lable at ScienceDirect

Radiography 17 (2011) 152e157

Contents lists avai

Radiography

journal homepage: www.elsevier .com/locate/radi

An investigation into the challenges facing the future provision of continuingprofessional development for allied health professionals in a changinghealthcare environment

Vivien Gibbs*

Faculty of Health & Life Sciences, University of the West of England, Glenside Campus, Stapleton, Bristol BS16 1DD, United Kingdom

a r t i c l e i n f o

Article history:Received 28 September 2010Received in revised form5 January 2011Accepted 9 January 2011Available online 1 February 2011

Keywords:Continuing professional development (CPD)Allied health professionals (AHPs)Lifelong learningReflective learning

* Tel.: þ44 117 328 8412; fax: þ44 11732 88437.E-mail address: Vivien.gibbs@uwe.ac.uk.

1078-8174/$ e see front matter � 2011 The College odoi:10.1016/j.radi.2011.01.005

a b s t r a c t

This paper outlines current challenges facing healthcare providers and education providers in trying toensure Allied Health Professionals (AHPs) are fit for practice, in a climate driven by financial constraintsand service improvement directives from the Department of Health (DH). Research was undertaken in2009 to investigate the current provision of Continuing Professional Development (CPD) in the south-west region of England. The purpose was to define exactly what problems existed with this provision,and to propose changes which could be implemented in order to ensure that the provision meets theneeds of stakeholders in future years.

� 2011 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

Introduction

AlliedHealthProfessionals (AHPs)are registeredandregulatedbythe Health Professions Council (HPC). This is an organisation createdto protect the public by establishing a register of health professionalswho meet prescribed standards of training, professional skills,behaviour and health. The HPC now also sets standards forContinuing Professional Development (CPD). In order to be includedon the HPC register, there is a requirement for AHP staff to remaincompetent and ensure their knowledge is kept up-to-date throughthe process of CPD. This is now a mandatory requirement for HPCregistered staff, and individuals are audited to ensure compliance.1

The HPC defines CPD as a range of learning activities throughwhich individuals can maintain and develop throughout theircareers, to ensure that they retain a capacity to practice legally,safely and effectively within an evolving scope of practice.1 The HPCrequire that registered AHPs must:

� Maintain a continuous up-to-date and accurate record of CPDactivities

� Demonstrate that these activities are a varied mixture oflearning activities relevant to current or future practice

f Radiographers. Published by Else

� Seek to ensure that their CPD has contributed to the quality oftheir practice and service delivery

� Seek to ensure their CPD activities benefit the service user� Present awritten profile containing evidence of CPD on request

The term AHP incorporates a number of different professions,including Podiatrists, Radiographers, Physiotherapists, Occupa-tional Therapists, Speech and Language Therapists, Dieticians,Orthoptists, Paramedics, Psychologists, Arts therapists, Hearing Aiddispensers, Operating Department practitioners, Clinical Scientists,Biomedical Scientists and Prosthetists. In order to ensure that AHPsare engaging in CPD activities, the HPC is rolling out a programmeto audit CPD portfolios across the HPC register. This began in July2008, and all professions are expected to be completed for this firstwave during 2010. This process requires randomly selected indi-viduals from each profession to provide a written portfolio ofevidence of engagement in CPD activities. The HPC held a numberof roadshows throughout the country explaining what the processinvolves, and highlighting how CPD requirements could be met. Itwas emphasised that a variety of methods could be undertaken,many of which are relatively inexpensive, such as reading journalarticles or shadowing colleagues. A study by Henwood et al.2

looking at radiographers’ attitudes to CPD demonstrated thatthere is a restricted view of what constitutes CPD. As a result, lessformal developmental activities are often overlooked.

vier Ltd. All rights reserved.

V. Gibbs / Radiography 17 (2011) 152e157 153

Background

The changing nature of healthcare service delivery

Karen Middleton, the Chief Health Professions Officer inEngland, outlined the challenges facing the NHS in a recentpresentation at the South West AHP Conference.3 During therecession Government expenditure has continued to grow whilstreceipts have fallen. We are now in an era with the highestspending since 1983, the lowest tax burden since 1961 and thehighest borrowing since the Second World War. Governmentborrowing will be £178 billion over the coming year, and unprec-edented levels of public sector savings will therefore need to bemade. As a direct result of this, the NHS has to plan to make hugeefficiency savings over the next few years.3 The approach to thischallenge is discussed in the DH document NHS 2010e2015: fromGood to Great.4 This details how the focus of the NHS will be onimproving quality and productivity through innovation, in order todrive sustained improvements across the system. To achieve this,healthcare will need to be more preventative (improving health,reducing untoward incidents, and reducing delayed discharge),more people centred (giving people what they need) and moreproductive (able to contribute to the care of more people).

