UniS

Improving Healthcare through Work-Based Learning:Practice Development Facilitators In Surrey and Sussex

Report

European Institute of Health and Medical Sciences

Submitted By:Larsen JA, Rhodes A, Colliety P, Ryle S, Smith P, Volante, M

Centre for Research in Nursing and Midwifery Education

Content list

1. Executive summary......................................................................................3

2. The introduction and development of the PDF role......................................4

3. The PDF role................................................................................................7

3.1 Key characteristics..................................................................................7

3.2 Variation: meeting Trusts’ needs............................................................8

3.3 Competency requirements, education and experience...........................9

4. Accredited Work-Based Learning...............................................................11

4.1 The EIHMS pilot module.......................................................................11

4.2 The pilot programmes...........................................................................12

4.3 Outcomes: learning, practice and patient care......................................15

5. A sustainable framework: recommendations..............................................17

5.1 Trust support.........................................................................................17

5.2 University support.................................................................................18

5.3 Practice development partnerships.......................................................20

References.....................................................................................................23

Appendices are found on the CD-ROM included in this report:

A PDFs’ Activity Reports

B EIHMS Handbook for AWBL pilot module: Using Work-based Learning

to Enhance Practice, Level 2

C EIHMS Handbook for AWBL pilot module: Using Work-based Learning

to Enhance Practice, Level 3

D AWBL pilot programme: Rehabilitation and Promoting Independence

for Older People, levels 2 and 3 (The East Surrey Primary Care Trust)

E AWBL pilot programme: Managing the Acutely Ill Patient on a Ward,

levels 2 and 3 (The Royal Surrey County Hospital NHS Trust)

F AWBL pilot programme: E to F Grade Development Programme for

Critical Care, level 3 (The Royal West Sussex Trust)

G Mid-way Evaluation Questionnaire for Work Based Learning

Programme

H End Evaluation Questionnaire for Work Based Learning Programme

I Mentor Evaluation Questionnaire for Work Based Learning Programme

J Manager/Assessor Evaluation Questionnaire for Work Based Learning

Programme

K Pilot AWBL programme evaluation

L Evaluation of non-accredited WBL programmes in mental health

M Paper on suicide prevention (The West Sussex Health and Social Care

NHS Trust)

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1. Executive summary

This report describes the development of University accredited work-based learning (AWBL) programmes. This approach supports developing a more effective and responsive health service (DoH 2000a, 2000b) where patients’ needs are in focus (DoH 2002a, 2004c) and the workforce is supported to develop their skills and take on new roles (DoH 1999, 2002b, 2004a, 2004b). The AWBL approach provides a timely response to training requirements arising from the National Service Frameworks.

The approach reflects a partnership between NHS Trusts and a Higher Education Institution (HEI). Since January 2001 Practice Development Facilitator (PDF) roles were financed by the Surrey and Sussex Strategic Health Authority (SHA) and supported through an action research approach by the European Institute of Health and Medical Sciences (EIHMS) at the University of Surrey.

The PDF role is characterised by operating at many levels of service delivery, integrating Trust-wide strategic policies with clinical needs and concerns at ward level. The effectiveness of the role is dependent on the balancing of the critical outside perspective with practice knowledge in clinical teams. PDFs demonstrate flexibility and sensitivity to meet the particular needs of Trusts while taking on board the National Agenda. The success of the PDF role depends on the postholder’s professional and personal qualifications and available support structures.

PDFs have taken a variety of approaches to practice development and team learning. This report pays attention to the work to develop AWBL programmes supported by the EIHMS pilot module Using Work-based Learning to Enhance Practice, Levels 2 and 3. The report presents details of three pilot AWBL programmes:

Rehabilitation and Promoting Independence for Older People (details in Appendix D)

Managing the Acutely Ill Patient on a Ward (details in Appendix E)

E to F Grade Development Programme for Critical Care (details in Appendix F)

Findings from the evaluation demonstrate that the pilot AWBL programmes created a positive learning environment where staff demonstrated: an increase in confidence regarding

practical skills and academic writing; increased knowledge base including

ability and competency; development of personal skills in

leadership, communication and assertiveness;

the ability to relate theory to practice; the confidence to converse with

patients on issues of care that were previously difficult due to a lack of knowledge;

being a more effective member of the multi-professional team and sharing best practice;

more effective patient care and service delivery.

The successful implementation of AWBL programmes has potential to stimulate the learning environment in the workplace and improve staff’s job satisfaction as a result.

The report suggests recommendations for a sustainable framework for AWBL:

Trusts to provide support through the establishment of and sufficient support for PDF type roles.

HEI to provide support through the establishment of a flexible module framework, an AWBL co-ordinator role and area-specific lecturers to engage in AWBL projects and support research to ensure the evidence base.

Practice development partnerships involving Trusts, HEIs and patients/users.

Commitment from the SHA to fund and encourage practice development partnership initiatives.

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2. The introduction and development of the PDF role

The Practice Development Facilitator (PDF) role was established in January 2001 in a joint initiative between the Surrey and Sussex Strategic Health Authority (SHA) and the European Institute of Health and Medical Sciences (EIHMS) at the University of Surrey.

The rationale behind the initiative was to support the development of innovative ways of delivering continuing professional development (CPD) in the practice setting (DoH 1999, 2004b). This is in line with the modernisation framework as set out by the Department of Health in the documents The NHS Plan (DoH 2000a) and Liberating the Talents (DoH 2000b). The project aimed to bridge the theory-practice gap, to strengthen the evidence base for healthcare practice (DoH 2000b) and to improve patient outcomes by shifting the balance of power (DoH 2002a) and putting people at the heart of the service, as outlined in the NHS Improvement Plan (2004c).

National Service Frameworks were key drivers for the establishment of PDF roles in mental health, critical care and intermediate/primary care. The Trusts involved were:

Ashford and St Peter’s Hospitals NHS Trust

East Surrey PCT Frimley Park Hospital NHS Trust North West Surrey Mental Health

Partnership NHS Trust Royal Surrey County Hospital NHS

Trust Royal West Sussex NHS Trust Surrey Hampshire Borders NHS Trust Surrey Heath and Woking PCT Surrey Oaklands NHS Trust Surrey & Sussex NHS Trust West Sussex Health and Social Care

NHS Trust

Figure 2.1 overleaf illustrates the Trusts’ involvement throughout the period January 2001 to December 2004. By detailing the months of PDFs’ employment the figure also demonstrates issues of continuity and retention in the PDF roles.

The University of Surrey was funded by the Surrey and Sussex SHA to engage with the PDFs in an action research approach. This engagement involved three phases.

Action research is a participatory approach to develop a product or achieve an outcome by using research in a circular feedback process (Bate 2000).

