Published: 01/08/2002, Volume II2, No. 5816 Page 26 27
Like all professionals taking on managerial roles for the first time, consultants and GPs need help to fulfil their potential. Caron Grainger and Neeta Manek outline an induction course that did just this
One medical manager observed that new consultants fail not because they lack clinical competence but because they lack supplementary skills.
1Many doctors have never had managerial responsibilities during their training and this can become more stressful than the clinical work in the first few years of being a consultant.At consultant level, there is personal accountability for patients' clinical care and for audit across the directorate.This may feel fairly worrying when this responsibility is given in the context of little control and too few resources.
Disillusionment in the NHS can creep in if newly appointed senior staff are unable to manage the expectations of them and their service, so management development early on is important.
Reviews of the development of clinical governance in trusts conducted by West Midlands regional office in 1999-2000 confirmed that the development of the consultant role was almost ignored from an organisational perspective.Consultants were not inducted into the role or given appraisals, and continuing professional development was focused on the individual's perception of need, rather than the organisation's.
Also, training for specialist registrars focuses on developing good clinical skills rather than teaching, risk management, team leadership and clinical management in the wider consultant role.
2Further policy initiatives, such as consultant appraisal and risk reduction, have contributed to the need to review the most appropriate way of developing newly appointed staff.
3,4 The medical director of Warwickshire health authority and the four trusts in Warwickshire joined together to consider ways of developing the consultant workforce.
We identified three groups of consultants:
Newly appointed consultants requiring basic skills in people management, team development, risk management and evidence-based practice.
Consultants who have been in post five to 10 years who may be considering becoming clinical directors and need more advanced skills in human resources management, budgeting and socio-political skills.
Consultants wishing to become medical directors or chief executives.
We considered that a first step to developing a clinical manager would be an induction scheme for new consultants.
Our application for funding from the West Midlands postgraduate deanery was successful in getting£13,000 to run two courses for 12 people, on the condition the scheme was extended to newly appointed GP principals.This joint GP and consultant training programme aims to equip newly appointed consultants and GP principals with the necessary skills to:
play a full part in clinical governance;
understand basic risk-management principles;
understand the principles of conflict resolution;
develop multidisciplinary working;
understand how to make the most of appraisal as an opportunity for development;
put together a basic personal development plan.
Dr Neeta Manek, a consultant microbiologist with an interest in management development, was commissioned to develop the course.Much of the training was provided from within the NHS, with only a couple of sessions provided by outside facilitators, and there was£3,000 sponsorship from pharmaceutical firms, reducing the cost of course delivery to about£6,000 per 12 individuals.
Local trusts and primary care groups were asked to nominate newly appointed consultants and GPs whom they considered would benefit from the course.Two sets of 12 participants have completed the course, with another set ongoing.The attendance rate ranged from 70-80 per cent and the participants were released for a total of six days' training over a variable period of time.
Each part of the course and the course overall has been evaluated in terms of participation, reaction, learning and performance.Participants were asked to identify their learning objectives on the first day and these were recorded and shared with the group.The participants and the course organisers set the learning objectives.Subsequently, each event has been evaluated using a feedback questionnaire designed to encourage the participants to reflect on:
the most important learning from the day;
what they will now do differently;
how their views have changed;
how this learning will change clinical practice.
In addition, course tutors were asked to give feedback on the evaluation from their own perspective.This showed that participants welcomed the opportunity to learn together and gained insight into work across acute and community healthcare boundaries.The programme also offered opportunities to set up learning clubs and support to learn together long term.
The events on clinical risk management and personal development planning were well received and do not require modification.However, there is a requirement to modify and develop the event on personal governance and clinical decisionmaking.These aspects have now been modified in the second programme.
Perhaps the most difficult area has been addressing multidisciplinary learning.We originally envisaged participants bringing along colleagues from different disciplines to allow them to work together for the day. In the event, it was impossible for other individuals to be released from practice, so key representatives from acute and community healthcare trusts were involved in the discussion groups.
Because the course had a positive impact, further money has been made available from the postgraduate deanery to roll out the programme to Hereford and Worcestershire.The West Midlands South workforce development confederation is also supporting roll-out across Coventry.This time the work will focus on consultants only, due to the advent of higher professional education for GPs.
The deanery is also supporting a fuller evaluation by an outside body, which will also be responsible for a full trainingneeds analysis.The National Leadership Centre has plans to evaluate the consultant/GP course that started in Warwickshire in May this year.
Inter-professional education is a key theme for developing NHS staff as part of the modernisation agenda.
Modernisation of services implies that learning and development opportunities will need to mirror patient pathways and cut across professional and healthcare boundaries if the patient is to benefit from the investment.This is already the case for care in cancer, emergency and other clinical services.
This development aims to facilitate the development of GPs and consultants as they take on management responsibilities.We hope it will improve their job satisfaction and enable them to build long-term careers in the NHS.
Practice makes perfect: the outline programme
Day 1. Introductory day
Role of a consultant
Conflict management
Stress management
Need for personal development
The health community and roles of organisations within it
Professional leadership and influencing clinical governance
Day 2.Personal development
Making the most of appraisal
Developing a personal learning plan
Day 3.Training the trainer
Day 4.Risk management: patients and risks and how to minimise errors and complaints
Identifying risk
Reducing risk lManaging complaints
Day 5. Introduction to clinical effectiveness and evidence-based practice
Day 6.Multidisciplinary working
Key points
Most newly appointed consultants have had no training in management.
Consultants who have been in post for several years may need extra management development to become clinical directors, medical directors or chief executives.
A training scheme initiated in the West Midlands appears to have been well received and is being extended.
Dr Caron Grainger is medical and professions director, West Midlands South Workforce Development Confederation.Dr Neeta Manek is director of education, George Eliot Hospital trust.
REFERENCES
1Fidler H.Starting off on the right foot.Br Med J 2000; 321:2.
2Khera N, Stroobant J, Primhak R, Gupta R, Davies H.Training the ideal hospital doctor: the specialist registrars'perspective.Medical Education 2001; (35):957-66.
3Department of Health.Advance letter (MD) 5/01.Consultants contract: annual appraisal for consultants.2001.
4Department of Health.An organisation with a memory.Report of an expert group on learning from adverse events in the NHS.2000.
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