The Quality, Innovation, Productivity and Prevention (QIPP)programme5 is a framework designed to support the NHS to meetthe challenge of providing high-quality care for all, by increasingquality of healthcare provision whilst improving productivity. Thisinitiative puts emphasis on ensuring we have an NHS workforcethat is flexible, efficient and cost effective.

Amidst all the discussions around the changes required todeliver future healthcare, the document ‘Framing the Contributionof Allied Health Professionals: Delivering High-Quality Care’6

acknowledged the nationally recognised importance of thecontribution of AHPs to contemporary health and social careservices, and provided specific guidance for AHPs on how servicesfor patients could be improved. This guidance centred on three keyaspects:

� Mandating data collection to improve quality� Improving access to AHP services by enabling self-referral ofpatients to specified services

� Empowering patients

This was discussed further in the ‘Modernising AHP Careers’document7 which supports the national call for AHPs to be proac-tive towards policy drivers relating to Quality initiatives, andhighlighted CPD as the primary mechanism for developing the AHPworkforce with the skills for the future. The risks of not addressingCPD needs of staff have been highlighted, and include suboptimalcare of patients; lack of competitiveness in the provision ofhealthcare; lowered staff morale; problems with recruitment andretention of staff.

What is CPD

There are many definitions and descriptions of CPD, most ofwhich emphasise that a planned process of education and devel-opment will increase professional performance, which in turn willbenefit individuals, organisations and the wider community.8 Theaccepted outcome of CPD for healthcare professionals is to enhancethe outcome of patient care by improving practice through activi-ties such as reflection, evaluation and consideration of the evidencebase. Thus, as a result of CPD, patients should expect to receivediagnosis and treatment which is effective, and based on sound up-to-date evidence.9

The benefits of CPD include8e10:

� Increased flexibility of the workforce to ensure more costeffective use of staff

� Patient care improved by increasing the skills of the workforce� Reduced waiting times� Enhanced career development and improved morale for indi-vidual AHPs

� Improved strategic planning for the workforce� Compliance with national and local strategies� Well-informed and motivated workforce� Ensuring good governance and quality monitoring� Compliance with HPC CPD requirements

The risks of hospital departments or individuals not adequatelyaddressing CPD needs are numerous and can include a variety ofpotential problems3,4,7

Risks to patients e with patient safety potentially beingcompromised due to the provision of suboptimal care; lack ofsuccession planning leading to skills shortages in some areas andsubsequent lack of provision for patients; recruitment and reten-tion of staff becomes a problem leading to further shortages;departments become unable to offer specific services due to lack oftrained AHPs, and increased waiting lists due to skill shortages,resulting in inequitable provision of services to patients;

Risks to staff e shortages of staff lead to further difficulties inreleasing staff from clinical work to attend training activities;difficulties for AHP individuals to meet the HPC requirement forregistration; inability to meet Knowledge and Skills framework(KSF) and Personal Development Plan (PDP) requirements.

Risks to organisations e financial penalties maybe incurred dueto inability to meet commissioning specifications; inability tocomply with national directives and guidelines; inability to meetbroad local business objectives such as commitments to establisha workforce with the right skills organised in a way to deliver thebest possible care; lack of competitiveness in the tenderingprocesses; risk of overspend as local budgets need to be used tofund essential training to address skills shortfalls, and failure ofimprovement initiatives to flourish as staff do not have the requisiteskills or motivation to deliver quality improvements.

