Published: 13/05/2004, Volume II4, No. 5905 Page

Healthcare assistants can relieve pressure on primary care, but funding their training requires some inventive thinking. Vivienne Stimpson explains

The role of the healthcare assistant within general practice is designed to provide clinical and administrative support. Its development is an important part of the workforce modernising agenda, not least in terms of shifting the balance from secondary to primary care.

The NHS plan requirements for access to a healthcare professional within 48 hours and a GP within 24 hours are not met in most practices with a traditional skillmix, where practitioners carry out a range of tasks that could be performed by other team members following training.

Improved skill-mix would allow practices to treat more patients by developing skills in nurse telephone triage, nurse-led minor illness clinics and nurseled chronic-disease clinics. Nonqualified staff could undertake roles in new patient assessments and health promotion.

Healthcare assistants were first mooted as a possible solution to capacity problems caused by development of the nurse practitioner role in the north of Barnet primary care trust's area.

Three practices won pilot funding from the Department for Education and Skills' Individual Learning Accounts programme, and a steering group - including practice nurse leads, primary care service managers, clinical practice development nurses, a senior lecturer at Middlesex University and a training manager, reporting to the north locality director - was formed to develop the project.

The six-week programme provides healthcare assistants with the administrative and clinical knowledge they need to be safe and capable in their supporting roles, while ensuring ongoing support is provided by a practice nurse.

The core themes of the training are the role of the healthcare assistant, developing effective communication, management skills, clinical activities, understanding health and safety practice, and health promotion.

Students have formal and informal teaching sessions, case studies, experiential activities, work-based supervision and access to the PCT library and health promotion department, and they all complete a learning portfolio.

The initial impact of the role on primary care services and workforce development in Barnet was evaluated.Healthcare assistants who had completed training and had been in practice for over six months were included. Sixtythree per cent of questionnaires sent to practice managers, GPs, practice nurses and healthcare assistants were returned.

The majority of assistants were carrying out all of the possible functions - from new patient registrations, to ordering vaccines - apart from peak flow asthma tests and ordering vaccines and electrocardiograms.

Many practices have developed their healthcare assistants' health promotion role to offer smoking cessation, dietary advice and assistance with 'MOT' health checks, and some assistants had started to perform simple dressings.

GPs, practice managers and practice nurses consistently rated the benefits of a healthcare assistant as high.

Descriptions of service improvement often included the assistants' invaluable role in relieving nurses from a burden of non-clinical activities.

Only one HCA raised concerns about their new role, relating to the balance between reception and healthcare assistant duties.

It is important that the role is given space and time to develop and that boundaries are clear to the assistant and other team members.

Middlesex University has agreed to develop a mentorship pathway and programme for practice nurses to complement the course.

We also recommend that a framework for the mentorship and support requirements of the role should be undertaken as part of the PCT's workforce development opportunities.

Barnet PCT is currently developing a model of supervision that encompasses practice staff, after the evaluation highlighted a need for ongoing support.

All staff should have an annual appraisal to ensure their continuing professional and personal development requirements are met, not least because this will form part of the annual general medical services assessment by PCTs.

We also recommend that panBarnet guidelines and standards are developed by the PCT as part of ongoing development of healthcare assistants.

Many of the assistants had received additional training in first aid, cardio-pulmonary resuscitation and health and safety. Three healthcare assistants started national vocational qualification training and intend to start nurse training.

Healthcare assistants said further training in health promotion, counselling and communication skills would be useful, and identified a need for further support outside the practice as a group in the form of training or clinical supervision.

Asked how they saw the role developing in general practice, respondents said preregistration training, delegation of further tasks as appropriate, a wider role in health promotion training and more IT-based training to support the new general medical services contract should all be considered as next steps.

As a result of the evaluation, staff who take the introductory programme from 2005 will automatically start their skills escalator to professional registration, removing the need for participants to link with NVQ programmes, access courses or the cadet scheme if they choose.

This will strengthen the relationship between the introductory course and preregistration training, enabling more nurses to become professionally qualified in three to four years.

Because we were able to demonstrate the scheme's role in helping 100 per cent of participating practices to meet their access targets since February, funding for training has been agreed by the north west London workforce development confederation for 2004-05. This will enable more practices to benefit from the scheme.

Vivienne Stimpson is a Barnet PCT clinical practice development nurse.