Primary Care Reports – Online Training & Continual Professional Development for GP Practices by Global Business Media

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Online Training and Continuing Professional Development for GP Practices Training GP Practice Staff in the 21st Century Why Training will be Crucial in Helping GPs Rise to the Challenges of the 21st Century Developing Continuing Professional Development in Primary Care Getting the Most Out of eLearning Continuing Professional Development and the Future of Primary Care

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Foreword Introduction Overall Considerations Classroom or Instructor-Led Training Hands-On Training Online Training/eLearning How to Use a Blended Learning Approach The Future of eLearning in a GP Practice Case Study

Why Training will be Crucial in Helping 8 GPs Rise to the Challenges of the 21st Century

Tom Cropper, Editor

A Difficult Challenge Money is Tight The Evolution of Training

Developing Continuing Professional 10 Development in Primary Care Jo Roth, Staff Writer

The History of eLearning Achieving Compliance Improving Standards, Saving Lives

Getting the Most Out of eLearning

James Butler, Staff Writer The opinions and views expressed in the editorial content in this publication are those of the authors alone and do not necessarily represent the views of any organisation with which they may be associated.

Getting Full Value Assessing Performance Making it Work

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Continuing Professional Development 14 and the Future of Primary Care

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Tom Cropper, Editor

Beyond Reality Lessons from Entertainment Broadcast News

References 16

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ONLINE TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT FOR GP PRACTICES

Foreword T

RAINING IS a vital part of the NHS strategy

We’ll also take a close look at the environment in

going forward, but with time and money

which they are working. An ageing population means

in short supply, the search is on for fast,

more consultations and more complex cases, but

simple, affordable and effective solutions. Online

funding cuts are making life much more difficult.

training would seem to be a perfect fit, but how

Training which is streamlined reduces the interruption

useful can it be? Is it just a cut-price version of

of GPs’ work and improves services across the board.

conventional training methods or is it – as its

We will then examine the development of CPD

promoters suggest – a high tech system for

and, in particular, online and digital training solutions.

healthcare in the 21st century?

Jo Roth will focus on the rise of eLearning and how

Perhaps because it’s been difficult to prove the

it can help Practices achieve CQC compliance and

positive case for eLearning, most of the attention

inject widespread improvements to surgeries. James

traditionally has been on what you’d call negative

Butler, meanwhile, will compare and contrast merits

benefits – saving time or money. While these are

of eLearning with traditional offline training methods.

undoubtedly important, there is a much wider case

Finally, we look into the future. A host of new

to examine, which we will attempt to do in this report.

and exciting technologies promise great things,

Our first article comes from Blue Stream Academy,

especially in the realm of eLearning. We’ll look at

a leading name in the provision of eLearning solutions

some of these and assess how they might influence

to the healthcare sector. They outline some of the most

the work of GPs.

common methods of training currently being used in the NHS as well as looking forward to the future. eLearning suites, such as those that they offer, do much to improve the value of training while alleviating the administrative and financial burden on Practices.

Tom Cropper Editor

Tom Cropper has produced articles and reports on various aspects of global business over the past 15 years. He has also worked as a copywriter for some of the largest corporations in the world, including ING, KPMG and the World Wildlife Fund.

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ONLINE TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT FOR GP PRACTICES

Training GP Practice Staff in the 21st Century Shelley McCart, Blue Stream Academy Ltd. There has never been more focus on training within a GP Practice than at this present time. The old adage of “what if I train my staff and they leave?” has been replaced with “what if I don’t train them and they stay?”

Introduction The NHS England mission is: High quality care for all – now and for future generations. The single common definition of quality encompasses three equally important parts: • Care that is clinically effective– not just in the eyes of clinicians but in the eyes of patients themselves; • Care that is safe; and, • Care that provides as positive an experience for patients as possible. NHS England.[5] Training is a vital component when it comes to ensuring high quality care but it is sometimes neglected for such reasons as; “we don’t have the money to pay for training”, “we are too busy to carry out training at the moment”. Whilst training does come at a cost, the two biggest resources utilised are time and money, it should also be remembered that not training staff comes at a cost too! When hesitating over investment in training the following should be considered: Untrained employees: • Can feel inadequate, underachieving, or unsupported – this can lead to unhappiness and underperforming in their job. • Have a lower quality of work and lower quality of performance. • Are inefficient and take longer to do their work. • Make more mistakes – this impacts on the patient experience as well as finance. • Can lose customers – poor patient experience can lead to loss of reputation. Having a trained workforce means staff are learning new skills that can improve patient experience, increase Practice productivity, reduce costs, reduce mistakes, build confidence in the workforce, and create a better working environment.

An investment in staff skill sets is an investment in your organisation. “When everyone gets better, everyone gets better.” All staff need to be trained; trained staff are generally better at their job than untrained staff; staff who are good at their job generally enjoy their job; people who enjoy their job get better at their job and there becomes a cycle. Also, it generally costs the same to employ someone who is well trained as someone who hasn’t been well trained. It is important that, if anything untoward happened, the Partners of a Practice could stand in front of a coroner or judge and justify that the training they had provided for their staff was sufficient to ensure they were competent, and confident to undertake the task given to them. The emphasis on improving patient experience requires staff to have a greater understanding of an ever increasing number of subjects as they have a bigger and more crucial role to play in the care of patients and how services are run.