Phase OneIn the first phase (January 2001 – December 2002), this engagement paid attention to the introduction and development of the PDF role. The purpose was to put in place a system of support for the PDFs to meet service expectations of the post. Three approaches were taken. Firstly, supervision groups with a senior member of the University (mental health and critical care with intermediate care) to address the individual development needs of the PDFs. Secondly, the Head of Academic and Practice Development negotiated with the PDFs to set up a project monitoring and evaluation group consisting of PDFs, their managers and the University (this group evolved to become the project’s steering group). Finally, an external facilitator was brought in to support and develop the PDFs’ knowledge, understanding and skills of critical reflection to manage and evaluate the post. The development programme for the PDFs in the period 2001-2003 was subsequently formulated into a module ‘Enabling Innovative Practice’, 20 credits at level 3 and offered within the EIHMS Lifelong Learning framework.

Phase TwoAs SHA funding was provided for continuing the PDF roles for a further two years, focus was directed towards the development and piloting of a framework for University quality assuring and accreditation of work-based learning supporting practice development in Trusts. The University of Surrey was funded (July 2003 – December 2004) to reengage with an action research approach to support this development and evaluation work.

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Figure 2.1: Overview of Trusts’ and PDFs’ involvement in the project period 2001 – 2004, Phases One and Two

Clinical Area Trust 2001 2002 2003 2004

Critical Care Ashford and St Peter Hospitals NHS Trust Karen Coertze

Ruth Towell K. Tylor Bates

Frimley Park Hospital NHS Trust Alison Stevens Sam Keating (leave 6/03-11/03) S. Keating p/t

Royal Surrey County Hospital NHS Trust Catherine Derham Rosemary Maundrill

Royal West Sussex NHS Trust Jo Morgan (has continued Trust funded PDF role in Intensive Care)

Surrey and Sussex NHS Trust Paula Sloan

Intermediate/ Primary Care

East Surrey PCT Liz Mouland (has continued PDF work as Nurse Consultant)

Surrey Heath and Woking PCT Sandra Evans Kirsty Thurlby (leave 10/03-6/04)

Mental Health North West Surrey Mental Health Partnership NHS Trust Kevin Acott (left to Surrey Oaklands) Eileen Welland

Surrey Hampshire Borders NHS Trust Camille Whiby

Surrey Oaklands NHS Trust Sara Opie Kevin Acott

West Sussex Health and Social Care NHS Trust Bob Birtwell

Alex Jones

PDFs were given Honorary Contracts with the University of Surrey and provided 0.2 fte of their time for this collaboration.

Meetings between PDFs and the EIHMS team were held at a regular interval. Between July 2003 and December 2004 a total of 29 PDF meetings were held at the University Campus. At these meetings PDFs presented and discussed their ongoing work with each other and worked collaboratively with University staff to develop a collective approach to service development through the provision of accredited work-based learning (see also section 4). Summaries of the PDF meetings were distributed by email shortly after each meeting to keep an audit trail of the projects’ development and to allow PDFs who couldn’t attend the meeting to keep informed on the progress.

At the regular PDF meetings the EIHMS team comprised Ms. Alison Rhodes (Tutor with expertise in development and work-based learning and member of the workgroup for ‘Negotiated Learning’ at EIHMS) and Dr John Aggergaard Larsen (Research Fellow with a Social Sciences background and expertise in qualitative and participatory research methods). The wider EIHMS team comprised the PDF Strategic Group with the additional members: Dr Margaret Volante (Head of Practice Learning and Education in EIHMS), Professor Pam Smith (Director of the Centre for Research in Nursing and Midwifery Education and an experienced action researcher), Dr Pat Colliety (Senior Tutor, has conducted a study on practice development and is supporting the community PDFs in Phase Three – see below) and Ms. Sue Ryle (Head of Continuing Professional Development and Postgraduate Programmes at EIHMS). Additional support for the development of Level 1 AWBL programmes was provided by Ms. Melaine Coward (Deputy to Ms. Ryle and responsible for co-ordinating the CPD framework at EIHMS). During 2004 the EIHMS PDF Strategic Group met monthly to discuss the progression of the PDF project and how it might relate to the education provision strategy for EIHMS.

A PDF Steering Group was established to provide monitoring and evaluation (see Phase One) through regular, half-yearly meetings involving PDFs, PDFs’ line managers, the EIHMS team and, since

September 2002, headed by Ms. Sheila McKinley from the Surrey and Sussex SHA. Since the end of 2003 the first hour of the PDF Steering Group meetings did not include the PDFs. The meetings set out the strategic aims for the development of the PDF project and defined objectives for PDFs and the EIHMS team to deliver. An additional component of the PDF Steering Group meetings was to present an update on the project’s progress and to allow PDFs to express their experiences and views. The meetings have been essential to keep the stakeholders updated on the progress and agree a direction for the project’s development.

Since 2003 Dr Charlotte Ramage and Ms. Helen Stanley from the University of Brighton have attended PDF Steering Group meetings to contribute their experience with setting up Negotiated Work Based Learning. In addition, separate meetings have been held with the University of Brighton to inform the work in the PDF project.

Phase ThreeA third phase of the project started in January 2004 as the Surrey and Sussex SHA provided two years funding for PDFs in primary care. EIHMS is supporting these community PDFs in a parallel project (key responsible person is Dr Pat Colliety). This phase involves these Trusts: Adur, Arun and Worthing PCT Eastbourne Downs PCT Horsham and Chanctonbury PCT and

Crawley PCT North Surrey PCT Surrey Heath and Woking PCT

Key pointsPDFs have been introduced in Surrey and Sussex through three phases: Phase One (January 2001 –

December 2002): PDF roles were introduced and they worked on Trust specific practice development needs.

Phase Two (January 2003 – December 2004): focus was directed towards developing AWBL programmes and suggest a sustainable framework for future Trust-HEI partnership.

Phase Three (January 2004 – December 2006): PDFs have been introduced in primary care and will build on previous experiences.

3. The PDF role

The PDF role presents a unique mix of clinical, strategic, interpersonal and educational functions, which distinguishes it from other practice educational roles (see e.g. Ramage 2004). The PDF role pays special attention to the development of an organisational culture that genuinely supports innovative and creative clinical practice, and the learning – and integration – of new skills. This section specifies the characteristics to avoid the lack of clarity and confusion which often accompanies the introduction of new clinical roles and titles (Jones n.d.).

3.1 Key characteristics

Key characteristics of the PDF role became apparent at the PDF meetings (see section 2). The discussions continued during collaborative writing for academic publication (Larsen et al., n.d.) which further stimulated the ongoing reflexive process.

Getting into practiceIt is crucial that the PDF is actively involved in clinical work in the Trust. Working alongside clinical colleagues gives the PDF insight into the work culture at ward level and complexities related to the clinical work as well as staff-collaboration. At times PDFs have been struggling to establish a recognisable ‘membership role’ as an insider in the practice setting. Some PDFs have reported initially being seen as ‘a spy’ sent by management. PDFs have also felt tensions with other senior clinical staff who at times felt threatened by the PDF, challenging their position and authority in the staff hierarchy. PDFs have generally experienced that it took time, patience and continued effort to be seen as having ‘clinical credibility’ and recognised as having a positive and supportive function among staff. Practice development parallels good patient care: true and honest engagement is a necessary and respectful first stage. This forms a basis for the development of trust, which is essential for staff to engage in learning and practice change.

