Published: 05/09/2002, Volume II2, No. 5812 Page 16 17
How does a primary care trust go about setting up a training strategy? Carol Sutters, Marie Wallace and colleagues explain their experience with a protected learning time model for GPs and other staff, known as eSTAR
Protected learning time is intended to free people from the pressure of their day-to-day jobs. It provides all the tools and resources that people need to get away from their workplaces and learn in an educational environment.
Ealing primary care trust has developed protected learning time for the continuing medical education of primary, community and former health authority staff.
Ealing systematic training audit and review (e-STAR) uses a programme of workshops to bring together professionals to discuss clinical and nonclinical topics. In addition to addressing individual training needs, the programme has contributed to the development of the PCT.
The system was built on the Doncaster time for audit review guidelines education and training model (TARGET).
1Doncaster primary care groups introduced this as an educational initiative in November 1998. It initially focused on delivering protected learning time for GPs, but rapidly expanded into multidisciplinary work.
The TARGET model is built around workshops that allow multidisciplinary discussion of clinical and non-clinical issues.
Three primary care groups were initially formed in Ealing. Two of these, Acton and Central Ealing PCG and Northolt and Greenford PCG, formed a stakeholder group to look at education and training issues. A local GP tutor interested in the TARGET concept presented it to the group in late 2000.
Members of the stakeholder group set up a steering group to investigate the model. By this time, it was clear that the PCGs were going to merge with Southall and West Ealing PCG to form a new PCT.
All three PCGs set up a joint education and training sub-committee and this established an eSTAR committee to take forward the initiative. The committee comprised GP tutors, nurse trainers and other educationalists from the three PCGs and other organisations involved in the emerging PCT - Hounslow health authority, Hounslow and Spelthorne community trust and Riverside community trust.
The e-STAR project was launched a year before Ealing PCT was formed in April 2002. It provides protected learning time for continuing medical education for GPs' primary and community staff.
Ealing PCT has more than 1,100 salaried staff, including 172 GPs and staff in 88 practices. It is currently developing human resources training and development strategies. External assessment of e-STAR will assist in its development and in establishing where it fits within the larger organisation and its strategies.
In the first year of operation, the aims were to gain expertise and confidence in organising major events, to enable a large group of staff to attend each event and to focus on a few topics.
Early in August 2001, the e-STAR subcommittee sent out a letter asking staff to nominate areas in which they felt they needed additional information or that were a local/national priority. This exercise enabled the committee to highlight learning needs and take into account the priorities of the PCT and the wider NHS.
Six conferences were organised on topics identified by the exercise, the first of which took place in September 2001.
The conferences were held on Wednesdays and Thursdays, when most GP practices in the area are closed. It was hoped this would allow practices to attend as a team to get the most out of the events.
The events accommodate eight to 10 teams, or about 100 people. They are advertised through flyers, which are faxed to GPs, practices and community trust staff.
Out-of-hours cover is put in place if required on these half days to enable GPs to attend, and independently employed staff time is replaced.
Methods and techniques
The workshops use evidence-based adult learner techniques. The principles of adult learning - to design a programme in which the learner identifies their needs - is learner-centred and learner-led. Enjoyment and participation have featured strongly in our approach.
For each workshop, two members of the committee, including the co-ordinator, prepare a carefully constructed workbook. This includes information about the evidence base for the topics to be covered, questions for the delegates to consider and information to allow further reflection and team-based learning once the event has concluded.
The constraints on time and the broad range of topics to be covered inevitably mean that staff can only be given a limited insight into any one of the topics. The aim is to reinforce this with supplementary educational material. For example, the workbook includes useful websites and many include Department of Health and voluntary organisations guidance.
Meeting the needs of a large multidisciplinary audience is quite a challenging commitment. From the outset it was agreed that a group of facilitators should be trained to assist in delivering the programme.
The associate dean and an outside facilitator organised a special training event to meet the needs of these people. The recruitment and retention of facilitators is ongoing and the associate dean now undertakes development training.
The need was also recognised in the early stages for dedicated personnel and to ensure the project kept on track. A co-ordinator was appointed, whose salary is met by the PCT.
The budget in the first year included£15,000 for staffing. This covered recruitment of the facilitators and their training, payments for others involved in the project and replacement cover for delegates. The budget also included£22,500 non-staff costs. This covered hiring of venues, preparing workbooks and other event-related costs.
A further£18,000 was raised from pharmaceutical companies and other small bids. This was also put towards holding events. Each event costs around£5,000-£5,500, including the cost of delegates.
Each event is evaluated on content, methods and appropriateness to service delivery. Participants are encouraged to enter information into a diary for future reference and personal development plans.
Facilitator evaluation is also undertaken and points for future development are noted (see table).
GP teams have commented on how valuable it has been for them to have protected learning time to work things through. Staff have welcomed the equitable approach adopted to their involvement at all levels and disciplines.
The scheme has also been a major factor in building the 'virtual organisation' of the PCT. The e-STAR committee has included representation from all its constituencies and has engaged a large number of staff, including those employed by GP practices.
The initiative plans to run further workshops this year. A workshop on coronary heart disease has already been held. Further topics are elderly care, mental health, child protection and aggression in the workplace. The aggression workshop was requested because last year's was so successful. A diabetes workshop will also be repeated.
Some practice staff have been unable to attend the events. A target of£80,000 from sponsorship will be used to introduce a small programme of protected learning time in the workplace.
Other priorities this year are to:
appoint dedicated clinical leadership, since this is currently provided by a GP tutor with other calls on their time;
expand the pool of trained facilitators and produce a competency framework for their role;
raise awareness of GP appraisal and nurse/other staff continuing professional development needs;
secure objective external evaluation to measure the impact of training on personal behaviour and practice and team policies;
continue to network with the TARGET Foundation and regional target initiatives in London and neighbouring counties and trusts.
Discussions are taking place with a researcher from Imperial College, London, about evaluating the scheme.
Protecting time for staff to learn is important. It encourages staff to work together and maintains staff involvement and inclusion.Other organisations should be encouraged to take up this initiative to provide a little extra something for their staff.
A primary care trust has found that managers value the provision of locum cover for staff to attend multidisciplinary workshops.
Evaluation shows that GPs and other staff appreciate protected learning time.
If funding can be secured, the workshops will be supplemented with protected learning time in practices.
1The official protected learning time website.www. pltfoundation. com
Dr Carol Sutters is formerly deputy chief executive, Ealing primary care group; Marie Wallace is e-STAR co-ordinator, Ealing primary care trust; Dr Ramesh Bhatt is associate dean of postgraduate general practice, London Deanery; Dr Gouri Dhillon is primary care GP tutor, Ealing PCT and London Deanery.