CHOOSING THE RIGHT TRAINING

There are numerous methods and materials available to help a Practice prepare and equip employees to better do their jobs. Indeed, with so many choices out there, it can be daunting to determine which methods to use and when to use them. In this article, we take a look at options available and examine their advantages and disadvantages. We also consider how various WWW.PRIMARYCAREREPORTS.CO.UK | 3

ONLINE TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT FOR GP PRACTICES

“Improving patient experience requires staff to have a greater understanding of an ever increasing number of subjects”

methods can be combined into an effective blended learning approach.

Overall Considerations Before considering specific training techniques it is useful to ask the following questions; What are the training goals? • New skills. • New techniques for old skills. • Better workplace behaviour. • A safer workplace. Who is being trained? • New employees. • Existing employees. • Upper management. What is your training budget? How much time has been allocated for training within your organisation?

“with so many choices out there, it can be daunting to determine which methods to use”

What training resources and materials do you have at your disposal? Your answers to these questions begin the narrowing process for your training choices. Now let’s examine those training methods, their pros and cons, and where they best fit in a training program.

Classroom or Instructor-Led Training

with the outcome of each way described. This method is most effective with debriefing questions, such as: • How does this story relate to training? • How did the main character’s choices make you feel? • W hat assumptions did you make throughout the story? Were they correct? • What would you have done differently? Advantages Instructor-led classroom training is an efficient method for presenting a large body of material to large or small groups of employees. It is a personal, face-to-face type of training. It ensures that everyone gets the same information at the same time. Storytelling grabs peoples’ attention. Disadvantages It is costly if speakers/trainers need to be sourced externally. Sometimes it is not interactive. Too much of the success of the training depends on the effectiveness of the lecturer. Scheduling classroom sessions for large numbers of trainees can be difficult especially when trainees are at multiple locations or are on call.

Hands-On Training

CLASSROOM BASED TRAINING

“Begin the narrowing process for your training choices”

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There are many types of Instructor-led training including: • Blackboard or whiteboard. This may be the most “old-fashioned” method, but it can still be effective, especially if you invite trainees to write on the board or ask for feedback on what you write on the board. • Video inclusion – lectures can be broken up with videos that explain sections of the training topic or that present case studies for discussion. • PowerPoint ® presentation. Presentation software is used to create customised group training sessions that are led by an instructor. • Storytelling – stories can be used as examples of right and wrong ways to perform skills

HANDS ON TRAINING

Experiential, or hands-on, training, offers several more effective techniques for teaching employees, including: •C ross-training. This method allows employees to experience other jobs, which not only enhances employee skills but also gives companies the benefit of having employees who can perform more than one job. Crosstraining also gives employees a better appreciation of what co-workers do and how their own jobs fit in with the work of others to achieve company goals.

ONLINE TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT FOR GP PRACTICES

•D emonstrations. Demonstrations are attentiongrabbers. They are an excellent way to teach employees to use new equipment or to teach the steps in a new process. They are also effective in teaching safety skills. Combined with the opportunity for questions and answers, this is a powerful, engaging form of training. •C oaching. The goal of job coaching is to improve an employee’s performance. Coaching focuses on the individual needs of an employee and is generally less formal than other kinds of training. There are usually no set training sessions. A manager, supervisor, or veteran employee serves as the coach. He or she gets together with the employee being coached when time allows and works with this employee to: • Answer questions. • Suggest more effective strategies. • Correct errors. • Guide toward goals. • Give support and encouragement. • Provide knowledgeable feedback. •A pprenticeships. Apprenticeships give employers the opportunity to shape inexperienced workers to fit existing and future jobs. These programs give young workers the opportunity to learn a trade or profession and earn a modest income. Apprenticeships combine supervised training on the job with classroom instruction in a formal, structured program that can last for a year or more. •D rills. Drilling is a good way for employees to practice skills. Evacuation drills are effective when training emergency preparedness, for example. Advantages • Hands-on training methods are effective for training in new procedures and new equipment. • They are immediately applicable to trainees’ jobs. • They allow trainers to immediately determine whether a trainee has learned the new skill or procedure. Disadvantages • They are not good for large groups if you do not have enough equipment or machines for everyone to use. • Personal coaching can be disruptive to the coach’s productivity. • A pprenticeships can be expensive for companies paying for employees who are being trained on the job and are not yet as productive as regular employees.

