Scoping the cancer-specific learning & development needs of the healthcare

workforce in primary, community & palliative care in Manchester

Gunn GrandeProfessor of Palliative Care

University of ManchesterCLAHRC Greater Manchester

IntroductionThe MCIP L&D Scoping Project set out to improve cancer care in Manchester by increasing the cancer-specific knowledge, skills and awareness of clinical and non-clinical staff working in primary, community and palliative care. Project Objectives:

Undertake a Workforce

Analysis

Gain Understanding of Services for

PABC

Cancer-specific Learning Needs

Analysis

Implement and enhance

L&D

1. Mapping of ServicesPrimary Care

Out of HoursSpecialist Palliative Care

Community Services

• Cancer pathway developed to map and contact primary, community & palliative care organisations/services involved in delivery of cancer care

• Service mapping included:• Size of population covered• Stages of the cancer pathway involved in• How organisations link together• Number of referrals for PABC

• The number of cases referred to each organisationCreation of preliminary list of questions for different workforce groups & key contacts via which to disseminate questionnaire

2. Telephone Interviews

11 key contacts across all services recruited for telephone interviews

Services/Team Leads (Community, Palliative, Social,

Out of Hours)Practice Managers (Primary)

Services included:Primary Care x4

Community & Social Care x2Specialist Palliative Care x4

Out of Hours Service x1

Provided overview of workforce numbers within each organisation, staff roles and activities relating to cancer care

3 Questionnaire DesignCancer-specific Learning Needs Analysis Questionnaire (CLeaNA) developed to:

Ascertain cancer-specific learning

and development needs amongst

workforce

Provide insight into the

organisational structure of

services

Questionnaire focused on knowledge and skills of respondents in:• Communication and signposting• Care planning and holistic assessments• Symptom management• The stages of the cancer pathway

4. Development of CLeaNA Questionnaire:PABC Focus Group

• Lancaster Research Partner Forum – Co-interviewers• “Primary & Community staff cannot know everything about cancer”• Expectations about what Primary & Community staff should know about

cancer• One area requiring better knowledge is “the experience of having cancer”• Findings informed CLeaNA Questionnaire design

Macmillan Cancer Voices Exchange Macmillan Database

Patient User Partnership Groups

Social Media

Recruitment of Participants

5. Organisational Survey n=40CLeaNA Questionnaire: Gap analysis to identify education/development needs in each organisation

Organisational: aimed at key contacts (Practice & Service Managers/Leads) onlyQuestions:1. No. of workforce groups & staff within each

group/ role2. Cancer-specific knowledge, skills & training

within each workforce group3. Educational needs identified by organisation

Responses• Of 410 responses, 40 from key contacts• Only 28% reported cancer-specific or

communications skills training in previous 2 years

Demographics

Yes (n=40)

Key Contact?

Discipline

No (n=370)

Organisational SurveyEnd of Survey

6. Workforce Survey n=370

Demographics

Yes (n=40)

Key Contact?

Discipline

No (n=370)

Organisational SurveyEnd of Survey

CLeaNA Questionnaire: Set standards for ‘what needs to be learnt’

3 workforce categories:• Administrative/Reception staff • Unregistered Support Workers in Health &

Social Care• Registered Professionals in Health & Social

Care

Questions:1. Current level of cancer-specific skills and

knowledge 2. Required skills and knowledge to deliver

improved cancer care including meeting any professional regulatory or role requirements

3. Perceived skills and knowledge gaps

Findings: Learning & DevelopmentAdministrative/Reception Staff

Knowledge Gaps Identified

• 83% of all staff and 50% of Community staff are confident they know what cancer is

• 70% of all staff and 50% of Community staff are confident listening to patients on cancer related issues

• 53% of respondents are confident about providing information relating to cancer

• 60% of all staff and 37% of Community staff are confident in signposting to specialist services

• 51% of all staff and 28% of Community staff are confident in dealing with impact on patients of diagnosis of cancer, dying death and bereavement.

Findings: Learning & DevelopmentUnregistered Support Workers in Health & Social Care Staff

Knowledge Gaps Identified

• 32% of all staff are confident in talking to patients on cancer related issues• 26% are confident talking about impact of diagnosis of cancer, the

treatment, dying, death and bereavement• 15% are confident to provide information and support about cancer care in

a range of formats• 26% are confident in sharing patient views with MDT• 23% are able to recognise when a person is dying• Less than 20% are confident with holistic assessment, end-of-life

assessment tools, coping strategies, understanding ACP and supporting patients deciding wishes.

