Primary Care Academic Partnership Adviser, General Practice and Primary Care Research Unit, University of Cambridge, Cambridge, UK
Jane Payling MA Cantab
Head of Workforce Finance, Norfolk, Suffolk and Cambridgeshire Strategic Health Authority, Cambridge, UK
Received date: 17 December 2004; Accepted date: 14 January 2005
The clinical governance agenda prioritises staff development as one key factor in the improvement of healthcare services. This paper describes a scheme designed to support healthcare professionals in learning about research and in applying these newskills within their professional roles to develop health services. The contribution of the original phase of the scheme is described as is the definition of the new scheme (PEARL – Practitioner Enterprise Awards in Research and Learning). The new scheme reflects national recommendations for development across the service/academic boundary and its definition has required explicit acknowledgement of the different policy drivers impacting on the organisations involved.
primary care, professional develop-ment, research, service/academic partnership
Clinical governance emerged as a cornerstone of the UK government’s drive towards improved quality of healthcare services in 1997. Early documentation stressed the importance of nurturing the ‘human resource’ to enable this improvement to take place.
The staff of a healthcare organisation will be the key to how it rises to the challenges of the new agenda. Firstly, good recruitment, retention, and development of staff will make a major contribution. Secondly, staff must be supported if they are to practise well: skills training, modern infor-mation technology, access to evidence are all important. Thirdly, staff must participate in developing quality strat-egies and be encouraged to look critically at existing processes of care and improve them. Finally, valuing staff and letting them know that they are valued – easily espoused but often overlooked – is a common feature of organis-ations that show sustained excellence in other sectors.
This paper describes a scheme designed to support healthcare professionals in developing their skills in using and undertaking research. The scheme is in two phases, reflecting the different Funding scenarios to which it has needed to respond. The paper describes what the scheme has contributed with respect to the clinical governance agenda, and how it has evolved in response to both changing national policy and our growing understanding of the strengths and weak-nesses of such an approach.
The paper is authored by an academic adviser (HB) who participated in the implementation and evaluation of the first phase of the scheme, and by a member of the local workforce development directorate of the strategic health authority (JP) who has been instrumental in helping to define and resource the second phase.
Phase 1: the Enterprise Award Scheme
The first phase of the scheme, called the Enterprise Award Scheme, was set up in 1998. To obtain an award, a healthcare professional was asked to define a pro-gramme of activities spanning formal research train-ing (usually a Masters course) and research project activity (usually service based). Consistent with good educational practice, each individual was encouraged to tailor this programme to their own professional aspirations and circumstances.[3,4]
Funding was provided by NHS Eastern Region Research and Development (R&D), with the expec-tation that the scheme would generate outcomes of value to the national R&D policy agenda. In particu-lar, it was expected that the scheme would increase the number of primary care professionals who had re-search qualifications and who might expect to have current or future involvement in robust research pro-jects which would attract external Funding and be publishable. It was also recognised that these health-care professionals might provide a valuable mechan-ism for spreading knowledge about research and the use of evidence among their service colleagues.
The evaluation of the scheme showed that outcomes of relevance to the R&D policy agenda were achieved. Even more marked was the reported impact of the scheme on the professional contribution of those who participated. Benefits consistent with the require-ments outlined by Scally and Donaldson are exempli-fied in Table 1.
However, the evaluation also raised three areas of concern. The two concerns of most relevance to this discussion are firstly that award holders had difficulty in identifying opportunities to continue their research interests when returning to their full-time service roles, and secondly that award holders did not dem-onstrate much knowledge of local and national R&D policy. These are important concerns. The healthcare professionals involved were already reporting the ways in which they were able to apply their enhanced know-ledge and confidence to service development, but it seems likely that these benefits would gradually be lost if these individuals were unable to maintain and up-date their expertise in R&D. The lack of knowledge about national R&D policy would mean that the award holders were not well informed about how to negotiate service-based opportunities for further R&D involve-ment, with collaborators who could help them to main-tain and develop their particular R&D knowledge and skills.
Despite the apparent success of the Enterprise Award Scheme in delivering outcomes of value to both the national R&D and service agendas, the scheme was discontinued in 2002 following changes in the struc-ture and allocation of national R&D resources.
Phase 2: the PEARL scheme
Stakeholder groups involved in, or aware of, the Enter-prise Award Scheme (see Box 1) were keen to identify further Funding. However, the ability of the scheme to deliver outcomes of value to both the service and R&D/ academic agendas was to some extent a disadvantage, since no single funder was ready to assume sole respon-sibility for its continuation.