Working at a strategic levelWhile working alongside clinical colleagues the PDF has also an important strategic function, stimulating best practice and working towards the Trust’s performance targets. The PDF has to be ‘politically aware’ of these strategic requirements and seek to implement them in practice, while bridging the gap between policy formulations and the requirements of everyday practice. PDFs have benefited from taking an active part in Trust-wide strategic meetings concerning training provision and practice development (e.g. ‘Training and Implementation Group’ or ‘Practice Development Group’) as well as the relevant clinical group (e.g. ‘Nursing Forum’ or ‘Nursing and Midwifery Group’). The Trust-wide strategic involvement gives the PDF insight into ‘the bigger picture’ and allows identification of structural issues to direct their work focus and avoid ‘working in a silo’. Equally, by being a member of these groupings the PDF has a direct voice at a Trust level and is better able to make a significant impact on Trust practice development priorities.

‘Drip-drip-drip’ approachDue to the above mentioned characteristics of the work PDFs have to be ‘thick skinned’ and not expect quick and immediate changes to practice development. They are by the very nature of the role in it for ‘the long haul’ if they are to succeed. Practice development is an ongoing process which demands continuous attention and deliberate action. It has to do with creating and sustaining a certain practice culture which embodies the ideology and practice of a ‘learning environment’. The PDF is, as the title says, the facilitator of this ideology and practice. PDFs have described how they see themselves as providing their clinical colleagues and the practice culture with the ‘optimism’ and ‘energy’ to develop and sustain best practice.

Insider-outsider statusThe PDF role incorporates insider and outsider characteristics in terms of the clinical practice environment. PDFs are working hard to be recognised as insiders in order to have clinical credibility and be

seen by clinical staff as a positive resource for their work. At the same time PDFs are critically evaluating practice in order to stimulate the development and sustainability of best practice. PDFs have reported that they have to be assertive and demonstrate positive energy and optimism to achieve this. The social position and interpersonal demands can be emotionally draining for the PDF, and especially in the beginning it may be necessary to have ‘thick skin’. It is, however, an important function of the role to be in that insider-outsider position as it is necessary in order to identify problems and suggest changes.

Support from peersThe PDF project has demonstrated the important value of support for the PDF, not least due to the emotional labour and stresses from being in the insider-outsider position. Without doubt it is important that the PDF has support in their immediate work environment, and interviews with PDFs’ line managers confirmed the value of regular supportive meetings. The PDF project has also, however, shown the importance for the PDFs to have opportunities to share experiences and support each other at the regular meetings. Mental health PDFs have been less frequent visitors at these meetings and this might relate directly to the fact that the mental health PDFs already work closely together and see each other on a regular basis. Discussions at PDF meetings have illuminated how it has been important for PDFs to help each other by giving moral support and encouragement as well as advice on when to avoid getting pulled too far into the politics of everyday practice.

Involvement with University The last characteristic of the PDF role is its relationship to the University, which has supported critical and reflective thinking and working to develop University accredited learning. The University has provided a forum to stimulate and encourage practice development, applying academic standards for learning and evidence-based practice. Furthermore, through the action research approach the PDF meetings with the EIHMS team deepened the peer support (as mentioned above) by supporting PDFs’ critical perspective and enabling them to apply a

strategic approach to service development.

3.2 Variation: meeting Trusts’ needs

Common elements characterise the PDF role, as outlined above, but an equally important characteristic of this role is its local variation. This is due to the fact that PDFs are in post to address the particular needs of Trusts who are working to meet the National Agenda within their individual practice environments. It is essential that PDFs demonstrate flexibility and sensitivity to meet and follow such individual requirements whilst taking on board the National Agenda. (Examples of PDFs’ different activities are presented in Appendix A.)

In some settings PDFs worked Trust-wide to identify areas in particular need of practice development and they worked strategically to develop learning initiatives to meet service development requirements. In other situations PDFs were required to concentrate their work to a relatively small practice field, engaging on a daily basis with staff primarily on one ward. PDFs have highlighted the value of having the strategic Trust-wide overview, while pointing out that being solely responsible for practice development in a whole Trust is an unrealistic responsibility for one PDF. For PDFs who worked Trust-wide it has been necessary to focus their involvement on areas and wards in particular need in order to make a significant impact on the practice culture. Also, PDFs’ discussions have emphasised the value of not ‘working in a silo’, by which they referred to only having responsibility for a single ward and not having the Trust-wide overview. When working in only one practice area the PDF risks getting ‘sucked in’ to the everyday political and administrative practicalities and this can reduce the critical outside perspective which is essential to identify practice development needs. Hence, the insider-outsider status of the role is subject of constant negotiation based on the existing and emerging Trust needs. Variation has also been demonstrated in the focus of the PDFs’ practice development work. The majority of the Trusts involved have directed attention to practice development through supporting

the skill development of professionals such as nurses, dieticians, physiotherapists, occupational therapists and medical staff. In other Trusts meeting the clinical knowledge needs of healthcare assistants (HCAs) and working to develop their practice were identified as being able to generate the greatest impact to improve service and patient care.

The PDF role has not been restricted to supporting one particular professional group, but taken a broad approach to address the emerging needs. This flexibility and multi-capacity is crucial for the role to address the demands put on Trusts to meet changing policy objectives for service delivery.

While addressing these strategic concerns, PDFs have equally to take account of the practice culture and staff morale when facilitating change and practice development. Experiences from the PDF project have demonstrated that the ability to integrate strategic policy aims with ward level concerns is crucial for securing the backing for the culture of a learning environment towards creating effective and sustainable service development.

Some PDFs engaged substantively with the EIHMS team to develop a system for University accreditation of Trust-based learning programmes (see section 4). Meanwhile, the mental health PDFs continued their work to develop a team approach to practice development (supported by previous research, e.g. McCormack and Corner [2003]). This involved work-based learning programmes which were followed up by a supported team expertise approach. Having completed the programme learners were supported through regular meetings to discuss developmental needs and provide peer supervision. This organisationally recognised method facilitated them to disseminate expertise through helping deliver future modules and offering advice and supervision to colleagues and managers (see Appendix M).

Also, mental health PDFs have been working to set up a system for involving service users, clinicians and educators in practice development work (the Acute Care Partnership). These different initiatives reflect various concerns as

indicated by Trust needs. All initiatives have shared the overall aim of designing and piloting work-based learning systems to support practice development and suggesting sustainable frameworks which can be transferred to other Trusts (see section 5).