Findings: Learning & DevelopmentRegistered Nurses & Allied Health & Social Care Professionals

Knowledge Gaps Identified

• 63% (PPE) and 52% (Community) workforce confident giving health information, support and advice relating to risk factors for cancer

• 57% (PPE), 28% (Community) workforce confident making timely referrals to cancer services

• 51% (PPE), 27% (Community) workforce understand the cell biology relating to formation of a cancer cell

• 73% (PPE), 37% (Community) workforce confident assessing and managing symptoms associated with treatment effects

• 62% (PPE), 38% (Community) workforce confident to act as a key worker to undertake holistic needs assessment

• 60% Practice Nurses and 45% AHPs confident to work with individuals, their families and friends in a flexible and sensitive way that demonstrates

• 50% Practice Nurses and 38% AHPs feel able to recognise when a person is dying.

Findings: Learning & DevelopmentAll GPs and Doctors

Knowledge Gaps Identified

• 63% (PPE), 52% (Community) workforce confident giving health information, support and advice relating to risk factors for cancer

• 56% (PPE), 29% (Community) workforce confident explaining the range of treatments for their cancer and the potential side effects

• 79% (PPE), 38% (Community) workforce can recognise signs and symptoms associated with acute treatment effects and possible recurrence

• 66% (PPE), 40% (Community) workforce feel equipped to support self-management of cancer and related symptoms

• 72% (PPE), 44% (Community) workforce can use EoL care tools.

Recommendations

Information & Communication

Early Diagnosis Acute Oncology

Survivorship Palliative & End of Life Care

1. Agree a minimum standard of learning and development for the workforce groups identified

2. Agree the minimum learning and development outcomes to be achieved by each workforce group

3. Agree the learning and development opportunities proposed for each workforce group

Five key areas identified by MCIP as targets for education:

• Consider ‘MCIP & City of Manchester Certificate for Cancer Care’• Consider a passport for:

o Demonstrating completion of minimum standard for cancer care o Individual professional developmento MCIP & partners to monitor progress of organisations against key performance

indicators• Consider implementation plan for year 1 (2015) - including initial

estimated target of 15% annual achievement of the passport• Consider years 2-5 (post MCIP 2016-2019) including 75% of workforce

achieving ‘MCIP & City of Manchester Certificate for Cancer Care’ by 2019• Consider process for evaluation, including identifying key performance

indicators, to demonstrate: – return on investment– enhanced care for people affected by cancer across Manchester

Recommendations

One minimum operating standard for MCIP and stakeholder/partner organisations to develop, deliver and monitor

the L&D programme for the workforce

Minimum learning outcomes, curricula and suggested learning opportunities for each workforce group to achieve the five

educational areas. This helps MCIP to commission appropriate cancer-specific L&D to meet the workforce needs

Minimum Operating StandardThe L&D Scoping Project developed:

Minimum Operating Standards: Estimated target of 15% of workforce annually to complete ‘MCIP Certificate for Cancer Care’

Existing & bespoke courses to be confirmed by sub-group and commissioned for all community staff

Learning & development opportunities to be delivered to Palliative & Primary Care workstream via LCS

Proposal for five-year roll-out plan subject to buy-in from partner organisations and MCIP board

Conclusion & Impact

Sub-group involving community workstream members and project team lead to agree minimum operating standard

Implementation

November 2014• MCIP Board ratified recommendations • MCIP Programme Teams have protected budget to

implement priorities in 2015 and..• Develop sustainable model of delivery after funding

period closes• Sub-group meetings with service leads held during

2015 to co-ordinate priority delivery• Recommendations included plan for evaluation

Scoping the cancer-specific learning & development needs of the non-cancer specialist healthcare workforce in primary, community & palliative care in Manchester

Project Team:Vanessa TaylorGunn GrandeDai RobertsJohn HumphreysHester BensonPeter MellorAnne Marie SowerbuttsCatherine PerryMichael Spence

Full and Summary Reports available at:http://clahrc-gm.nihr.ac.uk/our-work/community-services/end-of-life-learning-and-development-scoping-project/

7. Review of available learning & development opportunities n=60

Aims:• Make recommendations for new or enhanced learning & development

opportunities• Outline currently available resources and providers

How?Desk-based review to identify local, regional & national L&D opportunities

University Accredited Provision

Continuing Professional Development

Workplace Learning Opportunities

Findings: Learning & DevelopmentPractice Managers

Minimum Outcomes identified for Practice Managers

• Critically review the different policy contexts in which cancer care is delivered

• Outline the principles of cancer practice and explain how healthcare is organised through the cancer journey

• Communicate the different roles, responsibilities and functions of a multi-professional team

• Lead a service that supports individuals through significant life events including adequate procedures, resources and staff to provide support.