Online Training/eLearning There are five key ways in which eLearning has

ELEARNING OR ONLINE TRAINING

transformed the landscape of learning and development. When compared to the traditional mode of classroom learning there is clear evidence that eLearning brings: • Faster delivery. • Lower costs. • More effective learning. • Lower environmental impact. • Benchmarking of competency. Faster Delivery At a time when members of staff have more and more training to do and show evidence of competence, a key advantage of eLearning is that it has quicker delivery cycle times than that of traditional classroom-based instruction. Research indicates that eLearning reduces learning time by at least 25% and up to 60% in comparison. [1, 2] The reasons for this are: • There is no lengthy start up and closure to an eLearning session. • Trainees set their own pace rather than the pace of the group. • There is no travel time needed. • Trainees can give extra focus to what they don’t know. • Trainees don’t have to wait until there is a practical training course available. Lower Costs There are immediate cost savings from: • Reducing training time. • Trainer costs. • Course materials. • Travel and in some cases accommodation. • Not having to put on additional training sessions due to poor turn out. More Effective Learning Evidence shows that eLearning has positive benefits for the trainees, such as: • Improved long-term retention of information. • Positive attitude to the eLearning format. • Better results in knowledge tests (as the training is self-paced). • Greater ability to apply what has been learned to practical situations. • Greater productivity – according to a report released by IBM[3], organisations that utilise WWW.PRIMARYCAREREPORTS.CO.UK | 5

ONLINE TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT FOR GP PRACTICES

“More effective techniques for teaching employees”

THE BENEFITS OF ELEARNING

eLearning tools and strategies have the potential to boost productivity by up to 50%. For every £1 that an organisation spends, it’s estimated that they can receive £30 worth of productivity.

“eLearning has transformed the landscape of learning and development”

“eLearning reduces learning time by at least 25% and up to 60%”

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Lower Environmental Impact eLearning lowers the environmental impact of an organisation by: • Reducing travel and accommodation costs. • Reducing the use of natural resources, e.g. paper, fossil fuels, etc. Benchmarking of Competency In contrast to classroom sessions, where a lecture is given and trainees then sign to say that they have attended, eLearning is able to evidence training completion and competence – shown by achieving a pass rate in a randomly selected knowledge test. This is invaluable during a CQC inspection, when proof of understanding may be requested by an inspector. Advantages • Effective for training across multiple locations. • Saves the Practice money on travel expenses. • Less expensive way to get training from expert professionals and consultants. • Useful for refresher training. • Excellent for self-directed learning. • E asily updateable with new policies or procedures, legislation and compliance issues. • Offers trainers a growing array of choices for matching training programs to employee knowledge and skill levels. Disadvantages • Requires trainees to be computer literate. • Some employees may not like the impersonal nature of this training.

• E mployees may be intimidated by the technology or the remoteness of the trainer to ask questions. • Self-instruction offers limited opportunities to receive context-specific expert advice or timely response to questions.

How to Use a Blended Learning Approach

BLENDED LEARNING APPROACH

Blended learning is a common sense concept that results in great learning success. The blended learning approach is simply acknowledging that one size doesn’t fit all when it comes to training. Blended learning means using more than one training method to train on one subject, here are several good reasons to use a blended learning approach: • Blended learning affords both trainee and trainer the best of both worlds in the sense that it creatively and effectively combines the traditional classroom with a modern, electronic one. [4] In short, it maximizes the strengths of each and renders potential weaknesses inconsequential – what one lacks, the other makes up for. • For learners, a blended learning approach means that they can access training resources outside scheduled face-to-face training sessions.

ONLINE TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT FOR GP PRACTICES

• Learners benefit from multiple learning channels and media formats – appealing to all learning styles. • Learning experts believe that a big advantage of blended learning is that it more closely replicates how people actually learn on the job, through experience and interaction with co-workers. This approach works well because the variety of approaches keeps trainers and trainees engaged in training. Blended learning simply makes a lot of sense. Consider the many factors that affect training: • Subject matter. • Audience make-up. • Types of learners. • Budget considerations. • Space constraints. • Compliance issues. Any or all of these considerations affect the choices for training and may even necessitate the use of a blended learning approach. Examples of a blended approach are: • Breaking a complex subject into parts and using a different training method to teach each section or step. • Using a trainer with hands-on demonstrations for initial training and eLearning to consolidate learning and show evidence of understanding.

The Future of eLearning in a GP Practice

THE FUTURE OF TRAINING IN A GP PRACTICE

Rapid proliferation of mobile devices, shrinking training budgets, and time constraints have changed the way eLearning is designed, developed, and delivered. Traditional methods have given way to the development of new bitesized learning modules. It is now important that eLearning can be used at a time and in a place that suits the organisation and the trainee. It should be accessible from all tablets and mobile devices. It is important, therefore, that it is compatible with any browser.

“eLearning remains at the cutting edge of technology ” There are already trials in the use of eLearning with augmented reality glasses. Virtual reality training lends itself perfectly to such topics as fire training and risk assessment. It is vital that any eLearning remains at the cutting edge of technology in order to offer costeffective and up to date training in an area where the need is on the increase.

Case Study Mick Smith (IT Manager) – Fordingbridge Surgery, Hampshire As a large Practice, we decided over 2 years ago to sign up with Blue Stream Academy to use the online training package. We have 65 staff members setup using the package. The modules are easy to navigate and use and provide a certificate on completion of which we keep a copy in staff records. We now have various modules built into our new staff induction process and ongoing training. We’ve also linked many of our protocols so that when staff do the module it is recorded that they have read the document. It is very easy to setup new staff and to report on what modules have been completed. Until we started using Blue Stream Academy it was a constant battle to source expensive external training and to organise internal training sessions, which all takes valuable time and resources, especially in an environment where there is very little free training available locally. I think the best thing about it is the flexibility for individual staff to access training whenever they have time to do so and, if needed, it can be accessed away from the Practice.

