Healthcare assistants in general practice: a qualitative study of their experiences.

AIM: To explore the experiences of healthcare assistants (HCAs) working in general practice (GP). BACKGROUND: HCAs increasingly play an important role in UK GP teams. The role is relatively new and little is known about how HCAs feel about their work in GP, and the challenges that they face. METHODS: Semi-structured interviews were undertaken with 14 HCAs from two Primary Care Trusts in the West Midlands, United Kingdom. Transcriptions were analysed using the framework analysis approach. FINDINGS: Overall, HCAs reported that they enjoyed their work, and particularly appreciated the patient contact and positive feedback gained. Attitudes to the role were affected by previous position, experience, and length of time working within the practice. The HCAs felt accepted and supported by GP team members and valued the support they were receiving. Key sources of frustration included the poor salary, the lack of initial clarity with regard to role definition, and the constraints of their scope of practice. Role boundaries between HCAs and practice nurses were experienced as well defined, and no perceptions of role ambiguity were reported. HCAs considered their work to be of relatively low status, with its main purpose being to ease the practice nurse's workload. Although many had the desire to train as nurses, few saw it as a realistic possibility. CONCLUSIONS: Although HCAs appear to be satisfied overall, the elements of dissatisfaction relate to status, pay, and career progression, which may limit the retention of individuals in this role. Practices should consider the importance of recognising and valuing the work of HCAs and of providing protected time and resources for mentorship and career progression.

Allied health professionals' intention to work for the National Health Service: a study of stayers, leavers and returners.

While there has been a recent squeeze on staff costs, it continues to be important to offer graduating clinical staff National Health Service (NHS) employment in order to maintain the long-term strength of the service. In addition, the experiences of the Canadian nursing profession suggest that complacency about an improving recruitment situation can lead to problems. Consequently, the objective of this study was to identify what influences allied health professionals' (AHPs) intention to work for the NHS. A postal survey was sent to members of four Allied Health Professions equally (N = 4800), targeting Stayers in, Leavers from, and Returners to, the NHS. One thousand nine hundred and thirty-nine questionnaires were returned giving an overall response rate of 40%. Stayers' intention to remain in the NHS was influenced by continuing professional development opportunities, confidence that they can find NHS work, commitment to their profession, a sense of moral obligation and a belief that other people important to them think it is a good idea. Returners' intention is influenced by similar factors as Stayers. Leavers are influenced by similar factors as Stayers/Returners but to a lesser extent. The study shows that perceptions of various NHS work characteristics, which lead to reasonably positive attitudes towards the NHS, do not necessarily translate into intention to work for it. The study also shows that intention to work for the NHS is not solely dependent on perceptions of NHS jobs and that career-decision-making is a social process, with the opinions of people who are important to AHPs also influencing career decisions.

Benefits and challenges of employing health care assistants in general practice: a qualitative study of GPs' and practice nurses' perspectives.

BACKGROUND: Estimates suggest that over half of general practices in England currently employ a health care assistant (HCA) but there is little evidence of their impact, effectiveness and acceptability to patients and primary care team members. OBJECTIVES: To explore the role of HCAs in general practice and the benefits and challenges associated with their employment. METHODS: Semi-structured interviews were performed with 6 GPs and 13 practice nurses as part of a larger qualitative study that also included HCAs. Interviewees were from 16 general practices from two Primary Care Trusts in the West Midlands. Transcripts were analyzed using thematic and framework analysis. RESULTS: HCAs were seen as a valuable addition to the primary care team. They were reported to accelerate, rather than extend services, allow more appropriate use of nurses' skills and enable cost containment. Their training and supervision were felt as time intensive, demanding of time and commitment. Patient safety was raised as a concern, although no specific experience of it being compromised was reported. Nurses recognized the usefulness of HCAs, helped to make the role work, but were often anxious about the impact on their own roles and professional identity. Patients were perceived as being generally neutral or positive. CONCLUSION: Cost-effectiveness, patient safety, quality of care, potentially contested role boundaries and patient attitudes are among the issues that policy-makers, commissioners and those responsible for workforce development and training need to consider in relation to HCAs in general practice. There is also a need for more in-depth evaluation of this role.

Why do speech and language therapists stay in, leave and (sometimes) return to the National Health Service (NHS)?

BACKGROUND: Research into recruitment, retention and return of speech and language therapists in the National Health Service (NHS) is relatively limited, particularly in respect of understanding the factors that drive employment choice decisions. AIMS: To identify what factors influence speech and language therapists working in the NHS to stay, and consider leaving, but not do so. To identify what features of the NHS and alternative employers influence speech and language therapists to leave the NHS. To identify why some speech and language therapists return to the NHS after working elsewhere. METHODS & PROCEDURES: A total of 516 male and female speech and language therapists, in three distinct groups (NHS stayers, leavers and returners) completed a questionnaire and gave responses to open-ended questions regarding their perceptions of the NHS and other employers. Qualitative data analysis identified reasons why individuals stayed in, left or returned to the NHS employment, and what actions could be taken by management to facilitate retention and return. OUTCOMES & RESULTS: Stayers value job and pension security; professional development opportunities; the work itself; and professional support. Leavers not involved in childcare left because of workload/pressure/stress; poor pay; and not being able to give good patient care. Returners returned because of flexible hours; work location; professional development; and pension provision. Stayers and returners primarily wish to see more staff in the NHS, whereas leavers would return if there were more flexibility in work arrangements. Returners were particularly hostile towards Agenda for Change. CONCLUSIONS & IMPLICATIONS: Whilst some preferences appear to require increased resources, others such as reducing bureaucracy and valuing professionals do not. The full impact of Agenda for Change has yet to be established. Predicted excess labour supply of allied health professionals and future structural changes present pressures but also possible opportunities for speech and language therapists.

Healthcare assistants in general practice: practical and conceptual issues of skill-mix change.

The emergence of healthcare assistants (HCAs) in general practice raises questions about roles and responsibilities, patients' acceptance, cost-effectiveness, patient safety and delegation, training and competence, workforce development, and professional identity. There has been minimal research into the role of HCAs and their experiences, as well as those of other staff working with HCAs in general practice. Lessons may be learned from their role and evidence of their effectiveness in hospital settings. Such research highlights blurred and contested role boundaries and threats to professional identity, which have implications for teamwork, quality of patient care, and patient safety. In this paper it is argued that transferability of evidence from hospital settings to the context of general practice cannot be assumed. Drawing on the limited research in general practice, the challenges and benefits of developing the HCA role in general practice are discussed. It is suggested that in the context of changing skill-mix models, viewing roles as fluid and dynamic is more helpful and reflective of individuals' experiences than endeavouring to impose fixed role boundaries. It is concluded that HCAs can make an increasingly useful contribution to the skill mix in general practice, but that more research and evaluation are needed to inform their training and development within the general practice team.