The purpose of CPD is to develop the abilities of the individualand, through this development, change and improve practice andservice provision. It should be a continuous process of professionallearning and personal growth. The responsibility for CPD lies witha range of different partners, all with different agendas, which maynot necessarily be synonymous. However, the outcome shouldalways be that CPD benefits the patient.11

One of the key principles of CPD is that the individual profes-sional must take some responsibility for planning and undertakingtheir own CPD, ensuring that it is relevant to their current practiceand future career development. Employers may choose to use thisargument, however, as ameansof abdicating responsibility, andmayfail to provide support in the form of time, funding or appropriatestaffing levels.12 An additional problem is that it is often difficult toassess the impact of CPD on practice. Formal learning can be ass-essed, but this does not always show how the individual will applythe learning, and the impact of informal learning is therefore oftenconsidered tobe subjective. Individuals believe that CPDaffects theirpractice, but are often unable to define exactly how or why. Asa result of this lack of tangible evidence, employers often find it tooeasy to take the view that CPD is a luxury which cannot be affordedwhen funding is in short supply.12 The process of supervision andreflective records may help to alleviate this problem.

In order to demonstrate participation in CPD activities indi-vidual staff have a requirement to keep a portfolio of activities for

V. Gibbs / Radiography 17 (2011) 152e157154

both the HPC1 and the Knowledge and Skills Framework (KSF).13

This can be either an electronic or hard copy record, and needs tofocus on recording awide variety of activities. It should aim to showimprovements in the quality of the individual’s work, and how CPDis benefiting service users.

Educational institutions have a role to play in the provision ofCPD. The Skills for HealthWebsite (SFH)13 states that there is a needto develop educational awards which are relevant to the needs ofemployers and, more specifically, the clinical departments, and thatthe most effective way is by taking a competence based approach.The website stresses that CPD courses provided should be:

� Fit for purpose� Based on service and patient need� Easily accessible through flexible delivery� Designed to improve and expand the skills of individuals

Education providers need to ensure these points are addressedwhen developing CPD activities.

The requirement for a new CPD framework

The economic challenges affecting healthcare service delivery willresult in fewer opportunities for education and development.3,4,6 Cutsin training budgets and shortages of staff to cover day to day activities,are already creating problems in releasing staff to attend trainingevents. Costs of CPD will become an issue, with Trusts being encour-aged to provide in-house education for staff, or to look at independenttraining organisations. A new CPD framework is therefore required tolook at the challenges of providing CPD in a competitive environment.

Changes in thenature of funding for role specific training have leftmany heads of services concerned about the future quality of theirservices if specific trainingneedscannotbemet.3,14 Limited resourceswill potentially lead to disgruntled staff when training requests arerejected, and this has sometimes resulted in an over prediction ofneeds by managers in an attempt to get the minimum funding.

Various anecdotal local initiatives have been implemented in anattempt to tackle the shortfall in funding for CPD. AHP leads haveundertaken learning needs analyses to establish priorities; StrategicHealth Authorities (SHAs) have provided additional funding fortraining to support some areas where particular skills shortages havebeen highlighted; in-house Trust programmes have been provided;underspentmonies from statutory andmandatory training have beenmadeavailable forother training; attemptshavebeenmadetomanagestaff expectations within the context of limited training budgets.

In response to the modernisation agenda4,6,7 healthcareproviders will need to be innovative in the design of the clinicalworkforce; this will lead to skill mix changes and result in roles thatfall outside of conventional role boundaries. Healthcare commis-sioners will dictate funding and education in the future which willmean education will be patient pathway driven, and highereducation institutions (HEIs) will therefore be required to demon-strate a more rapid response to flexible training requirements.Initiatives such as encouraging amore generic style of AHPworkingmay well be implemented, particularly as AHPs are in the uniqueposition of being able to work across organisational and sectorboundaries. Some AHP staff however, may prefer to stay workingwithin their professional boundaries, and tensions may arise whentrying to move towards a more multiprofessional style of working.

Methodology

It was in this context that in 2009, the South West StrategicHealth Authority (SW SHA) funded a project to investigate ways ofmodernising the provision of CPD for AHPs.

180 questionnaires were distributed electronically to AHPs inthe SW region asking about current knowledge of the CPD provi-sion, and seeking suggestions for improvement. A questionnairewas sent to individuals in every AHP department in the SW region,in order to obtain a good cross-sectional representation of viewsfrom across the region and across the AHP professions. The ques-tionnaires were distributed to all AHP names on a university emaildatabase, and to all AHP Heads of Department, with a request todistribute to all members of staff within their department. Thequestionnaires were designed with only open-ended questions, inorder to obtain maximum qualitative data on participants’ infor-mation and views on the CPD process. The intention was that thequestionnaires would provide qualitative data comparable withthat from interviews.15 A total of 93 forms were returned givinga response rate of 52%.