References [1] eLearning: Strategies for Delivering Knowledge in the Digital Age - Rosenberg, M.J. (2001) [2] Six Steps to Implementing eLearning Hall, Brandon. (2001) [3] IBM Report – The Value of Training (2014) [4] Blended learning solutions. In B. Hoffman (Ed.), Encyclopedia of Educational Technology (Alvarez, 2005) [5] Implementing our mission - high quality care for all NHS England

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ONLINE TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT FOR GP PRACTICES

Why Training will be Crucial in Helping GPs Rise to the Challenges of the 21st Century Tom Cropper, Editor

Big challenges lie ahead for primary care and ongoing training will prove more crucial than ever.

With less funding available, GPs struggle to afford the cost of locum cover. The expense of paying tutors and buying training packages can also be off-putting

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HE NHS enjoys a reputation for excellence across the world, and rightly so. But despite this, the coming years and decades will present a great challenge. The role of GPs is expanding, their workload growing and their resources tightening. With the health and social care landscape developing rapidly, their skillsets will need to adapt.

A Difficult Challenge Many areas of the public sector are being asked to do more with less. The last ten years have seen a dramatic increase in the number of GP consultations. Since 1998 consultations have risen by 24% and that is only the beginning. An aging population means the workload is likely to increase still further. An opinion poll from the BMA in 2015 found that 60% of GPs said they planned to retire early because of their workload1. The nature of the job is also changing. As the RCGP states in its paper The 2022 GP, a Vision for General Practice in the Future NHS2: “we are in a time of transition, moving away from a twentieth-century model with its outdated divisions of hospital-based and community-based Practice and of health and social care. We are moving instead towards a twenty-first-century system of integrated care, where clinicians work closely together in flexible teams formed around the needs of the patient and not driven by professional convenience or historic location.” Care will be more integrated, connected and patient driven. A changing landscape will make Continual Professional Development (CPD) central to the future strategy of the NHS, but with this increased workload, the question is: where will staff find time for professional development?

Money is Tight In such an environment one might expect funding for GP Practices to be rising. In fact, the reverse is happening as the government looks to squeeze public spending at every opportunity. Since 1998 funding for GP Practices has been in decline. By the end of 2014 it had dropped to less than 9% of the overall NHS budget. At the beginning of 2015 a campaign entitled Put Patients First3 set out to save General Practice by calling on the government to increase funding to 11% of the total NHS budget. Instead, funding remains constrained. By the end of 2015 it had reached a record low of 7.4% of the overall budget4. In Feb 2016, RCGP Scotland said GP services had been cut by £1.6bn5 over the course of a decade, contributing to 9 million lost consultancies. GP surgeries around the country are struggling. A report from the BMJ highlights one Practice which is facing a reduction in funding of nearly 50%. According to GPs at Slaithwaite Health Centre, an NHS Review could see its funding fall from £146 per patient in 2015 to £78 per patient by 20186. With these cuts comes an inevitable risk to standards of patient care. A report from the research arm of Pulse found that more and more Practices are having to rely on locums for patient care because of staffing shortages. A total of 47% of Practices said they had increased their use of locums in the past year while 16% had increased their use of agency nurses. Approximately 80% said they believed the quality of care had deteriorated over the past 18 months. Most said the problems stemmed from insufficient healthcare budgets, while 90% of those who said care had worsened put

ONLINE TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT FOR GP PRACTICES

the cause down to a lack of staffing. 82% said they had not been able to spend sufficient time with patients7.

The Evolution of Training If standards are in decline, training will play an important role in reversing this trend. However, a Sheffield University study into the impact of CPD found a number of barriers to its adoption. Among the most commonly cited barriers were: •T ime and workload: GPs may need to leave early or miss a day entirely. In some cases, where it may not be possible to bring in cover, a Practice may have to close for an entire day with an inevitable negative impact on patient care quality. •F unding constraints: With less funding available, GPs struggle to afford the cost of locum cover. The expense of paying tutors and buying training packages can also be off-putting8. Even once a Practice decides to adopt training packages, there is no guarantee those learnings will have a real impact. The report cites one respondent as saying: “Time is a major pressure on consultants in respect of applying learning from CPD activities in that as soon as they return from any length of study leave they are right back in the front line seeing patients.” A further problem stems from the mentality with which a Practice adopts training. Because CPD has not been tied into the appraisal process, one respondent said it encouraged a tick box mentality. A GP would be focused

on gaining enough points rather than actually bringing the training into place and generating effective improvements. The report also cited an idiosyncratic approach to training which meant CPD was left to individual Practices with little uniform guarantee of standards as well as the opportunity to implement and test new learnings. The ability to test new knowledge in a safe environment without fear of failure could prove important in ensuring training has a genuine impact on development. There is, then, a gap in technology, skills and approach. Practices need to assess how they think about training and how they ensure any training they use has an impact. At the same time, providers of CPD need to develop approaches which satisfy the needs of surgeries and encourage tangible improvements, namely: • Training that is affordable. • Modules which require less time away. • Courses which truly embed training and ensure learnings have a real impact. Change is coming. Both online and offline training systems are developing to be more in tune with the needs of users and the real world. A new generation of online training suites offers solutions which are more interactive, flexible and intuitive. Equally, traditional courses are introducing techniques such as storytelling, simulation and roleplay to help users transfer their learnings into their day-today operations. The challenge with both options is to ensure they continue to evolve and keep pace with the rapidly developing nature of healthcare in the UK.

