Agenda for Change

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Consultant Practitioner Project
Fleur Kitsell Associate Dean, Wessex
Institute Severn and Wessex Deanery Fleur.kitsell_at_
sevwesdeanery.nhs.uk
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NHS Career Framework
PhD
MSc
BSc
Foundation Degree
Apprenticeship
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Consultant Practitioner

• Job role
• Expert practice (50)
• Professional Leadership
• Education, training and development
• Service/practice and policy development through
  research and evaluation

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Consultant?

• Engineers, IT, Finance
• Doctors no clear statement on Consultant job
  role, it is recognised as being a familiar if
  imprecise term
• (The Competent doctor, the Specialist, the
  Consultant
• A position paper Academy of Medical Royal
  Colleges and Faculties, 2004)

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Drivers

• Modernise Service Provision
• NHS Plan, July 2000
• NHS Improvement Plan, June 2004
• Career progression (AfC level 8)
• EWTD, new Doctor contracts (Hospital and Primary
  Care) OoH, etc

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Disruptions in Healthcare
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(No Transcript)
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History

• Consultant Nurse posts announced in 1998 (first
  appointments in 1999)
• Consultant AHP posts announced in 2001 (first
  appointments in 2002)

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How to become a CP

• ????

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General Challenges

• Variation in scope of CP role
• Balance between practice and academic capability
• Literature largely descriptive
• Organisational and Professional readiness for
  these roles
• No recognised training for the role

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Programme framework

• Programme
• 3-6 year programme, training in expert practice
  in specialty area together with an MSc or
  Professional Doctorate
• 50 service contribution, 50 learning SD
• Early year(s) at AfC level 6 later years AfC
  level 7
• Minimum Entry
• registration with eg NMC, HPC etc
• First degree (or equivalent)
• 2 years experience working in specialty (more
  experienced individuals may enter programme at
  advanced level)

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Framework

• Focus on 6 specific factors from AfC
• Knowledge, training and experience (2)
• Analytical and Judgement skills (3)
• Responsibilities for patient/client care (6)
• Responsibilities for leadership, training (9)
• Research and Development (11)
• Freedom to act (12)

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Specific programme

• Programme Neurological Rehabilitation, with an
  emphasis on Stroke
• Team Consultants (Doctor, Nurse,
  Physiotherapist, Occupational Therapist)
• Documents - Existing Curricula, NSFs
• Patient need/journey
• Multi-professional programme with academic and
  clinical competences
• In synergy with PG medical training (SpR level)

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• Two specific programmes
• Emergency Care
• 5 about to graduate, 4 more recruited
• 3 new CP posts created locally
• Neuro Rehab, Stroke
• 4 recruited

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Consultant Nurse in Stroke

• Before appointment
• Time to review after TIA 6 weeks
• Poor communication between Primary and Secondary
  Care
• No clear patient pathway
• No evidence-based Stroke Patient Management
  Protocols
• No real service development

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Consultant Nurse in Stroke

• Now
• Time to review after TIA 1 week
• Nurse-led beds for Stroke in Acute Trust
• Evidence-based stroke patient management
  protocols
• Protocol for transfer of care
• Service Development through regular audit and
  research project in partnership with Kings
  College London Medical School

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C Physio in M/S

• Before appointment
• Inappropriately late GP referral to physiotherapy
  for musculoskeletal problems
• First physiotherapy appointment DNA rate of 15
• Long waiting list for Physiotherapy

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C Physio in M/S

• Solution
• CP appointed - physiotherapists trained in
  supplementary prescribing and PGDs and patient
  self referral to physio
• After 6 months
• 66 patient musculoskeletal needs managed by
  phone
• First appointment DNA rate dropped from 15 to 1