Four focus groups, each composed of six AHPs, and representingseven different AHP professions, were organised, to enable oppor-tunities for discussions, and to obtain views, and ideas forimproving CPD. Invitations were sent to all AHP departments in thesouth west to send an individual representative to the focus groups,and 24 individuals were identified as being able to attend. A mixedgroup of AHPs attended, with varying age ranges, enabling a widecross-section of views to be obtained. The focus groups were askedto specify their knowledge on the current provision, what problemsthey were aware of, or had personally experienced with the CPDprocess, and what ideas they had for improving the provision ofCPD. The project lead recorded all views and findings.

Individual in-depth interviews then took place with a variety ofstakeholders, including service group leads, education co-ordi-nators and education providers, both within the SW region andnationally, to explore what is currently happening, what concernsthere are, andwhat opportunities exist for improving the provision.28 individuals were identified within the region and 6 outside theregion, in terms of their strategic involvement with CPD, their roleswithin their organisations and their experience in either deliveringor participating in CPD. These individuals were then approached,and a total of 32 of those invited agreed to be interviewed. Allinterviews were recorded with the participants’ consent, andresults later transcribed. Anonymity and confidentiality wereassured for all respondents of the questionnaires, and all partici-pants of the discussions and interviews.

Results

During the research, although discussions and responses werewide-ranging, several common themes began to emerge. Athematic analysis approach was taken in order to understand thefindings, by manually assigning codes to each of the topics as theywere identified. The concerns and ideas for improving CPD provi-sion that arose from the discussions and questionnaires, werereviewed by the project lead by defining subject content of thedata, and then coded according to their content.16 As the codeswere accumulated, they were then sorted into themes. Unlikequantitative coding, where preconceived codes are applied, quali-tative coding involves creating the codes as the data is studied, andthis process was applied to the transcribed interview data, focusgroup discussion data, and questionnaire responses.17 This processresulted in a transfer of the descriptive data summarising theresponses, into a more interpretative approach to help understandthe data.

All the points raised by the groups and individuals were iden-tified as fitting into one of four themes. These were: Communica-tion, Practical provision of CPD, Strategic long-term workforceplanning, and Administration of the CPD system. The commentshave been synthesised, summarised and outlined below:

Concerns with current provision Opportunities for improvement

Communication betweenHEIs and clinicaldepartments needsimproving.

� Improve the HEI websites, make them easier to navigate, to encourage this as a two-way means of communicating bothCPD needs and provision. Encourage the use of hyperlinks from HEI web pages to Trust websites and vice versa

� Establish a database of email addresses of key AHP Trust staff for HEIs to communicate with regarding CPD provision� HEIs to host annual postgraduate open evenings and invite clinical departments to showcase what is offeredand provide an opportunity to discuss needs

� Improve links with clinical managers, and AHPs by involving them in HEI programme meetings; Programme Leaders couldvisit them and email communications to keep them updated

� Simplify the HEI CPD provision, which is currently perceived as being too complex for clinical departments to follow� Promote the CPD courses on offer in a regular regional AHP newsletter

Practical provision of CPDwas often not suitablefor clinical staff

� HEIs need to look at more weekend/evening provision of workshops and courses to avoid taking staff out of clinical time� HEIs could deliver workshops locally in the workplace for small groups� Ensure clinical courses are delivered by clinically active staff� Promote more Work Based Learning (WBL) modules and inform departments how it can be linked with practice based workto provide academic recognition of learning

� Compile a database of potential mentors and their areas of speciality skills for potential mentees to communicate with� Utilise new technologies more widely to augment and enhance the provision of flexible learning such as webinars, podcasts,webcasts, on-line packages, discussion boards and video conferencing

� HEIs should avoid competing with each other and rather, ensure duplication of provision does not occurStrategic long-term workforce

planning often does not takeplace, leading to a failure toplan for future requirements

� Patient pathways need to be explored to inform CPD provision, in order to ensure that patient needs are met. HEIs need tolook at developing courses/workshops to promote and enable Integrated Care pathway management e.g. stroke strategy;screening for dementia in the community. This would require more generic AHP styles of working, to enableinterprofessional diagnosis, treatment and care.

� The increased use of business models in the commissioning and design of services will result in a need for individualsto acquire basic and more advanced leadership and business skills.

