Unit Two

The employment of health care assistants in general practice

Unit key benefits

Reading this unit will:

  • explain the background to the development of the health care assistant’s (HCA) role
  • explain why following good employment practices is important for general practice.  

The principles of employing staff who can provide the best and most effective care for patients is outlined in A Health Service of All the Talents: Developing the NHS Workforce.1 This emphasises the importance of:

  • team working across professional organisations and boundaries
  • flexible working to make the best of the range of staff members’ skills and knowledge
  • streamlined workforce planning and development, or that which stems from the needs of patients, not of professionals
  • maximising the contribution of all staff to patient care, doing away with the barriers that state that only doctors and nurses can provide particular types of care
  • modernising education and training to ensure that staff are equipped with the skills they need to work in a complex and changing NHS
  • developing new, more flexible, careers for all staff
  • expanding the workforce to meet future demands.

The NHS Plan emphasised the importance of primary care and there has been central commitment to support general practice in improving standards and providing a wide range of more accessible services for patients. It is recognised that in order to make the most of new investment, changes to working practices are needed and many practices have already begun to lead the way by making better use of skill mix. National direction for nursing, Liberating the Talents3, has provided a framework for planning and delivering nursing services in primary care. This recognised the vital role of nursing staff in ensuring that patients get the right care, in the right place, at the right time.

Primary care – your first point of medical contact in the community, eg your general practice surgery.
Seconday care – where patients are referred for more specialist attention or treatment.

Primary care continues to evolve and grow, with new services being developed. Practices face numerous changes that contribute to the continuing improvement in patient care. Many of these changes demand new ways of working in order to make the best use of workforce skills. Patient-led services and the drive for quality have led to the deployment of staff skills based on patient need, not professional group. This has allowed the development of new roles, with many nurses taking on advanced clinical skills that previously fell within the domain of doctors.

Just as the role of the GP is changing to embrace more complex care, so new roles for nurses are evolving within general practice settings.

This, in turn, allows HCAs to develop their roles, with nursing supervision, creating a greater skill mix
within the practice.

Understanding the role of the HCA

An HCA is defined as ‘someone who works under the guidance of a qualified healthcare professional’

At the present time, HCAs are not regulated or registered, so it is important that they have clear guidance about their role.

It is considered good practice that all employees are given a job description and person specification detailing their role and responsibilities. In addition, an HCA should receive:

  1. a clear list of appropriate tasks, with training to enable them to undertake the tasks as necessary
    (see Unit 3: Competences)
  2. a clear understanding of the boundaries; the ultimate boundary being the safety of the patient
    (see Unit 3: Competences)
  3. agreed protocols for the delivery of care
    (see Unit 3: Competences)
  4. clarification of the issues around delegation, accountability and indemnity
    (see Unit 7: Integration of health care assistants in the general practice workforce)
  5. support and guidance in the role
  6. opportunity to develop new roles as practice needs allow.

The new General Medical Services (nGMS) contract is an important government document, which evolved in partnership between the NHS Confederation and the General Practitioners Committee of the British Medical Association. It creates greater flexibility for GPs and represents an unprecedented level of investment in primary care.

Practice-based commissioning (PBC) is a policy which enables GPs and other frontline clinicans to commission services that are focused on the needs of their patients. This is likely to lead to more services being provided in community settings, resulting in greater convenience for patients.

The nGMS contract provides resources to support role development and higher quality services. It offers GPs and practice staff the opportunity to:

  • reconfigure the skills base of the workforce
  • improve quality
  • manage workloads
  • improve the working lives of all staff within the practice.

With the introduction of PBC, the opportunities for all staff to expand their knowledge and expertise will grow. General practices with good employment practices will be better placed to recruit and retain high-calibre staff who will help to deliver a greater range and quality of services.

By following guidelines such as these, practices can ensure that their employment practice is of the highest standard.

The Royal College of Nursing (RCN) has developed an employment charter for practice staff, which lays out a basis for a good employment strategy.5 It states that practices should:

  • follow the spirit and requirements of the relevant national human resource strategy
  • provide an up-to-date written contractual statement and job description for every post
  • link salaries to national scales, providing annual increases in line with national pay awards
  • offer staff a personal training and development plan (see Unit 4: Personal and professional
    development of health care assistants    )
  • ensure staff have the right to join, and be represented by, a trade union of their choice, suffering no
    disadvantage as a result
  • offer healthcare professionals a source of professional advice and support within the primary care trust
    have written procedures to handle disciplinary matters and grievances, following guidance published by the Advisory, Conciliation and Arbitration Service (ACAS)
  • have a written health and safety policy, based on the concept of risk assessment
  • observe the requirements of the Working Time Regulations
  • have a system for recording accidents and violent incidents involving staff, including verbal or other abuse
  • have a written equal-opportunities policy and follow good practice in making appointments, staff management, terms and conditions of employment, training opportunities and promotion
  • have a written policy on sickness absence, including sick pay arrangements that apply in practice. 

Summary

  • The development of the HCA role is part of a wider development of primary care.
  • Demand for patient led services is forcing practices to think carefully about the mixture of skills that their team possess.
  • HCAs are increasingly seen as a core component of a well structured team in primary care.
  • HCAs require clear guidance and documentation to define their role and its limits.
  • By following good recruitment and employment processes practices are more likely to get the right person for the job. 

References

  1. Department of Health. A Health Service of All the Talents: Developing the NHS Workforce. London: Department of Health; 2000. http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4007967&chk=ftJn9C
  2. Department of Health. The NHS Plan. London: Department of Health; 2001. http://www.dh.gov.uk/assetRoot/04/06/69/38/04066938.pdf
  3. Department of Health. Liberating the Talents. London: Department of Health; 2002. http://www.dh.gov.uk/assetRoot/04/07/62/50/04076250.pdf
  4. NHS Careers. Health Care Assistants/Auxiliary Nurses. NHS Careers website. http://www.nhscareers.nhs.uk/nhs-knowledge_base/data/5187.html
  5. Royal College of Nursing. RCN Nurses Employed by GPs – RCN Guidance on Good Employment Practice. London: Royal College of Nursing; 2005.
    www.rcn.org.uk/publications/pdf/nurses_employed_by_gps.pdf
  6. Department of Trade and Industry. Your Guide to the Working Time Regulations. London: Department of Trade and Industry; 2003.
    http://www.dti.gov.uk/employment/employment-legislation/employment-guidance/page14382.html