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ONLINE TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT FOR GP PRACTICES

Developing Continuing Professional Development in Primary Care Jo Roth, Staff Writer

How a changing health and social care environment requires a new approach to ongoing training for GPs.

What’s just as important for systems such as these is that they do more than just demonstrate compliance. They can inject real change and improvements which deliver usable benefits to the Practice

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IGITAL TECHNOLOGY is being deployed everywhere in GP Practices. Whether it’s Jeremy Hunt’s desire to digitise all records and move to a paperless NHS, automated appointment notifications or online sharing of records, new technology is making itself felt in many different ways. However, while the corporate world has powered ahead with new online training modules, the NHS has remained slightly behind the curve. Many Practices still rely on traditional personal training while some have employed eLearning programmes without success. However, the developing nature of the healthcare sector – coupled with improved technology – is sparking a change.

The History of eLearning eLearning – or at least computer based learning – has been a part of the education scene for longer than most people realise. In 1924 the first testing machine made it onto the market, which allowed self-testing for students. By 1960, computer based learning was making its way into the classroom, which allowed pupils to use computers as a supplement to tutors’ lessons. It wasn’t until 1999 and the emergence of the internet that the term eLearning became widely used. Nevertheless, it relies on principals which have been in place for decades. Since then eLearning has evolved steadily. As devices become smaller and more portable, so eLearning has become increasingly flexible and interactive, enabling workers to refresh their skills at a time and place which suits them. At the same time, modules are becoming more sophisticated and effective as providers discover new ways to improve learning and embed lessons into daily working practices. The concept itself, then, is hardly new. Indeed, many traditional online training courses are

beginning to look tired and out of date. We are entering what could perhaps be termed the world of ‘eLearning 2.0’ where a new generation of technology and fresh thinking is changing the way in which we use it.

Achieving Compliance The aim of eLearning can change from organisation to organisation. For some, it is simply a way of achieving and demonstrating compliance with CQC standards. New eLearning suites, therefore, are often promoted to clinics as a quick and easy way of satisfying the requirements of CQC inspections. Here the focus is on training which can: • Be measured against requirements to ensure and demonstrate CQC compliance. • Provide flexible access to staff anytime and anywhere. • P rovide clear reports to demonstrate compliance to inspectors. • Monitor progress through regular reports and assessment. • Distribute learning material quickly and efficiently to all those who need it. • Minimise the interruption of business within the Practice. The latest generation of eLearning technologies takes this a little further in providing a complete system. For example, the eLearning suite on offer from Blue Stream Academy provides a complete end-to-end education product for every aspect of the Care Certificate Standards (CCS). Users can complete a series of modules covering all the knowledge outcomes of the CCS. It comes with a management information system which records all eLearning training completed as well as a record of assessed performance. It can be used with no additional software and is compatible with all browsers as well as android

ONLINE TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT FOR GP PRACTICES

and iPhone systems. The advantage is that it creates an online record which can be accessed at any time. It’s a complete one-stop solution which makes the process of training and obtaining and demonstrating compliance, easier and more streamlined. By providing a clear overview of where staff are in their journey, eLearning products can show who has done what and who still has modules to do. All these points are important, but solutions can, and should, do much more and the design of the Blue Stream Academy eLearning suite shows how. The system allows for the transfer of records so, if an employee moves jobs to a new location, they have a paperless option for taking their certificates with them. It saves time and money for all parties. What’s just as important for systems such as these is that they do more than just demonstrate compliance. They can inject real change and improvements which deliver usable benefits to the Practice. For example, at the Ivy Grove Practice in Derbyshire which uses the system Dr Peter Smith has been working on a safeguarding module. The system not only helps him to improve his competencies, but it also empowers other employees, such as administration assistants, to do more with their jobs. “There has been a change of culture recently. With things like safeguarding, the buck would stop with the GP,” he explains. “It empowers receptionists. If they see something that concerns them, they are empowered to raise that if they think there’s an issue there9.”

Improving Standards, Saving Lives These benefits help reverse a trend in which time pressures appear to be harming the quality of care. Over the past few years there have been multiple reports relating to poor performance and time pressures in the NHS. Take, for example, a