Administration of the CPD systemis often expensive, complexand unwieldy

� Make funding of courses less complex and more transparent� Look at the possibility of ‘re-branding’ or re-defining CPD to shift the focus of responsibilityfrom the employer to the individual

� Issue vouchers to each department or member of staff to pay for CPD to ensure equity of access� HEIs could offer Masters and undergraduate lectures as CPD for AHPs to reduce costs� Ensure clinical departments are billed for CPD activities at the time of booking, to ensure staffs honour theircommitment to attend. This would help to avoid the current situation where courses become non-viable due toclinical staff cancelling attendance at short notice

V. Gibbs / Radiography 17 (2011) 152e157 155

Discussion

Many of the concerns highlighted during the investigations intothe provision of CPD, demonstrated the two-way communicationproblems generally between HEI and clinical staff. HEI staffs do notalways communicate adequately with clinical staff to find out whattraining is needed in the AHP departments and conversely clinicalstaff do not always communicate their needs adequately to HEIs.Various suggestions were put forward, such as improving HEIwebsites andproducing a regular AHPnewsletter, andmanyof theseideas have now been put into practice in the South West region.

The actual provision of CPD was an area where Trust staffwanted a more flexible delivery of CPD to allow for the difficultiesin staff being released from clinical departments to attend coursesor workshops. Clinical departments are often unable to release staffto attend CPD activities due to staffing issues and funding problems.AHP staff often fund themselves for courses and workshops, andhave to take annual leave or attend at aweekend. Requests for moreweekend or evening provision, on-line learning or work basedlearning were made.

A spectrum of learning activities could potentially be utilised,whereby Work based learning (WBL) could form a major part ofa programme or just a minor part. WBL has been incorporated intoHEI programmes for several years, but has not had a major role toplay. It is a method of gaining knowledge and achieving compe-tencies which involves learning in the workplace. This style oflearning incorporates flexibility thereby enabling HEIs to respondmore rapidly to changes in the workforce requirements.18 Activitiescan be identified which demonstrate learning that has occurredthrough work based activity. The drive for flexibility underpinningmany of the initiatives introduced in recent healthcare policiessuggest that more extensive participation in WBL would be bene-ficial. HEIs are required to map the development of competencybased attributes needed for the workplace with WBL modules.Where this happens, on completion of the award, students

automatically will have demonstrated that they have the skills andattributes needed for a particular role.18 Alternatively a hybridapproach could be used whereby generic guides are availablewhich can be used directly by the students or customised byacademic staff to suit their particular subject area. Use of a blendedlearning approach, whereby on-line resources or on-line tutorialsupport can be made available to underpin this style of learning,would help to facilitate this.

The context of financial constraints will result in a requirementfor a more strategic approach to commissioning education. AHPswill be required to take a more strategic view of training needs, tobe able to anticipate future areas of development. The focus will beon the need to support patient care pathways, particularly aroundthe five Darzi recommended key areas of priority: Cancer, Stroke,Dementia, End of Life Care and Leadership skills.19 AHP leaders willbe required to design and manage complex pathways for patientswith complex needs, and will need staff with these specificcompetencies. HEIs will need to engage in more discussions withhealthcare commissioners and service leads to facilitate a moregeneric or multiprofessional style of AHP working. AHPs need torecognise that skills will increasingly be required for a wide diver-sity of roles outside of the traditional professional boundaries. SomeAHPs may resist attempts to engage in a wider portfolio of activitiesand should be encouraged to become more patient focused andthink strategically, rather than focusing on professional issues.

In these financially challenging times for the public sector,pressures will grow for more cost effective ways of deliveringeffective healthcare training. The scenario whereby CPD studentssit in a small class is too costly, both in terms of releasing staff fromtheir clinical roles, and of providing educational resources, and thesystem will therefore need to be reviewed. Reductions in oppor-tunities for formal training conflict with the requirement fordocumented evidence of CPD, and this puts additional emphasis onthe need for more creative methods of education delivery andlearning opportunities. The ability of professionals to be able to

V. Gibbs / Radiography 17 (2011) 152e157156

learn independently and move away from an expectation of class-room based learning throughout their careers, will feature moreprominently in this requirement for fulfilling CPD obligations.20

The HPC takes a flexible approach to its requirement forengagement in CPD, and lists a variety of potential types of CPDactivities other than formal classroom based learning, which anindividual could incorporate into their portfolio.1 These includereflective practice, case studies, journal clubs, work shadowing, orcommittee membership. AHPs need to demonstrate engagement ina variety of activities in order to ensure a balanced portfolio.