3.3 Competency requirements, education and experience

The PDF role requires a multi-competent professional. Dependent on the specific requirements in individual Trusts, the postholder would have to demonstrate all or a selection of following skills and characteristics:

A high level of clinical knowledge. Practice experience. Strategic/policy awareness. Independent working and leadership

skills. Partnership working and

interpersonal/negotiation skills. Educational/academic skills. Research/evaluation/audit skills. A high level of energy and motivation.

These qualifications and skills enable the PDF to engage effectively in practice; take strategic responsibility; take a critical practice development perspective; engage constructively with clinicians, Trust managers and University academics; work in partnership to design and deliver educational programmes; and demonstrate learning, practice and patient outcomes. The personal characteristics of a high level of energy and motivation is required for the PDF to engage in all these dimensions of work while at the same time demonstrating flexibility to meet changing Trust needs for service delivery.

The professional characteristics and the experience with retention (see Figure 2.1) indicate that the PDF role attracts clinical professionals with significant career potentials. PDFs’ line managers have pointed out the need to develop clear career plans for the PDF postholder. PDFs develop skills transferable to a ‘modern matron’, consultant nurse, allied health professional and/or lecturer in clinical practice working with the University, depending on their own individual propensities and developments and what

new ways of working the NHS/Trusts opens to them.

Due to the demands of the role it is, however, important not only to stress the requirements aimed at the postholder (in terms of education, experience and motivation). For the PDF to work effectively it is necessary that the postholder works in a supportive and stimulating environment. This support requirement includes: 1) line manager support, 2) support from peer PDFs and 3) support from a HEI environment which can help sustain and develop a strategic approach to service development.

Key points The PDF is actively involved in clinical

work in the Trust. The PDF has to be ‘politically aware’

of Trust-wide strategic issues. The PDF’s insider-outsider position is

necessary in order to identify problems and suggest changes.

Practice development is an ongoing process which demands continuous attention and deliberate action to develop and sustain a ‘learning environment’.

PDFs need support in their immediate work environment and from peers in similar roles.

The University/HEI provides a forum to stimulate and encourage practice development.

PDFs work differently in different Trusts depending on local needs and priorities. There is no standard ‘job specification’.

4. Accredited Work-Based Learning

From January 2003 PDFs were required by the Surrey and Sussex SHA to develop and pilot Accredited Work-Based Learning (AWBL) programmes by designing their Trust-based learning activities in such a way that they could be recognised by Universities. This new direction meant a reorientation to the previous function of the PDF role from solely addressing the individual Trust’s needs regarding the National Agenda. The Surrey and Sussex SHA was making a strategic investment in using the PDF role to support the development of learning programmes which could be adapted by other Trusts.

This sharpened focus arose from the intention to ensure a flexible approach to develop skills and improve practice (DoH 2000b, 2004a) that would focus on the real needs of patients (DoH 2002a, 2004c) and build a highly competent and adaptive workforce (DoH 1999, 2002b, 2004b).

From July 2003 EIHMS engaged with PDFs in an action research approach to support this new development and provide the University of Surrey’s expertise in setting up accredited learning programmes. The unique challenge was to develop an University validated and accredited module with learning provided in the work place which would, at the same time, integrate the Trusts’ requirement for flexibility to respond to emerging needs for practice development and service delivery.

PDFs have engaged in a variety of practice development activities (see Appendix A for examples) and they have been involved in developing the AWBL framework to varying degrees. Three PDFs have engaged fully over the entire period and achieved designing and piloting AWBL programmes to meet their Trusts’ needs (they will be described below). For issues to do with lack of continuity due to job change and maternity leave three PDFs were delayed in developing their programmes, but are currently in the process of delivering these. When this new focus on AWBL was introduced mental health PDFs had already developed and run systematised learning

programmes, but they were not accredited by the University.

In the early stages of the development process, mental health PDFs prioritised to work with teams and not to providing individual learners University credits. At this point mental health PDFs expressed scepticism towards the stated aim of securing University accreditation as they feared that this would mean a focus towards individual learning and away from team development with direct and sustained impact on practice. Their concerns reflected a common observation that university, classroom-based (i.e. not work-based) learning does not always have optimal impact on practice as individual learners at times are unable to implement the new learning in the practice culture. However, since November 2004, mental health PDFs have engaged constructively to negotiate how the AWBL module can present a useful framework for future learning provision (see section 4.2).

The importance of directing the learning and practice development towards the team and practice environment has been sharpened by the above observations. The work to develop an AWBL framework emphasised developing an approach which would both meet Trusts’ needs for practice development and ensure that the learning would require the individual learner, through the work-based approach, to actively engage with the team practice to make maximal impact.

4.1 The EIHMS pilot module

The 2001-2002 support and development phase of the PDF project identified a need to develop formal recognition of learning outcomes achieved through Trust service and practice development practice. From the beginning the challenge for EIHMS and the PDFs was how to recognise individual learning outcomes achieved by way of the team development essential to sustainable practice development and desired client outcomes.

The framework needed to be responsive, accommodate diversity and flexibility, whilst also providing robust governance processes to assure client safety and the quality of learning support in both the design and delivery of the work-based learning process. Quality assurance processes therefore needed to be in place that would both satisfy clinical and academic standards. Assessment of the learning outcomes for both individuals and teams is essential to assure competency for the delivery of the service whether or not individual practitioners wished academic accreditation for their learning achievements. The work-based learning framework was developed from a Trust-based perspective to embrace learning within service and practice development to support clinical / practice/ client outcomes.

A pilot module was developed through collaboration between the PDFs and the EIHMS team. The work-based learning framework developed at University of Brighton provided important inspiration (see section 2). The approach was one of flexibility and debate at the PDF meetings to ensure that all needs would be met. Each PDF had an opportunity to explore how work-based learning could be delivered within their Trust, the target groups to be involved and the level of study that would be appropriate. In January 2004, pilot modules (see Appendices B and C) were presented to the undergraduate Lifelong Learning Framework Board of Studies for their consideration.

AWBL pilot modulesUsing Work-based Learning to Enhance Practice, 30 credits, Levels 2 and 3

The modules were approved by the board members with the stipulation that it should only be offered to those learners involved in the project and therefore would sit along side the framework until the completion of the project and the evaluative process. By designing an umbrella module framework the PDFs could develop their specific programmes, utilising work-based learning strategies, which were based on the needs of their Trusts, their specialist area of practice, the clinical teams and the needs of individuals within the teams.

One Trust identified the need for academic Level 1 provision. This was met through mapping the required outcomes against an existing EIHMS Level 1 module.

4.2 The pilot programmes

AWBL programmes were designed at academic levels 2 and 3 and have been delivered in three Trusts: Rehabilitation and Promoting

Independence for Older People – levels 2 and 3 (The East Surrey Primary Care Trust).

Managing the Acutely Ill Patient on a Ward – levels 2 and 3 (The Royal Surrey County Hospital NHS Trust).

E to F Grade Development Programme for Critical Care – level 3 (The Royal West Sussex Trust).