The local academic unit and the workforce develop-ment confederation decided to attempt to re-establish the scheme as the PEARL scheme (practitioner enter-prise awards in research and learning). To make the new scheme viable we needed:
• to break down the resourcing of the scheme so that different stakeholders would be enabled to take responsibility for resourcing elements of the scheme that particularly reflected their own policy drivers. Resourcing might involve financial contribution or the contribution of time and expertise
• to adapt the original scheme to ensure that award holders would be better placed to sustain their involvement within their employer organisation. (Strengthening the ability of the healthcare pro-fessionals to stay involved in research activity beyond the completion of the award is important partly because this issue was raised by the award holders themselves and also because it is consistent with our understanding of how professionals learn. Learn-ing is not just reinforced but is further increased and developed through professional application.)
We perceived that these requirements could be linked together effectively since where employer service or-ganisations are involved in Funding individuals, they are also likely to have greater ownership and commit-ment to follow-on opportunities that make full and appropriate use of the new skills acquired.
Following discussion, we identified that various stakeholders might be prepared to commit resources to a new scheme as long as their own policy drivers were respected within the contribution to which they were committed and within the specific overall outcomes sought. Stakeholder involvement is envisaged asfollows:
• workforce development directorate of the stra-tegic health authority (WDD): the WDD is con-cerned to support the development of healthcare professionals in line with the NHS Human Resources Strategy. The accessibility of any scheme to all healthcare professionals and its respect for existing HR developments, such as personal development plans (PDPs) and the new NHS Knowledge and Skills Framework (KSF) which will be introduced under the NHS Agenda for Change policy are important. As a general principle the WDD was prepared to consider Funding costs associated with course and conference attendance but not locum cover costs
• service organisations: service organisations are concerned to support quality improvement and service development and to ensure that value for money is achieved. Therefore any scheme will need to demonstrate impact on service development while at the same time requiring relatively small levels of additional resources. Service organisations are also driven by the need to recruit and retain established and valued professional staff. They may be prepared to release staff for training and consider Funding backfill or locum cover. This is most likely to be the case where organisations are confident that staff are learning new skills of relevance to their professional roles, and where the objectives respect organisational needs and priorities
flacademic units of general practice/research de-velopment support units: these organisations are concerned to support the development of R&D understanding and skills within the service com-munity. The expectation is that the healthcare professionals concerned will be better placed to contribute to major national R&D programmes in future by, for example, representing the service per-spective in the development of such studies, and promoting the value of the studies and their out-comes within the service community. These organ-isations are prepared to support the new scheme by providing expert advice and guidance on the selec-tion of appropriate courses, on how to apply what has been learnt in practice, and on national R&D policy.
PEARL has been designed to balance these differing organisational needs and contributions. The revised scheme requires that the award holder negotiates their involvement within their organisation and that this organisation contributes an agreed percentage (usually 80%) of the one day a week locum cover required during the period of the award. Within the application form, the individual applicant is asked to provide details of how their plans link to the policies and priorities of the organisation with which they are working, how these plans have been incorporated into their PDP, what discussions have taken place regarding what hap-pens beyond the period of the award and which indi-vidual within the organisation is taking responsibility for working with the applicant on these considerations.
It is expected that these requirements will ensure that both the individual and the organisation are commit-ted to the award and to realistic and desirable further developments to which such involvement should lead.
The involvement of the different stakeholders in providing resources towards the PEARL scheme is reflected in the anticipated outcomes from the PEARL initiative. It has been important to ensure from the outset that the means are in place to monitor what has been achieved in line with the various drivers that these stakeholder organisations have identified. Table 2 summarises the outcomes identified, the rationale for their inclusion and the evidence that will be collected as the scheme is implemented for the purposes of monitoring and evaluating.
In May 2003 the concept of ‘health and education strategic partnerships’ (HESPs) was introduced jointly by the Department of Education and Skills and the Department of Health. It was recognised that learn-ing and research are essential to the delivery of quality healthcare services and an initial project was set up to map current workforce and HR issues at the health/ education interface. This mapping project stressed the importance of contributions from both service and academia to initiatives in this area and also identified some of the current difficulties and gaps. The PEARL project is an exemplar of an initiative which aims to develop skills and opportunities across this service/ academic boundary. The way in which the project has been set up to acknowledge the different requirements that stakeholders may legitimately hold within the same scheme may provide a helpful model for other initiatives that are being planned at this interface.
The evaluation of the Enterprise Award Scheme suggested that it is possible to set up a scheme to deliver the requirements identified by Scally and Donaldson. However, the evaluation of the Enter-prise Award Scheme and educational literature alerted us to the concern that what such a scheme achieves should be judged not only in terms of short-term and easily measurable outcomes, but also in terms of whether, and in what form, that benefit is sustainable into the future.[2,5] In defining the PEARL scheme we have attempted to ensure that we are engaging stake-holders and collecting data in a way that will make the understanding and assessment of longer-term impact more relevant and achievable.
Our experience in defining the PEARL scheme in this way is already attracting interest from other initiatives under development and we offer this paper as a trigger to wider discussion about the nature, fund-ing and evaluation of initiatives that provide oppor-tunities for the development of staff and services at the service/academic boundary.
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