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Introducing healthcare assistants to primary care

Paul Vaughan
National Project Manager
HCA Project
Working in Partnership Programme

In response to the increasing demand on general practice, the healthcare assistant (HCA) role has emerged as an important role within the general practice team. With this increasing demand on general practice, where 90% of all NHS contacts take place, there is a need to create more capacity in order to be able to meet the challenges of delivering care in a changing world.(1) Some of the challenges that need to be addressed are:

  • The shortage of staff in key professional groups.
  • How to address the public's desire to have services delivered locally.
  • By 2020 there will be twice as many people over the age of 85, leading to an increasing demand on primary care services.
  • How to create capacity to enable GPs to diversify their role with the establishment of GPs with Special Interests.
  • How to enable general practice to embrace practice-based commissioning.

The Working in Partnership Programme (WiPP), developed as a result of the nGMS Contract, will help general practice create capacity. WiPP seeks to identify, evaluate and signpost effective ways to manage demand in general practice while improving the availability of services for patients.
The HCA Project, one of 13 projects in the WiPP portfolio, aims to support general practice with the recruitment and retention, training and development and the integration of HCAs into the general practice team.
HCAs are an important element to skill mix; employing HCAs enables workload shifts from GPs to nurses, as well as more proactive management of patients with long-term conditions. As the practice nurse role within primary care is afforded more opportunities to expand, there are more opportunities for the delegation of a greater range of tasks to HCAs.

In order for the role of the HCA to be successful and deliver to its full potential, HCAs need to be integrated into the general practice team and supported by general practice nurses. General practice nurses can help address issues facing HCAs as the role emerges. Some of the issues facing HCAs are:

  • Lack of understanding of the role within the general practice team.
  • Insufficient protected learning time.
  • Isolation in role.
  • Limited training and development opportunities.
  • Confusion over accountability and delegation of tasks.

To support the general practice team with the introduction of the HCA role into the practice, the HCA Project is developing a toolkit that will be available on the WiPP website to help address these issues. Patient safety being paramount, there will be a range of core principles, examples of good practice and practical tools to support general practice employers in safely employing and developing HCAs to deliver high-quality care to patients.

Practice nurses have a central role in the development of HCAs. With this responsibility comes major rewards. Practice nurses can:

  • Delegate tasks, enabling them to develop their practice nurse role.
  • Gain skills in mentorship and supervision.
  • Take pride in supporting others with developing their career.
  • Help their practice meet its business plan and achieve maximum Quality and Outcomes Framework (QOF) points.

Already in general practices in England, HCAs are making a significant contribution to the delivery of general practice by:

  • Relieving workload pressures, especially in general practice, since the delegation of routine procedures facilitates the effective use of clinicians' time.
  • Helping practices achieve on health promotion and disease prevention targets, especially in relation to the QOF.
  • Meeting 24-hour and 48-hour access targets.
  • Bridging the gap where there are shortages of professional staff, especially in areas experiencing serious recruitment issues.

These benefits are realised when HCAs are properly trained, developed and integrated into the general practice team. Their input, in freeing up professionals' time for personal, professional or practice development purposes, creates capacity that enables practices to participate in service redesign and modernisation, an essential element of the expansion of the primary care sector. What's more, where HCAs have been successfully established and integrated into the general practice team, patients have been shown to respond positively.
During the work of the HCA Project, a number of issues have been raised about the role of the HCA and the range of the tasks that they can undertake - for example, there has been considerable debate about whether or not HCAs can administer the flu vaccine or undertake cervical cytology. There have been fears expressed about HCAs being used in general practice as a cheaper alternative to practice nurses. Questions have been raised about whether or not HCAs can be employed in a practice where there is no practice nurse. If this were to happen, who would be in a position to assess and supervise the competence of the HCA to carry out their role?

We have discovered the problem HCAs in general practice face when trying to secure sponsorship to undertake nurse training. There are an increasing number of qualified nurses due to retire in the next 10 years. Where will future practice nurses come from? Following their July conference, UNISON reported that 84% of HCAs said they would like to undertake nurse training. But unless HCAs in general practice can access funding schemes in the same way HCAs in the acute sector can, general practice will not be able to tap this enormous resource for its future development.

And as if this were not enough, it has been discovered that, in some parts of the country where HCAs in general practice try to enrol to undertake an NVQ level 3, some educational providers will not allow them to register. They argue that HCAs from general practice are not able to demonstrate their competency in the units they offer to NVQ candidates, as the units are geared towards the acute and social care sector.
As with any emerging role, there is no surprise in the array of challenges facing HCAs in general practice in order for the role to be accepted and for it to be developed to its full potential. Some have expressed concern that HCAs "could perceive task training as just a means to an end and not a way of integrating such skills into the patient's holistic care" and that by undertaking more complex tasks HCAs would increase their status.(2)
A place to start so as to diminish these challenges is to undertake a skill mix review. For example:

  • Undertake a needs analysis of your patients.
  • Map the competencies required to be able to meet the needs of your patients.
  • Group the competencies according to the level of skill required.
  • Map out the skill mix required by the practice to meet the needs of your patients.

That way you will be able to identify how each role has a part to play in the delivery of care. You will be able to focus your education and training plans to equip the practice staff to be competent in their role. And you will be able to offer personal and professional development opportunities to practice staff that will maintain motivation and aid retention. With this approach you maintain the focus on meeting patient need and ensuring an holistic approach to care.

Identifying a definitive solution to these issues is not the remit of the WiPP HCA project; it has become a champion for the role of HCAs in general practice. The HCA Project is articulating how the role of the HCA can help to meet patient needs and is recognising the enormous contribution HCAs can make to the delivery of high-quality care in general practice nursing.

In a complex world there may not be a simple solution to some issues. We need to open our minds and listen and contribute constructively to the debate so that best practice can emerge. Sometimes it's about hearing the dialogue rather than finding a solution.


  1. RCGP. General practice in the UK: a basic overview. Information Sheet No 4. London: RCGP; 2005.
  2. Castledine G. The role of the healthcare assistant in nursing. Br J Nurs 2004;13(19):1161.

Working in Partnership Programme