In this feature, Thoreya Swage, healthcare consultant, explains why general practice reception and administrative staff can benefit from training to meet the requirements of the GP Forward View and related initiatives such as the development of medical assistants in primary care.
In April 2016, the General Practice Forward View (GPFV), published by NHS England together with the Royal College of General Practitioners (RCGP) and Health Education England (HEE), identified the specific needs of primary care in the context of the Five Year Forward View strategy.
The GPFV recognised that the primary care workforce needed to be enhanced and increased. In addition to the initiatives to improve the numbers of doctors practising in primary care, the support and training for non-medical staff was identified to be of equal importance. The strategy recognised the contribution of administrative and clerical staff in primary care and proposed the enhancement of their role in the navigation of patients and handling clinical paperwork to free up doctor time.
Medical assistants in GP practices
A report published in July 2015 by the Primary Workforce Commission called The Future of Primary Care: Creating Teams for Tomorrow, highlighted the fact that general practitioners spend 11% of their time on administrative tasks. These tasks could be undertaken by trained, dedicated administrative staff, for example, medical assistants, and by doing so could yield the equivalent of 1400 full time GPs.
With this in mind, the HEE North Central and East London (NCEL) and South London (SL) local offices developed a Care Navigation Competency Framework supporting the development of non-clinical staff in primary care, including the role of medical assistant. In addition, the HEE, NCEL and SL local offices sought the assistance of local Community Education Provider Networks (CEPNs) to develop an education package for the medical assistant role. It was aimed to pilot this package in primary care.
The Care Navigation Competency Framework developed by the HEE NCEL and SL local offices covers areas such as:
These competencies have been developed further to identify different levels of skills from level 1–4.
In response to this request, the local CEPNs in North East London comprising Tower Hamlets, Waltham Forest and Newham commissioned training for medical assistants in primary care for their local GP practices in 2017.
GP receptionist and administrative staff training programme
The three North East London Community Education Provider Networks secured the services of two experienced primary care providers to deliver a programme of training to include:
customer service and care (including the management of challenging patients and complaints, and developing effective face-to-face and telephone communication)
medical terminology at a basic level (including administration such as time management)
improving patient experience (including better patient involvement through Patient Participation Groups (PPGs))
information provision/sources (including signposting patients to other services).
The training programmes were designed to cover the knowledge and skills identified in the Care Navigation Competency Framework.
The customer service and care and medical terminology courses were one day in length, while improving patient experience and information provision courses were half a day long. All four courses were accredited by the RCGP and were conducted between May 2017 and November 2017. Each course was run more than once in each CEPN area.
Format of the training
The content and format of the interactive training sessions were a flexible mixture of didactic delivery, individual and group activities, group discussions, and case studies. At the beginning of each course the learning outcomes were identified and discussed with the participants which were then revisited at the end of the day to ascertain the learning. A key theme in all the sessions was regularly relating back the learning acquired in the training session to the workplace.
Handouts containing the key messages and information were provided to the attendees and the GP staff were encouraged to keep these following the session and to use these at work as a reference.
Each session ended with learners producing action points as to how they would apply their learning to their own work practice.
Outcomes of the training sessions
Pre and post session evaluations were conducted for each training session and a three-month follow up was arranged to ascertain if the learning was embedded post training.
Although the vast majority of the participants were administrative and reception staff, there were staff with other roles including patients’ services assistants, a Practice Patient Group (PPG) assistant and a practice manager who wanted to be able to train her staff back at the practice.
The evaluations consisted of anonymous questionnaires whereby the learners were asked to rate themselves on how confident they felt in the levels of knowledge and skills they had attained and developed between the start and end of the session. The knowledge and skills rated by the learners were linked to the learning outcomes of each session.
Participants’ reasons for attending the courses
Generally, the participants had identified a learning developmental need in the four programme areas prior to attending the courses. Although most considered that their knowledge was at a reasonable level, the feedback at the end of each course highlighted a recognition that their skills had been enhanced and self-confidence had much improved. Even the (few) participants who had been asked to attend by their line manager and were reluctant at the beginning, recognised the benefit of the courses to them by the end of the session.