Rehabilitation and Promoting Independence for Older People – levels 2 and 3This programme was designed around 6 taught study days, which were facilitated by the PDF. There was a multi-professional approach to the teaching and assessment component of the programme, e.g. allied health professionals, pharmacist, risk management team and patients and carers who had received local services were co-opted onto the teaching team, which proved to be very successful. The learners were also allocated 4 supernumerary shifts in order to practise their skills under supervision. The method of assessment was based on the attainment of competencies (10 credits) and the production of a portfolio of evidence (20 credits), which included a care study, S.W.O.T. analysis, learning contracts, reflective accounts, reading logs, clinical assessments, formative and summative assessments to show achievement and development. In addition to this, a high priority was given to the development of the professional handover. This was considered to be a key activity for the learner as it gave rise to opportunities for team learning and development in order to agree and set patient goals and objectives of care, improve inter-disciplinary team functioning with the ultimate aim of improving patient outcomes. The cohort also worked in action learning sets (ALS), which (as reported by the PDF) the learners found

valuable to take forward their learning. (See Appendix D for details).

Managing the Acutely Ill Patient on a Ward – levels 2 and 3This programme took a similar approach as the above, in so much as the design included a taught programme of 6 study days but a difference was that this module was built around the use of workbooks. The workbooks had to be completed by the learners outside of the study days but were reviewed on a regular basis to ensure that their knowledge, understanding and levels of competency developed appropriately and to test what impact this had to their practice. The method of assessment was a portfolio of evidence, which included the completion of five competencies (which follows the Trusts competency documentation), with one reading log to support each competency. The completed workbooks were presented as part of this evidence plus a summative assessment in the form of an assignment, which was a critical analysis of an episode of care. (See Appendix E for details.)

E to F Grade Development Programme for Critical Care – level 3This programme took a unique approach to work-based learning as all the teaching occurred within the Intensive Care Unit (ITU), with no taught study days. The framework was built around fortnightly meetings between the mentor and learner (to explore learning outcomes, achievements, action planning for further development) plus four supernumerary days, whereby the learner was given the opportunity to ‘act up’ in the F grade role, with the mentor offering clinical support and supervision. The method of assessment was the completion of a portfolio of evidence which included a S.W.O.T analysis, learning outcomes, an action plan, 8 review meeting logs, 4 reflections based on supernumerary experiences, 8 reading logs, a summative assessment by the mentor and to conclude, a final reflection on how the learner has developed throughout this work-based learning programme. (See Appendix F for details.)

Further AWBL programmes are currently being designed and planned for delivery in:

Ashford and St. Peter’s Hospital NHS Trust (topic: essential skills in rehabilitation care). This programme will be aimed at Health Care Assistants (HCAs) to assist in the development of their skills in rehabilitation. It is planned for delivery early in 2005. This Level 1 provision will be mapped against an existing module that is currently being offered through EIHMS.

Surrey Heath and Woking Primary Care Trust (Leg Ulcer and Wound Care – Level 2: 30 Credits). This is a programme that has been delivered within the Trust on a number of occasions but not accredited. The PDF and the EIHMS team have been working together to develop this programme, along with the assessment strategy. The programme will be based on 4 half-day study sessions (over a 3-month period) and is planned to commence in November 2004 with 10 learners.

Frimley Park Hospital NHS Trust is currently (April 2005) implementing a work-based learning programme for critical care skills. Based on a review of twenty NHS Trusts' competency programmes the Greater Manchester critical care skills programme was chosen as the preferred model. It involves as a multiprofessional  programme in caring for patients level 0-3 comprising of core competencies, skills workshops and workbooks for evidence. The respiratory module has been successfully piloted to a small group across the Trust and the whole programme has been implemented within the Critical Care Unit at Frimley Park. It is the plan to take the programme Trust-wide, commencing January 2006. It is the aim that the programme will be developed to achieve accreditation with EIHMS, University of Surrey in line with the Trust plan to increase level one care capacity. (For further information please contact Samantha Keating at Frimley Park Hospital NHS Trust.)

Mental health PDFs are working with the EIHMS team to develop an AWBL programme (Suicide Risk Assessment – Level 3: 30 Credits) with planned start in March 2005. This programme

is based on experiences since 2003 with delivering a non-accredited programme with a similar content (see Appendix L for an evaluation of non-accredited programmes in ‘Suicide Risk Assessment’ and ‘Relapse Prevention’). The learning will continue to be supplemented through the supported team expertise approach (as described in 3.2). Programmes are being prepared for delivery in 2005 on the subjects of ‘Relapse Prevention in Psychosis’; ‘Working with Delusions’; ‘Self-Harm’; ‘The Admission Process’; ‘Voice Hearers’; ‘Cognitive Deficits’; ‘Dual Diagnosis’; and ‘Working Therapeutically with Aggression’.

Trust supportA significant qualification of AWBL programmes is that they arise from a needs assessment carried out in the Trust. PDFs have played an instrumental part in conducting this needs assessment through involvement at strategic and practice levels (as described in section 3). The success of this wide consultation work depended on a well-functioning communication network in the Trust whereby members of the multi-professional team were consulted, along with managers, colleagues and peers. The needs assessment included the following elements to be established: Evidence for the need for the learning. The extent to which the need might be

best met by an AWBL programme in the work place, or existing modules on offer in the Trust or from education institutions.

Support from Trust managers for the AWBL programme.

Availability of resources (e.g. time, teachers, mentors, rooms) for the programme delivery.

Sufficient numbers of staff or teams who need the learning and are willing and able to take part in the AWBL programme.

While concluding the Trust needs assessment the PDFs engaged in collaborative work in the EIHMS group and with the AWBL co-ordinator to develop the programme content and structure. This involved support in exploring the feasibility of specific programmes, primarily considering learning and assessment strategies that would be appropriate and

match the purpose for which they would be used. This learning process was time consuming but essential to the overall quality of the programme and the subsequent skills that would be required in practice. Furthermore, the process meant a strengthening of the links and collaboration between the Trusts, PDFs, multi-professionals, clinicians and the University.

Most PDFs chose to timetable multi-professionals to teach elements within their specialist field of practice. As the cohort sizes were likely to be small, it was identified that the PDFs would be the mentor. However, it was important that whoever was involved would need to be supported in whatever way was appropriate, i.e. with lesson planning, mentoring, assessment strategies, academic writing and collating portfolio evidence.

University supportThe University of Surrey provided structural support for the AWBL approach through endorsing the development of the pilot AWBL ‘umbrella’ module framework Using work-based learning to enhance practice (as described in 4.1).

A lead in designing the pilot AWBL module was taken by the EIHMS team’s AWBL co-ordinator, Ms. Alison Rhodes, who provided expertise support for the process of designing, delivering and assessing work-based and University assessed learning. Designing the module and the individual AWBL programmes was a parallel and mutually informative process. Following the action research approach it was considered prudent to take the lead from the PDFs, to match their level of knowledge to an appropriate level of support. This was provided through facilitative and collaborative group discussions during regular PDF meetings (as described in section 2).