Guardian report from January 2015 which claimed A&E waiting times were soaring because people had difficulty getting an appointment from a doctor10. More streamlined training frees up time and allows the doctors and surgery staff to do a much better job with their limited resources. Better trained staff will also help drive down the costs of claims made against the NHS. An analysis by the Daily Telegraph suggests NHS Trusts have spent £1.1bn on medical blunders over the course of just five years11. The Daily Telegraph has also claimed that the NHS has set aside a quarter of its overall budget to cover negligence claims12. Systems like the Blue Stream Academy platform, and others, provide a significant step forward in the quality and value of eLearning, but time will always be a challenge. Regulatory demands are changing and so too is the nature of healthcare. Keeping up to date and ensuring a system remains relevant in every way is a constant struggle. The developers of the Blue Stream Academy system have worked closely with their customers bringing in feedback and learnings to continually build and develop the system. It is one which has, in effect, been built and evolved by the people who use it. As such it can continually stay ahead of the curve and improve its value. eLearning, then, can be said to be coming of age. While it’s been around for decades – in some forms – it is only now that the industry truly understands the way it works. Online technology is driving greater connectivity, which improves its value to the entire industry. As we move to the future, new approaches and methods are being developed which offer further improvements. Some of these sound like the stuff of science fiction, such as ‘augmented reality’ or ‘gamification’. Online training is moving quickly and evolving. Practice managers can do well to understand these terms, what they mean and how they could further improve learning in the future. WWW.PRIMARYCAREREPORTS.CO.UK | 11

ONLINE TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT FOR GP PRACTICES

Getting the Most Out of eLearning James Butler, Staff Writer

eLearning has enormous potential for GP Practices, but only if used effectively. Here’s how practitioners can ensure they get the best options possible.

For some, training can be seen as a box ticking necessity; an interruption to the daily work of a surgery and a drain on the finances. It’s tempting to view training as something which ‘has to be done and dusted’ as soon as possible

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LEARNING COURSES are increasingly common and popular within the NHS. Even so, many Practices still rely heavily on conventional face-to-face training practices. The reasons can vary; perhaps a worker prefers to interact face-to-face with a tutor, or maybe a subject is not appropriate for online training. The question each Practice Manager must face is – which option is the best for their Practice?

Getting Full Value Companies working in all industries spend millions educating and training their workforce and the NHS is no exception. Back in 2013, the coalition government announced a major new project focused on training staff backed by an investment of £5bn. At the time, Health Minister Dr Dan Poulter said: “The staff working in our NHS are our health service’s most precious resource, and we must do all we can to ensure that our staff have the right values, training, and skills to deliver the very highest quality of care for patients.”13 Training – including ongoing continuing professional development (CPD) – sits at the heart of the NHS strategy moving forward. However, at times there has been a lag between the theoretical commitment and practice. A 2008 study assessed this lag. While CPD was promoted as being of key importance, it suggested the reality did not always match up. It pointed to what it describes as “a perceived, and actual, shortfall in current systems and structures to meet the expectations of the organisation, relevant professional bodies and individuals.14” The problem continues to this day. For some, training can be seen as a box ticking necessity; an interruption to the daily work of a surgery and a drain on the finances. It’s tempting to view training as something which ‘has to be done and dusted’ as soon as possible. Such an approach, though, fails to recognise the real value that

good training will offer a Practice. Staff will be better trained and so will be able to do their job more effectively. Processes can be carried out more efficiently and costs kept to a minimum. GP services can take many approaches to training. But, for the purpose of this article, we’ll condense these down into two main groupings: online versus offline. Increasingly, online training is being seen as an effective alternative to more conventional training methods. Both have their merits and both will exhibit variation between different providers. Understanding these, and what each approach can offer, is one way to decide which one offers the most appropriate proposition for any particular Practice.

Assessing Performance This task is made more difficult by the relative lack of evidence. Many of the available studies are old, use patchy data and, in some cases, offer contradictory conclusions. Even so, there is some evidence. A study from Fletcher and Tobias entitled ‘Training and Retraining’ said: “Learners learn more using computerbased instruction than they do with conventional ways of teaching, as measured by higher posttreatment test scores15.” A study based on a Midlands CCG suggested the return on investment for an eLearning solution was 80% higher than traditional training. The report took 35 practices into consideration, with an average of 25 staff per practice who each had a training profile covering from eight to thirty subjects. The options for completing the required training were: 1. Subject Matter Expert 2. External Courses 3. eLearning Option 1 would have cost £2250.00 + VAT per practice for 9 subjects and £7500.00 + VAT per practice for 30 subjects. This is also assuming that all trainees within a Practice attended the course.

ONLINE TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT FOR GP PRACTICES

Option 2 would have cost £22,500 + VAT per practice for 9 subjects, £75,000.00 for 30 subjects assuming that the CCG funded it, otherwise the cost would be double. Option 3 cost £18.00 + VAT per person whether the trainee completed 9, 30 or all 44 modules, an approximate cost of £450.00 + VAT per practice or £15,750.00 for all practices in the CCG.16 A study from the ROI institute – focusing on eLearning in general not just in healthcare – suggested that participants of eLearning courses are less likely to follow through than with conventional training techniques17.