Range of age, qualification levels and experience of the participants
The reception and administrative staff who attended the courses varied in terms of age group, qualification levels and experience. The age ranged from early twenties to over fifties and the majority were female. In addition, the range of qualifications varied widely, with some having left school with no qualifications to those who had studied for NVQs or at degree level reflecting the diversity of this staffing group and differing career ambitions. Most, with the exception of those who had just started their reception or administrative roles, had had on the job training either in-house or externally. It was apparent from the discussion within the courses that the participants who had been in post for a number of years had gained much experience while doing the job. However, even this group reported that they benefited from sharing ideas and experiences from staff in other general practices.
Actions identified by the participants post course
At the end of each course the participants were requested to identify up to three action points that they had identified to apply on return to their workplace. The post evaluation feedback revealed specific actions by participants to find out more about the subject that had been discussed in the course back in the workplace, for example:
finding out more about patient feedback
getting more involved in running the Friends and Family Tests
being more proactive in diffusing potentially difficult situations and difficult patients
being more proactive in offering access to different types of GP appointments, eg telephone, extended access, etc
being able to apply the knowledge gained from medical terminology to assist patients directly with referrals, letters and pathology results
prioritising their work better
being able to signpost patients to their services in the area, particularly the voluntary sector
trying out new patient engagement initiatives such as PPG coffee or open mornings
explaining delays (in, for example, appointment times) in a constructive and professional manner
finding out more about the outcomes of complaints.
Three-month follow up
For one of the CEPN areas a three-month telephone follow-up evaluation was conducted. The questions focussed on the learning outcomes, any change in approach to their work and the level of confidence.
Respondents reported continued confidence in dealing with issues such as understanding and interpreting medical terminology, dealing with demanding patients both face-to-face and on the telephone, informing patients about local services and managing complaints proactively.
The increase in confidence had translated into better relationships with patients, for example, in one instance one of the doctors in the practice had provided feedback from a patient reporting that the receptionists had been very helpful to them. Respondents also felt more confident about explaining the reasons for delays and informing patients in a timely manner also helped with potentially difficult situations.
It was also reported that the handouts provided at the course were used as a reference for individuals in their day-to-day work or to train up other administrative and reception staff in the practice.
One individual was inspired enough after the medical terminology course she attended to begin a foundation course at the local higher education college with a view to applying to university to study nursing the following year.
The participants appreciated the investment that had been made in the programmes and valued the training that they had received, for example, one delegate had decided to attend the course on her day off. Many of the participants demonstrated great commitment and care in their approach to their jobs even when the demand was sometimes overwhelming.
There were still some gaps in knowledge, mostly in the area of the outcomes of complaints and how this was translated into improvements in services. In addition, for some attendees, the role of the practice PPG was unclear.
The support provided by the line managers (eg reception supervisor or practice manager) varied from practice to practice. This was particularly apparent when reception staff had to face demanding patients. The support ranged from fully backing up the staff to either not reinforcing the practice policy on issues such as making appointments or by countermanding the actions taken by the front-line staff.
General practice reception and administrative staff perform a challenging job sometimes with little support from their line managers. Their role is not always valued and it is not necessarily appreciated by others in the practice as to how difficult their job can be. Such staff can feel vulnerable without the skills, knowledge and expertise to deal with the demands of general practice today.
The participants who had more experience in their roles were able to demonstrate the development of their own strategies in dealing with various issues through the group discussions which others found to be helpful in their own practices.
These courses provided the general practice staff with the confidence and skills to perform their tasks which are far more complex than the title “receptionist” implies. This is essential as the future development of primary care is dependent on the new roles that are envisaged for these front-line staff.
Overall the staff attending these courses valued their training particularly in the context of general practice and the future development of medical assistants in primary care. This raises the question of whether the development of general practice reception and administrative staff receives enough attention given the increasing demands on primary care.
With thanks to the providers Nicci Iacovou and Thoreya Swage who delivered the receptionist and administrative staff training programme and conducted the evaluation.
General Practice Forward View, NHS England, Royal College of General Practitioners, Health Education England, April 2016
The Future of Primary Care. Creating Teams for Tomorrow, Health Education England, July 2015
Medical Assistants in GP Practices, Health Education England, North Central and East London and South London local offices, 2016