)

Education 3.3 Assessment visit
The doctors and practice-employed nurses should be questioned on the nurses' appraisals
The appraisal system for practice-employed nurses should be discussed with the nurses themselves and the person responsible for managing the appraisal scheme eg GPs, nurse, practice manager.

Education Indicator 4

All new staff receive induction training

Education 4.1 Practice guidance
The use of a structured induction programme will help new staff fit more quickly into the practice and support them in becoming effective team members. It is useful to establish a programme of induction for a post, but to remember that it may need to be used flexibly, for example when an employee:
- is returning to work after a long absence
- has not worked before
- as a disability
- is from an ethnic minority group.

A programme could include:
- going through terms and conditions of employment
- meeting other members of the practice team, possibly including shadowing
- clarifying areas of responsibility and accountability
- practice codes and/or standards and regulations including Health and Safety/special hazards, uniforms, arrangements for working overtime, time in lieu etc
- familiarisation with protocols and procedures including employment procedures eg sickness absence policy
- training in the responsibilities of the post.

This list is not exhaustive.

Clear recording of the areas covered in the programme and regular reviews of progress will help establish the standard of performance which is expected and help the manager and new member of staff to identify remaining areas of lack of knowledge and understanding. This will help the new team member to feel valued and supported.

Education 4.2 Written evidence
If a new member of staff has commenced after 1 April 2003, the induction programme which has been implemented should be sampled. (Grade B)

Education 4.3 Assessment visit
The induction programme should be inspected.

Education 4.4 Assessors' guidance
It may be useful to speak to the newest member of staff as well as inspecting the induction programme itself if he or she has commenced in post after 1 April 2003.

Education Indicator 5

There is a record of all practice-employed staff having attended training/updating in basic life support skills in the preceding 36 months

Education 5.1 Practice guidance
Although it is rare for practice non-clinical staff to have to deal with a cardio-pulmonary collapse, the situation may arise within or outwith the practice premises.

See Education 1.

The interval for training is pragmatically set at three years although many practices offer training on a more frequent basis.

Education 5.2 Written evidence
Attendance at CPR training should be listed. (Grade B)

Education 5.3 Assessment visit
Staff should be questioned on the date of their last CPR training.

Education 5.4 Assessors' guidance
Confirmation that practice non-clinical staff have attended training should be obtained by checking the CPR attendance list.

Education Indicator 6

The practice conducts an annual review of patient complaints and suggestions to ascertain general learning points which are shared with the team

Education 6.1 Practice guidance
Practices and clinicians generally find complaints stressful. It is important that the practice view complaints as a potential source for learning and for change and development.

Reports should include a summary of each complaint or suggestion and an identification of any learning points which came out of the review. It may be useful to agree at the time of each review how the learning points or areas for change will be communicated to the team; it is likely that not all team members will be involved in every review meeting for various reasons. It will also be useful to identify an individual responsible for implementing the change and monitoring its progress.

These reports may form part of the written evidence for the indicators on significant event analysis (Education 2 and Education 7).

Education 6.2 Written evidence
Reports/minutes of team meetings where learning points have been discussed should be made, with a note of the changes made as a result. (Grade A)

Education 6.3 Assessment visit
The issue of learning from complaints should be discussed with staff and doctors.

Education 6.4 Assessors' guidance
Assessors should discuss with team members their involvement in reviews of patient complaints and suggestions and how the learning points are shared with the team.

Education Indicator 7

The practice has undertaken a minimum of twelve significant event reviews in the past 3 years which include (if these have occurred):
- Any death occurring in the practice premises
- Two new cancer diagnoses
- Two deaths where terminal care has taken place at home
- One patient complaint
- One suicide
- One section under the Mental Health Act

Education 7.1 Practice guidance
Detail of methodology on significant event analysis is given in Education 2.

This indicator is more prescriptive in the requirement to report on specific occurrences in the practice. Clearly if certain of these events have not occurred, eg patient suicide, then this should be stated in the evidence.

Education 7.2 Written evidence
Each review case report must consist of a short commentary setting out the relevant history, the circumstances of the episode and an analysis of the conclusions to be drawn. Evidence should be presented of any clinical and organisational changes resulting from the analysis of these cases. (Grade A)

Education 7.3 Assessment visit
The reviews should be discussed.

Education 7.4 Assessors' guidance
The practice should report on its analyses in a form consistent with either of the two methods described in Education 2.

Education Indicator 8

All practice-employed nurses have personal learning plans which have been reviewed at annual appraisal

Education 8.1 Practice guidance
The production of a personal learning plan may be one of the outcomes of the appraisal system. The plan could record the agreement between appraiser(s) and appraisee on areas for further learning, how they will be achieved, who is responsible for organising them, within what timescale, and how progress will be reviewed. It may also include learning areas which have been identified as an organisational need but which have been agreed at the appraisal as an individual development area for the appraisee to take forward. This information should be recorded.

Education 8.2 Written evidence
The staff appraisal system should be described. (Grade C)

Education 8.3 Assessment visit
A discussion should be held with practice-employed nursing staff about their personal learning plans.

Education 8.4 Assessors' guidance
Personal learning plans should be discussed with practice-employed nursing staff.

Education Indicator 9

All practice-employed non-clinical team members have an annual appraisal

Education 9.1 Practice guidance
Appraisal is a constructive opportunity to review performance objectives, progress and skills and identify learning needs in a protected environment. The learning needs identified may be personal to the appraisee and/or organisational learning needs which the appraisee has agreed to fulfil. The outcome of the appraisal should be a written action plan agreed between appraiser and appraisee which could include a personal learning plan for the appraisee. In addition the opportunity could be taken to review and update the appraisee's job description.

Education 9.2 Written evidence
The staff appraisal system should be described. (Grade C)

Education 9.3 Assessment visit
A discussion should be held with practice-employed non-clinical staff about their experience of appraisal.

Education 9.4 Assessors' guidance
It may be useful to discuss the appraisal system with the non-clinical staff themselves, the practice manager and the GPs.
 

 

 

 

 

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