Supporting nurses and junior doctors

South East London Workforce Development Confederation develops clinical technician and clinical assistant practitioner roles.

In September 2002, the South East London Workforce Development Confederation (SELWDC) recognised that a number of trusts were developing clinical support roles to assist in the reduction of junior doctors hours.

SELWDC worked to develop a standard role that could be supported across south east London and nationwide. In May 2006 SELWDC undertook an evaluation of the developed roles in Newham University Hospital, University Hospital Lewisham, and Whipp’s Cross University Hospital. The evaluation, undertaken by Matrix Research and Consultancy identified positive opportunities for staff development, potential time release for medical and nursing staff, reported improvements in patient care and waiting times and increased cost efficiency.

Programme Development

Clinical technician (CT) and clinical assistant practitioner (CAP) roles were developed by SELWDC with the six south east London trusts in 2003 using agenda for change standards, the knowledge and skills framework, and the national occupational standards, to enable roles to be transferable to other trusts. The group also worked with representatives of the army, who use medical combat technicians; roles which share similarities with those developed in south east London. SELWDC collaborated with South Bank University and the Guy’s, King’s and St. Thomas School of Medicine to design a foundation degree that is two years long, with a stepping off point at the end of year one when students can achieve a Higher National Certificate (HNC), the highest qualification for CTs.

The intellectual property for the course rests with SELWDC so that further training courses can be developed in other geographical areas.

The CT role has been developed to be an agenda for change Band 3 role and involves a number of tasks such as inserting cannulae and phlebotomy. CAP trainees are on band three whilst training but progress to band four once training is complete. CAPs will undertake similar but more complex tasks to CTs with additional scope for managerial responsibilities. At the time of the evaluation, the first intakes to the CAP scheme had not yet graduated.

Role implementation

The three trusts have set up and are developing and supporting the CT and CAP roles in different ways. At Lewisham CTs / trainee CAPs work across wards in response to need and are rotated into A&E. A similar system is used in Whipps Cross. Within Newham, a nursing led model is being followed for CAPs similar to Manchester’s assistant practitioner programme where trainee CAPs are more aligned to wards.

Feedback from trusts suggested that successful ongoing implementation will be dependent on clear organisational leadership, clear management structures, a clear vision, links to a career structure, and managed expectations within the roles. As the CAP roles are still in the early stages, an understanding of the benefits and shortcomings of the different models has yet to be fully realised.

Overall the introduction of the CT and CAP roles were viewed as providing an opportunity for staff to develop, as many of the CTs and CAPs interviewed had backgrounds in healthcare assistant roles or phlebotomy.

However, outcomes from the evaluation suggested there is potential for high turnover of staff within these roles, particularly where the new roles are not fully incorporated into a broader career structure, with some CTs and CAPs commenting that advancement opportunities beyond the CAP role are not clear.

Role impact

Trusts identified a range of benefits which the CTs and trainee CAPs provide. CTs and trainee CAPs are utilised within trusts to undertake activities previously carried out by other staff groups. For example, CTs now form part of the Hospital at Night team within Lewisham, enabling the trust to reduce the number of outreach nurses in the team.

The use of CTs and trainee CAPs to undertake routine tasks such as venepuncture and cannularisation was reported by staff as creating ‘time release’ from basic tasks for junior doctors and nurses, enabling them to focus on more complex tasks.

Supporting nurses and junior doctors

South East London Workforce Development Confederation develops clinical technician and clinical assistant practitioner roles

However, it was also highlighted that there may be a potential for the deskilling of junior doctors and nurses as they do fewer of these tasks. A further benefit of using CTs and trainee CAPs to undertake these routine tasks was that they became highly skilled in their roles, reportedly having a positive impact on the quality of care received by patients and reducing waiting times. Where CTs and trainee CAPs are utilised to help improve care pathways, for example by undertaking pre admission screening for MRSA, the impact could be highly significant. In financial terms CTs and trainee CAPs appear to be cost efficient in performing equivalent activities to nurses and junior doctors.

Success factors and challenges

The high level evaluation provided evidence to support the further rollout of the CT and CAP roles within the participating trusts and nationwide. It is likely that any such rollout would involve new areas of work, such as the use of CTs to undertake MRSA screening or in different areas such as maternity services. Whilst the roles are still in the early stages of implementation, it is apparent that clarity of purpose, strong leadership, clear career progression and effective support will be required to ensure long term success. National registration via a professional body would provide a crucial underpinning to this.

For more information contact Rebecca Kingsnorth at Matrix Research and Consultancy on rebecca.kingsnorth@matrixrcl.co.uk