Each PDF was asked to consider the generic learning outcomes of the AWBL module and to convert these into their own programmes. This was achieved through collaborative discussions at the PDF meetings. Furthermore, the AWBL co-ordinator provided individual meetings and email and telephone correspondence to assist the AWBL programme design.

Once the first two programmes had commenced it became apparent that there were generic needs that required support and development from the AWBL co-ordinator to ensure that the PDFs could provide the required academic level. Support and guidance was provided (in the form of face-to-face individual and group meetings, emails, telephone conversations and tutorials) in respect to: Reflection and reflective writing: PDFs

were given information on key principles and AWBL learners were offered the opportunity to have drafts of their reflective writing commented upon by the AWBL co-ordinator.

Marking and assessment guidelines: PDF were provided with a marking workshop at EIHMS and PDFs were given individual instructions on assessment criteria.

4.3 Outcomes: learning, practice and patient care

By the end of 2004 altogether 17 learners had been involved in the pilot AWBL programmes:

Cohort 1: Rehabilitation and Promoting Independence for Older People – levels 2 and 3 (The East Surrey Primary Care Trust): 5 commenced (1 non-submission) = 4 successfully completed.

Cohort 2: E to F Grade Development Programme for Critical Care – level 3 (The Royal West Sussex Trust): 3 commenced and successfully completed.

Cohort 3: E to F Grade Development Programme for Critical Care – level 3 (The Royal West Sussex Trust): 3 commenced (1 withdrew) = 2 currently on programme (Dec. 2004).

Cohort 4: Managing the Acutely Ill Patient on a Ward – levels 2 and 3 (The Royal Surrey County Hospital NHS Trust): 6 commenced (1 withdrew) = 5 currently on programme (Dec. 2004).

The evaluation strategy involved questionnaires (see Appendices G, H, I and J) and a focus group feedback meeting allowing learners to discuss, compare and contrast their experiences. The key outcomes of the evaluation include responses from learners in

Cohorts 1, 2 and 4 (see Appendix K for a more comprehensive presentation).

LearningQualities of the AWBL programme, as reported by learners: Enjoyable Relevant to practice Bridging the theory-practice gab

Learners’ assessment of the AWBL programme: Satisfied with the quality of support

from mentors. Reflexive writing facilitated a greater

understanding of learning and practice issues and created an opportunity to improve these.

Some emphasised the need for support to focus attention to the learning in the workplace.

Some emphasised the competencies as especially useful when doing work-based learning.

Some reported a need for more time to support the learning

I’ve really benefited from the course. I think work-based learning is wonderful because you’re focusing very much on what we’re doing here and in a really enthusiastic setting.

It didn’t make it easier, because that would be the wrong word, but because it was so relevant, you know, sometimes you sit in lectures and you just think “I’m never going to use this” and part of you just switches off. But when you learn something and the next day literally you think, “right, I can do it”. … It’s because we use it. It’s not something that we just file away.

I think that I’m probably more aware what I’m doing. I think more about how I do it and write it.

Benefits form the AWBL programme, as reported by learners: Extended knowledge of clinical

practice and being enabled to apply learning to clinical work.

Change and improve practice. Greater reflexive and critical

awareness of clinical practice. Developing a sense of

accomplishment and satisfaction.

Transformed the routine clinical practice into a stimulating opportunity for development.

Better understanding of the task at hand in clinical practice and place it in a bigger picture of service delivery and patient care.

Better understanding for the perspectives of colleagues.

PracticeThe learning’s impact on practice, as assessed by learners: New knowledge and skills were

applied in the workplace. New understandings and skills were

developed while practising them – it becomes ‘a new habit’.

Learners shared their new knowledge with the team, thereby making a broader impact on practice.

Learners became more confident and assertive in insisting on best practice – becoming ‘agents of best practice’.

Improved inter-professional communication.

Learners developed greater job satisfaction due to the positive stimulation from the learning process.

The achievement of greater job satisfaction might be of particular relevance to the Life Long Learning framework and issues of staff burn-out and retention, which is currently a major structural obstacle to achieve satisfying service delivery in the NHS.

[W]e’ve learnt it and it’s relevant and we’re using it already, even before the end of the course, I was using skills. So even if I don’t finish it [the programme], it’s made an impact.

The things that I have learnt are very practical skills, relevant to my work… And I’m also passing it on to other people.

[You need to sometimes be] badgering the doctor, sometimes you can’t do it [provide a certain treatment/ intervention] and you need the doctor to do it and you just have to keep going on at them [insisting that the patient gets treated]. So, in fact, they’re [the doctors] getting better at it and if you do that, the patients who you’re there for get better more quickly. It must be more cost-effective as well.

Patient careThe learning’s impact on patient care, as assessed by learners:

The new knowledge and skills have had a positive impact on patient care.

Positive impact on patient care was a result of the total effect of the learning in the workplace and the implications it had for delivering best practice.

Beneficial to have AWBL as a rolling programme that keep staff engaged in service development

Learners’ comments

Hopefully, they are constantly raising the bar, really. We will be learning, the quality of patient care is just constantly improving and the more you look at it, the more it should be improving. The more people go onto things that are work-based, be it credit-driven or not… The relevance will be to what you are doing on a day-to-day basis. If you’re applying it, patients are getting a more pro-active [treatment].

Now it’s much more immediate. It’s “I’ll do it”. You’re already seeing them, the face-to-face contact, but you’re also being much more professional. “I have the skills to do this”.

We all want to do a good job. We all like going to work and knowing when we come home that we’ve done a good job. The fact that this is so job-orientated is that you see what you’re learning.

Key pointsThe evaluation of the pilot AWBL programmes demonstrated following positive outcomes: The achievement of better practice

and patient care. Improved interprofessional

communication. Greater job satisfaction – with

potential to improve issues of staff burn-out and retention.

5. A sustainable framework: recommendations

The development and delivery of AWBL programmes require establishing a structural framework to facilitate a constructive collaboration between Trusts and Universities/HEIs. This is essential to successfully address Trusts’ requirements for service delivery and bridge the theory-practice gap to ensure evidence-based and best practice.

The focus on patients’ needs as outlined by the Department of Health in Shifting the Balance of Power (DoH 2002a) and the NHS Improvement Plan (2004c) requires an innovative and radical approach to secure practice development and high quality service delivery. Service development has to address the real issues and be supported by a solid evidence base, capitalising equally from practice knowledge and research evidence. There is an urgent requirement for a highly qualified and flexible workforce to take on new and emerging challenges of best practice healthcare provision (DoH 1999, 2000b, 2002b, 2004a, 2004b).