Making it Work If eLearning has struggled in the past to prove its value, part of the reason may be down to packages which have not been fully tailored to the needs of primary care. They may not help users apply lessons to their daily work, or they may not fully cover the competencies required by the CQC. More recently, though, new solutions have been coming to market, which have been developed in partnership with GPs and are tailored to the needs of surgery staff. It is difficult, therefore, to assess online versus offline in general when there can be so much variation between providers. What can be valuable is for Practices to develop their own rules for better ROI assessment. The study from the ROI Institute suggests data collection at four levels: reaction, learning, application and impact. They should assess the cost of an eLearning system versus the ongoing expense of offline training. This can help deliver more reliable assessment methods which avoid wasting money on systems which do not achieve tangible goals. It can be a mistake, also, to think of it as an either/or proposition. Both systems have their own advantages and limitations. For example, The advantages of an eLearning platform can be: •C ost: The single largest cost relating to training that an organisation absorbs is that of staff attending the course. In addition to this the absence of a trainer, lack of requirement for a dedicated location or equipment and avoidance

of travel mean that eLearning is usually a much cheaper alternative to face-to-face training; it can also be much easier to budget. •F lexibility: More flexibility allowing learning at a time which suits workers. •M ore time for GPs: Freeing up time for GPs and surgery staff to focus more on patient care. •F aster delivery: New guidelines are being released continuously. For example, in December, 2015, NICE released new guidelines on end of life care. eLearning can quickly help Practices understand and implement these guidelines. •R educed need for travel: Users can access training whenever and wherever they want. An additional, but less widely attributed benefit, can be a lower carbon footprint. As well using less paper etc. because learners need to travel less, they will burn less fuel and so the carbon footprint of a surgery can be reduced. An Open University Study found that distance learning could produce 85% fewer CO 2 emissions than conventional training18. Alternatively, advantages of offline training include: • The ability to interact and ask follow-up questions. • Does not require any IT knowledge. • Many workers prefer the personal face to face approach. Ultimately, much will depend on the individual situation of a surgery and what it hopes to get out of training. Managers can try asking these simple questions: • How much is training costing overall? • Does it adequately allow me to demonstrate compliance? • Is it working? Are staff able to take their lessons and apply them to their work? • Can I show a reduction in errors, improvement in efficiency or the number and quality of consultations? Evaluating between online and offline methods is an inexact science. What Practice Managers can do to improve the value of training, though, is to evolve their assessment practices. In so doing, they can go a long way towards ensuring they get full value for money. WWW.PRIMARYCAREREPORTS.CO.UK | 13

ONLINE TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT FOR GP PRACTICES

Continuing Professional Development and the Future of Primary Care Tom Cropper, Editor

The future of training lies in an effective blend of high tech online solutions and traditional offline techniques.

eLearning is moving rapidly with the times and that means evolving beyond the tight confines of the computer screen into the world of augmented reality

RAINING IS developing rapidly, both on and offline. New technologies combine with new thinking to give practitioners more options about the planning and implementation of training solutions. Looking forward into the future, then, what shape will training take? The internet will have a much bigger role to play. In Europe, 73.5% of the population are online19 and the number is still growing. We’re also becoming accustomed to using the internet in a wider range of situations such as communicating with doctors. Features such as online consultations, Skype conversations, online access to medical records and electronic prescriptions will become more common20. Surgeries themselves are making use of the internet for features such as record keeping, communication between Practices and administration. One of the major developments is in the way they make use of online training and development tools.

Beyond Reality eLearning is moving rapidly with the times and that means evolving beyond the tight confines of the computer screen into the world of augmented reality. The idea is to take the physical world and transplant digital features which a user can view directly. Learners could view the same room, but it could now be augmented with equipment, patients and other doctors. It’s a baby step towards the world of Star Trek and its holodecks in which it is possible to recreate an entire world using digital furniture. The implications from a GP’s perspective could be profound. Suddenly they can overcome one of the eLearning’s key weaknesses – the fact that it is constrained within one format and limits physical interaction. Users will be able to ‘learn by doing’ by undergoing sophisticated simulations. The Manchester Medical School, for example, is already bringing this technology into the learning 14 | WWW.PRIMARYCAREREPORTS.CO.UK

environment. An augmented reality app is now being used as part of prescription training. Students receive an iPad and are asked to use it to support their clinical studies. Digital stories can be added to posters to make them more interactive and valuable. Dr Kurt Wilson of Manchester Medical School said: “We’re just beginning to realise some of the potential in the use of AR in the medical school now, mainly with digital story telling…. And also with 2D asset development…. But there’s also loads of potential for more complex use of AR in the future such as technology enhanced learning around 3D equipment21.” Going forward, the potential could prove transformative. A recent article for the website elearningindustry.com envisaged a future in which doctors wearing AR glasses could instantly see up-to-date medical and physical records about patients. They would be able to see details such as how far they had run recently, any ongoing conditions they might have and treatments they were undergoing. It would enable them to provide a much more effective and swift diagnosis for patients22. AR technology is still very much in development, but even at this early stage the potential is clear. In the more immediate future, the onus is on using existing mobile technology that everybody already possesses, to deliver training and ongoing education in a more effective manner.

Lessons from Entertainment On a much less high-tech footing, training developers are also finding ways to make learning more entertaining and effective. The term gamification is increasingly being used in any discussion about the future of eLearning. Smartphone technology already allows people to download games which can make them healthier or work towards qualifications and it’s

ONLINE TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT FOR GP PRACTICES

already being used in the realm of healthcare. A study from ihealthcare.org showed doctors using an online game as their primary learning tool were able to deliver better health outcomes than their colleagues who were using only traditional reading material23. The game in this case was based on an online quiz which allowed doctors to make their own scores visible to others – as such it encourages competition and pushes doctors towards improving their own scores. Another study showed evidence of improved performance for surgeons who used video game technology24. It’s also having an impact in the education of patients. The game Packy and Marlon, for example, helps children with diabetes better manage their treatments. First released on the Super Nintendo system, it achieved a 77% reduction in the number of children needing urgent care25.

