Unit One

The development of the role of the health care assistant

Key messages

General practice teams have evolved to meet the changing demands of patients and the healthcare system.
Health care assistants (HCAs) provide extra capacity in general practice by freeing up the time of nurses and GPs.
HCAs are taking on a range of routine tasks delegated by nurses and GPs, for example phlebotomy, newpatient checks and health promotion.
This toolkit is intended to develop and optimise the role of the HCA so that both practices and patients benefit.

Health care assistants: helping GPs and nurses to care for their patients

General practice teams have changed and evolved to meet the growing demands of patients and the healthcare system. Historically, general practices were small, often single-handed organisations with the GP as the sole care provider. Today, general practice teams include registered nurses (such as nurse practitioners and practice nurses), other healthcare professionals (such as physiotherapists, mental health counsellors and therapists) and non-registered nurses (such as HCAs). By working in more diverse teams, general practices have been able to cope with an ageing population, developments in the management of long-term conditions and a new contract.

HCAs are helping general practice provide more services to their patients by freeing up the time of nurses and GPs. HCAs take on less complex, but important, tasks that have traditionally been performed by nurses. They also work alongside GPs so that GPs can spend more time focusing on the needs of their patients, and less time on administration and paperwork.

The range of tasks undertaken by HCAs in primary care varies from practice to practice. A recent review of training programmes for HCAs provides some idea of the scope of the HCA’s role in general practice.

The potential range of HCA duties in general practice

New patient registration
Blood pressure checks
Urinalysis
Height/weight/BMI
Ordering supplies/stock control
Cleaning sterilisation
Equipment
Phlebotomy/venepuncture
Ordering vaccines
ECG recording
Peak-flow measurement
Spirometry
Audiometry
Smoking cessation
Restocking of clinical area
Health promotion
Supporting practice
Nurse triage
Minor-illness clinics
Assisting with minor operations
Infection control
Health checks
Summarising patient records
Acting as a chaperone
Helicobacter testing
Patient recall
Helping with specific long-term conditions, eg diabetes, asthma

By taking on these, and other, roles, HCAs are becoming integral to the smooth running of many practices and have created the capacity, particularly among nursing teams, for practices to take in their stride the challenges that are laid down in the new contract and the trend towards moving services out of hospital.

Impact of the HCA in general practice

The Ridge Medical Practice, Bradford is a large general practice serving 17,500 patients and employing around 50 staff. Following on from the success of the rapid-access clinic, they decided to look at the work of their trained nurses. An audit showed that approximately 50% of their duties could be undertaken by someone who was appropriately trained, but did not need nursing qualifications. Support, mentorship and training are provided in-house by qualified registered general nurses using a distance-learning course run by the Primary Care Training Centre in Bradford. Competency is assessed on an annual basis and recorded in a portfolio. The HCA work covers a range of activities: new patient interviews, assisting at clinics, phlebotomy, ECG testing, blood pressure monitoring and smoking cessation. The practice has benefited in a number of ways, and this has enabled the GPs and nurses to undertake more specialised work in and out of the practice.

Introduction to this toolkit

The Working in Partnership Programme (WiPP) was established under the new General Medical Services (GMS) contract to support general practice with workload and capacity issues.1 Through this HCA toolkit, we aim to spread the positive experience of general practices that have employed HCAs. These innovative practices have changed in response to the combined challenges of modern practice and evolving policy to develop a new role in the general practice team.

The toolkit draws together a resource that supports practices to navigate the recruitment, education and training, personal development, competence assessment and integration of the HCA role. It is intended to minimise the effort needed to take forward the recruitment and optimisation of the HCA role.

This toolkit is designed to help the following groups to optimise the role of the HCA:

HCAs – and people thinking about becoming an HCA
General practice employers – who currently employ or are thinking about employing HCAs
PCTs – who want to encourage and support their practices to make use of HCAs
Education providers – who help to provide the support that is needed to train and develop HCAs
Patients – who come into contact with HCAs.

Each unit deals with a different aspect of developing the role of the HCA in general practice.

The effectiveness of the HCA is dependent upon a number of factors, each of which can be optimised to help the practice get the most out the role. These factors include the following:

Supervision and mentoring
Access to training and development
Needs of patients in the practice
HCA competences
Identified new roles for the nursing capacity that is released
Defined roles for the HCA.

This toolkit deals with each of these factors and provides the resources that you will need to get the most out of the HCA role.

If you are a general practice that currently employs an HCA, this toolkit provides self-contained units that you can use to review your current approach and to optimise the work of your HCA.

If you are a general practice that wants to introduce an HCA to your practice team, this toolkit provides advice and support to guide you through the process, beginning with recruitment through to the integration of the HCA role into your practice. There are many reasons why you should make an HCA part of your practice team. For more detail see: Tool - Why introduce an HCA into your practice

The toolkit is divided into nine units (this is Unit 1) that cover all aspects of developing and getting the most out of the HCA role. The other units in the toolkit are:

The role of the HCA in general practice is relatively new, but is growing. Our work with practices and their HCAs has shown that HCAs can make a valuable and meaningful contribution to the work of the practice team. HCAs provide a valuable increase in capacity to take on the challenges that practices face, while making the most of the existing resources within the practice team.