Close collaboration between NHS Trusts and HEIs regarding practice development and learning activities is a necessary response to this situation. The strategy reflects the University of Surrey’s vision statement to be ‘working for the world’ through productive partnerships and it ensures that practice learning approaches are improving and responding to the requirements of the changing workforce agenda and new ways of working.

This section draws on experiences of collaborative working through the action research approach to the PDF role and piloting AWBL programmes. A framework for Trust-University collaboration is suggested through the identification of key responsibilities within each institution and by proposing the development of a partnership model for the future.

5.1 Trust support

Within a sustainable framework for the development and delivery of AWBL programmes Trusts are required to

provide the necessary level of support in these key areas:

1. Development of AWBL programmes2. Collaboration with the University3. Delivery of AWBL programmes4. The PDF role

Development of AWBL programmesFirst of all, Trusts have to conduct a thorough needs assessment at strategic and practice levels consulting managers, colleagues and peers to establish: Evidence for the need for practice

development and learning. The extent to which the need might be

best met by an AWBL programme in the work place, or existing modules on offer in the Trust or from education institutions.

Support from Trust managers for the AWBL programme.

Availability of resources (e.g. time, teachers, mentors, rooms) for the programme delivery.

Identify sufficient numbers of staff or teams who need the learning and are willing and able to take part in the AWBL programme.

Failure to sufficiently address any one of these points might prevent the implementation of the AWBL programme. It is crucial to the success of work-based learning initiatives that this ‘ground work’ has been done.

In (future) service developments where a Trust might consider implementing an AWBL programme (e.g. those detailed in appendices D, E and F) which has already been developed for another Trust the content and structure of the programme would have to be re-assessed to ensure it addresses the specific requirements and conditions of the Trust. This assessment work requires close collaboration with the University to ensure the appropriateness of the AWBL programme design to the individual Trust.

The needs assessment and possible adaptation of existing programme structures would largely be a Trust

responsibility and carried out by a person who has the required level of knowledge of strategic Trust issues while also being aware of the practice needs of clinical staff ‘on the ground’. However, the work would require support from the involved University. The University is responsible for the quality assurance processes and the Trust needs to collaborate closely with the University when the needs assessment process is initiated.

Collaboration with the University/HEIThe development and delivery of AWBL programmes requires the Trusts to invest in collaborative working with the University. Involved Trust staff need to have the required professional knowledge and experience to constructively engage and negotiate with the University. Equally, time and opportunities for facilitative meetings have to be provided to achieve this. (See also sections 5.2 and 5.3)

Delivery of AWBL programmesIn order to provide learning in the work place it is required that the Trusts provide necessary facilities in terms of: Time for AWBL learners

(supernumerary time and study days, as required).

Teachers (freeing of clinical staff to prepare for and deliver teaching).

Mentors (identify relevant clinical staff and provide supernumerary time for them to support learners).

Support for teachers and mentors (ensure that learning and support is at required level).

Support for AWBL learners (if required in addition to mentor support).

Assessment of learners’ course work.

Some learners might not be interested in receiving University credits and having their course work assessed. While learners of course should have the opportunity to choose not to receive accreditation, if they wish so, experiences from the pilot AWBL programmes indicate that the learning nonetheless should present equal course work requirements as part of the learning process. For example, when writing a reflection (for the course assessment) on experiences in practice, learners develop their understandings of issues involved, and the reflective writing might then stimulate further practice development. In other

words, course work and assessment is an integral part of the learning.

The PDF roleExperiences from the pilot programmes document the requirement for a ‘PDF-type’ role in the Trust to support the development and delivery of AWBL programmes. Whether or not this role is called ‘PDF’, it is significant that it provides the functions identified in section 3, in order to enable the level of Trust support as described above.

An important characteristic of this role is the active involvement at ward level and engaging with teams to identify the best ways to improve service delivery. While an AWBL approach might be chosen in some cases, in other situations alternative methods of change management might provide more timely and effective solutions.

One PDF may not be able to provide all the practice development support in a Trust. The PDF could involve other senior clinicians in part-time PDF-type work. For example, a ward manager could be responsible for developing and delivering an AWBL programme in her ward as part of a practice development initiative. In this way, the PDF could build up a resource network of colleagues to provide AWBL programmes. While encouraging a broader learning environment culture this strategy would also make the Trust provision of AWBL programmes less dependent on a single individual (and, hence, less vulnerable to sickness, leave or resignation).

5.2 University support

The University/HEI is required to support the sustainable model for AWBL programmes through:

1. An University quality-assured framework for work-based learning with sufficient flexibility to address Trusts’ needs for staff training and learning to promptly support emerging requirements for service development.

2. Involvement with Trusts and clinical practitioners to identify practice development needs and participate to help achieve these.

3. Support and guidance for Trusts (i.e. PDFs) to design relevant AWBL programmes.

4. Support and guidance for Trusts (i.e. PDFs) to deliver and assess AWBL programmes in the workplace.

5. Support and guidance for work-based learners to meet the requirements of the AWBL programmes.

6. Support and guidance to conduct research and evaluation that will help shape practice development activities and secure the evidence base for the delivery of best practice.

University module structureEIHMS has validated the pilot module framework Using Work-based Learning to Enhance Practice and is currently developing a programme framework for Negotiated Learning which will form the future structural component for AWBL programmes. This structure will include directions for the Trust-University partnership and detail assessment procedures as well as the cost implications to Trusts of the AWBL support, the issue of ownership of modules (through the collaborative process) and the responsibility to develop the programme/approach in the light of evaluation.

Involvement with Trusts and practiceUniversity staff are required to engage directly with clinical practice and help identify the most suitable and effective approaches to improve service delivery and staff competencies. Working alongside teams and identifying issues on the ward allows the University to engage more comprehensively in practice development activities and set up AWBL programmes as required. This approach will also go some way to meet the clinical involvement requirement for clinical lecturers.

Design of AWBL programmesThe University is required to enter into a partnership working with Trusts to provide early guidance and support in terms of designing programmes based on service development and workforce development needs identified in the Trusts. This support should address not only the technical requirements to the structure of the learning programme but also the substantive aspects of the knowledge

base in the particular clinical area. The University staff should engage in collaborative work with the Trust representatives (i.e. PDFs) to provide their knowledge of the clinical evidence base in the field to ensure that the AWBL programme will stimulate best practice. (See also section 5.3, where this aspect is further elaborated.)

Delivery and assessment of AWBL programmesExperiences from the pilot AWBL programmes (see section 4.2) have indicated a number of areas where the University will be required to support the delivery and assessment of work-based learning in Trusts. The University would have to support and quality assure the Trust-based staff providing the learning (i.e. PDFs and other Trust-based teachers) by offering: Formal support sessions to explore

and develop a level of knowledge regarding:a) Practice learning strategies,

including teaching and learning methods.

b) Experiential learning approaches including different models of reflection and reflective writing.

A series of assessment workshops prior to a module commencing, to analyse assessment criteria, generic marking scheme relevant to AWBL and to develop skills of assessment.

