An inspector calls: Training and support

The Care Quality Commission has conducted more than 1,000 inspections in general practice and aims to have inspected every practice by April 2016. Our occasional series provides an insight into what happens at an inspection and what the inspector is looking for

The bedrock of providing safe, effective care in general practice is having the right staff in place to deliver it. People using the service should be confident that their health and welfare needs will be met by staff who have received appropriate supervision and training to enable them to do their job.

The Care Quality Commission (CQC) will be looking to see whether or not staff who are employed in general practice are fit for the job and have the right qualifications, skills and experience The provider must also have suitable arrangements in place to ensure that staff are competent to carry out their work and are properly trained, supervised and appraised.

RECRUITMENT

Practices must have a robust recruitment and selection process to include appropriate checks of all qualifications (including temporary staff) with the Nursing and Midwifery Council (NMC) plus Disclosure and Barring Service. (DBS)

There should be a comprehensive induction process for all new staff –including bank or temporary staff – to ensure staff are familiar with all policies and procedures relating to their employment, and staff should have a personal development plan in place as part of their annual appraisal.

A recent inspection revealed that although a practice had a recruitment policy this was undated. The policy did not make reference to the requirements stated under the Health and Social Care Act 2008(HSCA).

The policy stated that a job offer could be made to staff subject to the receipt of satisfactory references. However, when staff records were checked there was no evidence of references being checked. The policy did not mention the need for a work history to be provided, evidence of identity to be seen or a DBS check to be carried out for relevant staff. A full work history had only been provided in four out of eight staff files checked.

The practice manager stated that she checked that nurses were registered with the NMC when they first started work but the practice did not check their registration was kept up to date. Following the inspection the registration of the medical professionals were checked. They found that one professional had conditions placed on their registration by the registration body. This information had not been available in their personnel file.

At another practice, a recently employed nurse had not had her registration checked with the NMC. The practice manager informed the inspector that they were waiting for the nurse to bring a copy of her registration into the practice. The practice did not have any assurance that the nurse was registered and subsequently patients may have been at risk.

INDUCTION

Newly employed staff should have a supported induction. An induction is the process where new staff can adjust to their jobs and working environment. It should provide them with important information about the job and how they will be supported to conduct their role safely.

At one practice there was no induction process for newly appointed staff, and no clinical supervision of the practice nurses, to evaluate and improve the quality of service they provided, was in place. In contrast, at another practice inspected, staff induction was supported by ‘a welcome and induction checklist’ and staff had received appropriate support when they first started work at the practice. The inspector spoke with two members of staff who had started work at the practice within the last 18 months. Both of them confirmed they had received induction training when they joined. This included working with an experienced member of staff, familiarisation with the environment, safety procedures and awareness of important policies and procedures.

CONTINUING PROFESSIONAL DEVELOPMENT

Nurses must maintain their registration by meeting the post registration and practice (PREP) standards set by the NMC.¹ However, the NMC is in the process of reviewing and updating the standards for the maintenance and renewal of registration. A portfolio of training is recommended to help nurses keep up to date, and employers have a duty to support staff to meet their training needs.

Training should include:

• Annual mandatory updates training such as CPR, safeguarding, health and safety, fire safety and infection control
• Immunisations
• Individual learning needs identified at appraisal
• Personal development plan (PDP).

During a CQC inspection, the inspectors will talk with staff to establish what training and development nurses have received and will expect this to be evidenced by training records, which should contain essential information regarding training undertaken.

During one inspection the inspector spoke with staff who confirmed they had received basic life support training. They saw evidence that some staff had received safeguarding of vulnerable adults training and some e-learning evidence was seen in some staff files. However, there were no clear training records available to indicate what training staff had undertaken and what further training staff required. The manager could not provide certificates of training to support claims staff had up-to-date infection control training.

At one practice there were no records or information concerning any staff training. The inspector was told that staff kept their own records and copies were not kept. While it is important that nurses have a record of their own training and professional development, the practice also needs to have a record at all staff training in order to monitor when further training and updates are required.

The inspectors also looked at minutes of a practice meeting September, which stated that staff must receive training to meet ‘CQC standards’. Some staff had completed the online training suggested, but the manager was unable to say who had completed what training.

At another practice, the inspector looked at the training records for all staff who should have received the appropriate training in medical emergencies and cardiopulmonary resuscitation. Some staff had received basic life support training within the last three years, whilst others were out of date or had not received the training at all.

This showed that people using the service could not be confident that their health and welfare needs would be met by staff who received appropriate supervision and training to enable them to do their job.

APPRAISAL

In recent years, annual appraisals and personal development plans have been mandatory for practice nurses under the GMS contract in order to achieve the management quality indicators. Appraisal is a formal review in protected time to reflect on performance, to indentify achievements, and to look at the nurse’s developmental needs through setting objectives and identifying learning needs in conjunction with the Practice Professional Development Plan (PPDP) for the coming year.

In two recent inspections, staff appraisals had only been completed for a half of the nurses and in another practice appraisals were undertaken informally without any records. Inspectors were therefore not able to review any individual learning needs or personal development plans

So far of 1,000 practices inspected 34% were found to be noncompliant in the regulations and ten practices had serious failings. 2

Education and training is paramount in maintaining high standards in delivery of services and clearly is an area that cannot be left to chance.

REFERENCES

1. NMC. Meeting the PREP standards. Available at: http://www.nmc-uk.org/Registration/Staying-on-the-register/Meeting-the-Prep-standards/

2. Vaughan V. Interview: Steve Field on inspection and "the joy of being outstanding”. Management in Practice, March 2014. Available at: http://www.managementinpractice.com/editors-pick/steve-field-interview-inspection-and-joy-being-outstanding