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Healthcare assistants - what would we do without them?

Healthcare assistants / assistant practitioners / support workers - the titles are endless. However, whatever their title, there is no doubt they have become an invaluable member of the primary healthcare team. Initially developed to undertake venepuncture, BP monitoring and some housekeeping duties their role continues to develop at a fast pace. For some this can bring immense satisfaction, for others this can seem a daunting prospect, and what is clear is that for this to be successful there is a need for robust training and development opportunities along with high-quality mentorship by a qualified nurse and high-quality protocols and guidelines. The Working in Partnership (WiPP) toolkit provides a wealth of information to support practice staff to introduce and develop the role of the HCA in general practice.

Many of the anxieties expressed by qualified nurses when working with unqualified staff are around accountability, delegation and responsibilities. It is important that nurses are able to discuss these issues with the team to be able to understand and feel confident with the role of the HCA. The NMC Code of Conduct, which is currently being reviewed, will support nurses in answering some of these questions, in particular issues around delegation and ensuring that as professionals we are able to delegate appropriately.(1)

As discussions continue about professional regulation for such staff it is essential that nurses are clear about their roles and responsibilities when working with healthcare assistants. The Royal College Of Nursing has produced guidance and continues to provide clarity on this matter.(2,3) Patients need to be confident that the healthcare assistant is trained and competent to do the job they are being asked to do, and nurses play a key role in ensuring that this happens. Patient safety and clinical governance are paramount to maintain public protection and as nurses we have an important role to play in influencing this process.

We are currently undertaking a pilot for healthcare assistants and assistant practitioners in Stockport to undertake influenza and pneumococcal vaccinations. While initially there were many concerns about HCAs undertaking this role, the strength of our pilot is that the whole team was involved with this initiative from the start. We encouraged lots of discussion and provided the team with opportunity to discuss issues and gain clarity about the role. We have also used the WiPP toolkit to support us in developing our pilot. At a recent meeting a practice nurse commented on their HCA that: "they are an invaluable member of the team, I don't know what we would do without them."

The Wanless Report recognised the requirement for the NHS to expand the numbers of HCAs in the NHS to meet increasing demands on the service.(4) I feel we have addressed this in primary care and the benefits of employing and developing HCAs continue to grow. Likewise the career opportunities for HCAs are evolving, including opportunities to undertake national vocational qualifications (NVQ) studies and to gain entrance to preregistration nurse training. Indeed we have seen several go on to start their nurse training. What an achievement for staff who may never have considered nursing as a career. I feel privileged to be able to facilitate this. What are your success stories we want to hear from you?

Your comments: (Terms and conditions apply)

"Before joining my current practice as an HCA I had worked in hospital for best part of 15 years. Since being in my current role the practice and nurses have been very supportive, but it is very frustrating when you cannot access training courses especially when you have worked hard to get your NVQ 3. I know that my practice nurses would find it invaluable if I could give flu jabs but our PCT seems to be dragging its feet in sorting this out" - Name and address supplied

"We have recently employed two healthcare assistants. It has been a challenge training two at the same time but they are invaluable. The difficulty is finding courses suitable for them. The PCT do offer some generic courses but often what we do in general practice is very specific. I am able to do training in the practice but sometimes you need dedicated training time and underpinning knowledge to go along with the practical skills. Our previous HCA has gone on to do her nurse training after completing an NVQ level 3" - Michelle Davidson, Nurse Practitioner, Somerset

"We have a HCA at our practice who is invaluable but we have not been able to get a [vaccination] course for her to do, which resulted in me doing all 850 vaccinations myself, which has been a challenge as I only work part-time. We are also having a problem finding somewhere for her to do her NVQ. She is extremely keen and our local PCT are not helping at all" - Name and address supplied

"Our HCA, who has already achieved NVQ level 3, has always been very keen to develop her skills in primary care. She has recently successfully completed the influenza and pneumococcal vaccination course provided by the Primary Care Centre. Now complete, she has been working with the qualified nurses in the practice during this year's flu campaign. She gives vaccines using 'Patient Specific Directions'. This has been an enormous help to the practice. We are fully committed to developing her role and skills. She is now waiting to start the Rotherham Ear Care course. This course is specifically designed for HCAs. We are encouraging her to go onto do her nurse training but due to family commitments this is not currently possible" - Rosalind Bull, Nurse Practitioner, Clinical Manager, Slough