Support in the exploration of different approaches to assessing learners’ achievements (i.e. reports, presentation, seminars and action learning sets), with identified assessment criteria.

Support in developing individual programmes (i.e. learning agreements, learning outcomes, timetables and guidelines etc.) to ensure that each programme meets Trust requirements.

Tutorial time for Trust practice developers (i.e. PDFs) and supervision regarding their teaching capability, with the aim to identify achievements and further development.

Review of teaching to support the delivery of the programme.

Mentor meetings to explore assessment strategies, to be fully informed of the Trust role and the University involvement, building a

more extensive, collaborative partnership.

Experiences from the AWBL pilot indicate that the support need could be met through: A monthly supervision group lead by

an AWBL co-ordinator/liaison lecturer for a maximum of 6 practice developers.

Occasional Individual support for practice developers provided by the AWBL co-ordinator (per face-to-face, email, or telephone).

Support for AWBL learnersBoth PDFs and learners on the AWBL pilot programmes identified a need for the University to provide direct support for the learners. This should be provided as: A one-day introductory meeting at the

University for the AWBL learners to provide basic information and guidance. The AWBL co-ordinator would go through the content and structure of the learning programme and explain requirements for the assessment. Additional information could be provided regarding reading logs, critical reading of practice evidence and reflective writing.

Different learning activities to support work-based learning, i.e. face-to-face tutorial time for learners, e-tutorials, distance learning material etc.

Research to ensure the evidence-baseUniversity/HEI staff will be required to engage actively with clinical practitioners to design and conduct research into the learning process, developments of best practice and patient outcomes. First, work-based learning activities will have to be closely monitored by research and evaluation that document the quality of innovative approaches. Second, research and evaluation initiatives ensure that practice developments are related to and assessed against best practice in the field. Third, by rigorously monitoring patient outcomes it is ensured that patients’ needs are at the focus of the learning and practice development initiatives.

The integration of a sufficient research and evaluation strategy is essential not only to validate approaches to learning and practice development, but also to disseminate and share the innovative approaches in the wider practice and

research community. There is an acute need to reflect ‘local thinking’ in a nation-wide and international perspective.

In some circumstances University staff may take an active role in leading and conduction the research in the clinical setting. In other situations the academics may collaborate with sufficiently qualified practitioners to support and guide them to design and conduct the required research, evaluation or audit.

5.3 Practice development partnerships

The pilot described and evaluated in this report has paid particular attention to the introduction of the PDF role and action research collaboration to set up AWBL programmes. This effort has focused on developing a common approach and broadly defined collaboration systems that would be workable from both Trust and University perspectives. Experiences from this process have illuminated a potential area of development.

Further Trust-University collaboration in partnerships would be necessary to secure continued high quality service delivery through learning and practice development initiatives in the workplace. Also, representatives from patient or user groups may contribute significantly to identify areas in need of service development and how to deliver best practice. Although their total remit might be broader, these partnerships could have a particular role in respect to supporting the development of AWBL programmes as an element of service and practice development initiatives.

Key functions of these partnerships would be to provide a forum for clinical practitioners, area specific lecturers and patient/user representatives to meet on a regular basis to:

1. Share knowledge about best practice (whether theory- or practice-based)

2. Share, discuss and develop innovative methods of learning and assessment.

3. Discuss learning and practice requirements in specialised fields of practice.

4. Develop new learning programmes, whether University-based or work-based (AWBL programmes).

5. Develop research initiatives to document the evidence base for learning initiatives, best practice and service development.

The practice development partnerships would need to be specific to clinical areas to allow a sharing of clinical knowledge in particular fields. They would be a natural forum for the Trust-based role (i.e. PDF) and University-based role (i.e. AWBL co-ordinator) to meet to discuss ideas for AWBL programmes in a broader group of expert professionals. Equally, the collaborative work to design AWBL programmes and research initiatives could arise from discussions in the partnership.

At EIHMS there are already in existence Practice Development Units (PDUs) in a number of clinical areas: Child, Critical Care (including acute care and unscheduled care), Mental Health and Learning Disability, Midwifery, Older Age and Public and Community Health (including chronic disease management). The overall aims of PDUs are to: Provide an interface between EIHMS

and health and social care settings. Promote professional and practice

aspects of the collaborative work of EIHMS, NHS Trusts and health and social care agencies.

Develop scholarly practice to support practice development and practice learning for professional preparation and continuing professional development.

Consider contemporary practice development issues to ensure practice learning and teaching strategies reflect current thinking.

Stimulate practice development and research activities.

Develop a resource base of practice expertise for contemporary learning and teaching provision in university and practice settings.

The PDUs present a natural arena for the development of Trust-University partnerships around AWBL.

The mental health PDFs have been a driving force in developing the thinking in this field through their proposal of an 2-year pilot Acute Care Partnership. It will be a partnership of acute units, user and carer organisations, Surrey and Brighton universities and the SEDC, reporting to the

SHA, to develop practice in acute mental health care and evolve educational programmes which will service that development. An action research cycle will be established, with education running parallel with service improvement, emerging from and feeding into the process. Educational relevance to practice, practice change to accommodate new skills and the accumulation and sharing of best practice evidence will become interdependent parts of the system. This partnership project builds on the experience of the PDF project, placing practice development at the heart of continuing professional development work.

Key recommendations for a partnership structure involving NHS Trusts, patients/users, HEIs and SHAs: Trusts to provide support through the

establishment of and sufficient support for PDF type roles.

HEI to provide support through the establishment of a flexible module framework, an AWBL co-ordinator role and area specific lecturers to engage in AWBL projects and support research to ensure the evidence base.

Practice development partnerships involving Trusts, HEIs and patients/users, through ongoing collaboration in Practice Development Units (PDUs).

Commitment from the SHA to fund and encourage practice development partnership initiatives.

Summary

The evaluation shows that against health and social care policy drivers, service and practice developments provide a context for a sustainable framework for accredited work-based learning.

The sustainable framework would facilitate the negotiation of a quality assured learning programme (module) between a NHS Trust and an University as an element of planned Trust service and practice developments.

It is anticipated that the resourcing for the learning programme could come from a variety of sources, for example the proposed Acute Care Partnership as a specific funded SHA project and/ or from

the continuing professional development contract. The NHS Trust and University negotiated work-based learning and

development would involve processes as illustrated in Figure 5.1

Figure 5.1

References

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The EIHMS Strategic PDF Group

Dr Pat Colliety, Senior Tutor, Public and Community Health.

Dr John Aggergaard Larsen, Research Fellow.

Ms. Alison Rhodes, Tutor and Director of Studies, MSc Teaching and Learning.

Ms. Sue Ryle, Head of Continuing Professional Development and Postgraduate Programmes.

Professor Pam Smith, Director of the Centre for Research in Nursing and Midwifery Education.

Dr Margaret Volante, Head of Practice Learning and Education, Centre for Research in Nursing and Midwifery Education.