There maybe benefit to be gained from re-branding or re-defining CPD, to help ensure that all healthcare workers realise thatCPD is the individual’s responsibility, rather than the responsibilityof the employer. The terms ‘lifelong learning’ or ‘personal profes-sional development’, for example could be more appropriate labelsfor CPD to encourage a new approach. CPD activities could bedesigned to enable professionals to develop the qualities to becomeself-directed, proactive lifelong learners. These abilities will help toensure a flexible future workforce.

Hemmington21 observes that learning is more effective whenindividuals take responsibility for their own learning. Rather thanexpecting to be delivered all the information by a teacher, a moreeffective method of acquiring new knowledge is for students tolearn how to become independent lifelong learners. Any studentembarking on a programme of study needs to remember thatwhatever is to be learned must be learned by the student, and thatactive participation has to take place in the learning rather thanpassive listening.22 Training programmes therefore need toengender a sense of ownership and responsibility within thestudent. Effective CPD should be focused on enabling individuals todevelop the qualities to become self-directed, proactive lifelonglearners.14,23,24 By developing these abilities the individual will beable to transfer the learning to enhance their practice to the benefitof the patient and service provision.

However, O’Sullivan10 stresses that staff require support fromboth their professional organisations and their employers to enablethem to integrate CPD into practice. Individuals therefore needguidance to increase their awareness and understanding of CPD, inorder to enable them to become independent learners. The aim ofservice leads should therefore be to develop staff with the ability topursue lifelong learning by critically appraising personal andprofessional development, and to plan appropriate strategies fordevelopment of staff through a framework of CPD supported byemployers.

For deep learning to occur it needs to take place over a period oftime, and reflective practice is widely acknowledged by the healthprofessions to be an effective tool to facilitate the appropriate levelof integration of learning and practice.20 It is also more likely toengender learning that alters perceptions and behaviours. Reflec-tion tends to be a rather complex but vague concept however, andcan lead to scepticism amongst AHPs, affecting their ability toengage with the process.

The use of Action Based Learning (ABL)25 and Enquiry BasedLearning (EBL)26 within the curriculum is a potential solution, asthese tools provide opportunities for reflection, and tutors canprovide focused support for individual students. If used appropri-ately, the integration of ABL and EBL are useful tools to successfullydeliver CPD.27 Both styles of learning have been utilised in areas ofeducation over the past few years, however, more extensive inte-gration of these techniques will help to address the issues of therequirement for more effective use of limited resources and a needfor more flexibility of learning opportunities. This solution wouldhave the additional benefit of requiring students to take control oftheir own learning process rather than being a passive recipient ofknowledge delivered by others.28 This learner-centred approach is

generally considered a more effective method of acquiring skillsand knowledge, particularly at postgraduate level.21 However thisis often overlooked when designing the curriculum and assess-ments for a course.29 Learning at postgraduate level is usuallycomplex, and as individuals each have their own preferred learningstyle,30 any formal didactic approach to the teaching will often notprove to be effective for all students. Whilst some students willlearn more effectively from listening activities for example, otherswill need to watch and observe. As a result, the availability ofa wider range of learning opportunities will improve the learningexperience for all individuals.

Conclusion

A number of government initiatives in recent years have putforward recommendations for changing the provision of healthcareto meet the evolving needs of the country’s population. In order todevelop an AHP workforce with the abilities to put these initiativesinto practice, there needs to be appropriate education and devel-opment opportunities available. The financial constraints that thepublic sector will find itself operating in for the foreseeable futuremeans that the current system of post-registration workforcedevelopment is no longer sustainable and will need to be reviewed.

The purpose of this investigation was to define exactly whatproblems existed with the provision of CPD, and to proposechanges which could be implemented in order to ensure that theprovision meets the needs of stakeholders in future years. It hashighlighted that HEIs, AHPs and service leads will need to beinnovative in their search for alternative solutions; they will needto remain sensitive to new opportunities as they become availableand sufficiently flexible to avail themselves of these opportunities.

The key to successful CPD is to know what is to be achieved.Once this is clear then it is possible to plan an appropriate strategy.CPD by definition is an ongoing process, and is not a quick solutionto the problem of developing a sustainable skill base. It is rather,a long-term commitment to continuous improvement through thedevelopment of a capable and effective workforce.

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