Broadcast News The General Medical Council states in its ‘Good Practice’ leaflet that GPs have a duty to stay up to date on the latest developments in medicine. With advances in technology and changes to the way health and social care is managed, these

changes are coming thick and fast. As well as traditional avenues such as through conferences, seminars and trade titles such as the BMJ, GPs are turning to podcasts. These are familiar to us in the world of entertainment but they’re playing an increasingly important role in helping GPs to stay up to date. Leading podcasts such as those from BBC Health, the Health Service Journal and Pulse, help GPs and other staff stay on top of all the latest news, developments and guidelines. There is always a risk that a focus on new technology can drive attention away from what works. Offline or traditional training methods and reading material will always have a place. Many learners prefer face-to-face tuition and are not comfortable with online training. At times, there is also no substitute for interaction between a user and a tutor. What technology does do, though, is open up a new world of options. If these are integrated as part of a blended offline and online approach, training as a whole can become much more effective. Some of the new technological systems discussed in this article might appear exciting, but managers need to avoid being dazzled by what they can do. A clear eyed focus on goals and outcomes will be critical for success.

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ONLINE TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT FOR GP PRACTICES

References: 1

Can 10,000 new GPs Save General Practice? http://www.gponline.com/10000-new-gps-save-general-practice/article/1287536

The 2022 GP: A Vision for General Practice in the Future NHS: http://www.rcgp.org.uk/campaign-home/~/media/files/policy/a-z-policy/the-2022-gp-a-vision-for-general-practice-in-the-future-nhs.ashx

Put Patients First: http://www.rcgp.org.uk/campaign-home.aspx

Calls to Stop Decline in GP Spending: http://jerseyeveningpost.com/news/uk-news/2016/02/22/call-to-stop-decline-in-gp-funding-amid-claims-of-1-6bn-cut-over-10-years/

GP Funding Cut by ÂŁ1.6bn: http://www.scotsman.com/news/gp-funding-cut-by-1-6bn-over-decade-claim-doctors-leaders-1-4035509

GP Surgery Faces Funding Cut by Half: http://www.bma.org.uk/news-views-analysis/news/2015/november/gp-surgery-faces-funding-cut-by-half

7 GPs Turning to Locum Doctors: http://www.dailymail.co.uk/wires/pa/article-3433631/GPs-turning-locum-doctors-amid-staffing-crisis-report-reveals.html 8

A Study to Assess the Impact of Continual Professional Development: http://tiny.cc/55s59x

Communities of Care: http://www.bluestreamacademy.com/elearning-suites/blue-stream-academy-and-communities-of-care/

Lack of GP Appointments Driving One Million a Year to A&E: http://www.theguardian.com/society/2015/jan/09/gp-appointments-ae-units-hospitals-emergencies-patients Medical Blunders Cost the NHS Billions http://www.telegraph.co.uk/news/health/news/11733719/Medical-blunders-cost-NHS-billions.html

NHS Sets Aside a Quarter of its Budget for Medical Negligence Claims: http://www.telegraph.co.uk/news/health/news/11402075/NHS-sets-aside-quarter-of-its-budget-for-medical-negligence-claims.html

Measures to Improve Training: https://www.gov.uk/government/news/new-era-of-education-and-training-for-nhs-staff

Continuing Professional Development Rhetoric and Practice in the NHS: https://uhra.herts.ac.uk/bitstream/handle/2299/3030/901296.pdf?sequence=1

Training and Retraining: https://books.google.co.uk/books/about/Training_Retraining.html?id=JB1QAAAAYAAJ

http://www.bluestreamacademy.com/elearning/why-choose-elearning/

ROI of e learning: http://www.roiinstitute.net/wp-content/uploads/2014/12/The-Business-value-of-e-Learning.pdf

Towards Sustainable Higher Education http://www3.open.ac.uk/events/3/2005331_47403_o1.pdf

Internet World Stats: http://www.internetworldstats.com/stats.htm

The 2022 GP: http://www.rcgp.org.uk/campaign-home/~/media/files/policy/a-z-policy/the-2022-gp-a-vision-for-general-practice-in-the-future-nhs.ashx

Augmented Reality Enhances Learning at Manchester Medical School: https://www.jisc.ac.uk/podcasts/augmented-reality-enhances-learning-at-manchester-medical-school-30-nov-2015

The Augmented Future of E Learning http://elearningindustry.com/augmented-future-elearning-augmented-reality-elearning

23 Four Real Life Examples of how Gamification is Changing the Healthcare Industry http://www.edisonpartners.com/blog/4-real-life-examples-of-how-gamification-is-changing-the-healthcare-industry 24

The Impact of Video Games on Training Surgeons: http://www.ncbi.nlm.nih.gov/pubmed/17309970

Packy and Marlon: http://www.healthgamesresearch.org/games/packy-marlon

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