Establishing educational needs in a new organisationBMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7174.2 (Published 19 December 1998) Cite this as: BMJ 1998;317:S2-7174
The advent of primary care groups means GPs have to get to grips with a whole new range of population-oriented skills. The Oxford Primary Care Group outlines its approach
- Tim Wilson Dr, GP director,
- Fran Butler, senior project officer,
- Marion Watson, research facilitator
- Primary Care Group Resource Unit, Public Health Resource Unit, Institute of Health Sciences, Old Road, Oxford OX3 7LF
The creation of a new organisation requires a new collection of skills and knowledge. Its members will need an entirely novel programme of education and training. Primary care groups (PCGs) are a useful example of an organisation which needs to define its education and training needs. We asked two questions about these new organisations: “What skills and knowledge will be required?” and then “What means should be used for delivering the education and training?” The process is analogous to establishing the training needs of a new post within an organisation, though the Delphi process described below would probably be overkill for a single job.
Stages involved in establishing the training needs of a new organisation or post
Think about who would be able to help you with this task
Coal face with previous experience
represent the coal face
Establish what the new post is going to be doing
Write a job description for a single person or a more complex set of organisational tasks for an organisation like a primary care group
Use any official guidance available
Search for previous similar work
Ask any contacts you may have
Decide upon the skills and areas of knowledge needed
Create the list of skills and areas of knowledge
Within an organisation decide who might need what skills and knowledge
Think about how the skills might be delivered
Who will be responsible?
Where, how and to who?
How will an ongoing programme be decided?
In view of the important (and daunting) tasks facing primary care groups it seemed crucial to try and establish what the education and training needs for PCGs were and to consider how they could be delivered. Although it will be important for primary care groups to set their own curriculum once established, many are currently concerned with where their offices are, how they can relate to the Health Improvement Programme, and so on. This is true of any new post or organisation; in the early stages, education and training is likely to be a low priority and so an important aspect of development may be neglected.
The introduction of primary care groups heralds a radical change in the NHS. However, it is not the first time that the NHS has seen the arrival of a totally new structure. For example, the organisation of education was also patchy with the introduction of fundholding too. In some areas fundholders obtained their own training; in others, the health authority organised courses. Little thought was given to the curriculum and there was no overall planning. The introduction of trusts was met with an educational programme, which had a very “top-down” approach. It is unclear how the education and training needs were decided upon. Little attention had been paid to the concept of learner led curriculum.
We knew that many people were considering this problem, so we knew that some thought had gone into PCG education and training. We decided to ask everyone relevant we could think of within the geographical area of the PCG. So long as there is a broad representation from each category of person felt to have an important input or ownership, there is probably little to be added in having too many participants. Using the groups listed below we identified participants from each county we work in. We had 70 participants for the Delphi technique and 50 for the conference targeting those working at the coal face (GPs, community nurses, and practice managers) with experience of fundholding, commissioning or locality groups, those involved in coordinating or representing the coal face workers - for example, nurse managers/primary care development nurses, local medical committee chairs or secretaries, and those who had to implement policy at trust or health authority level. We also wanted to include individuals with expertise in providing and commissioning education and training - for example post-graduate medical education, non-medical education and training consortia.
How do you ask them?
We decided to use two methods; the Delphi technique over two rounds followed by a conference with workshops to review the results of the Delphi. This would then generate a definite list of skills and areas of knowledge needed, with suggestions about how they may be delivered. In brief, the Delphi consists of asking participants a series of questions, with each subsequent questionnaire based on previous responses. This involves participants in a powerful way, and gives a discursive quality to the process.
What do you ask them?
The defining guidance about primary care groups is to place function before form. Drawing up a list of desirable skills would be pointless if they did not match the tasks PCGs were going to undertake. Following this rule, we listed a set of tasks that PCGs would need to perform. We were guided by The New NHS1 and hoped to be guided by research that had already been done on similar groups. The latter was not easy to find. A systematic trawl for evidence was impossible, as this material is often unpublished or is commissioned within an organisation and remains there. However, we used our network of contacts and found enough previous work as a basis for the first round.
The participants were asked to comment on our list of tasks. Then, when they had considered the tasks and constructed a list, we asked what skills and areas of knowledge they thought might be needed to accomplish these tasks. We encouraged people to suggest any skills they felt appropriate, although, to make the task easy we did give them a picking list we had devised, based on past research. This part of the Delphi was complex and difficult, because, although we tried to help our participants with suggestions, they were essentially working in a completely new area.
However, once this part was completed, it became easier for the participants. The second round was used to reconsider the tasks and, more importantly, which skills and areas of knowledge were the most important. Furthermore, since the PCG was going to be made up of many different groups, we defined three types of primary care group participant: board member, the ‘doer' (who performs the day to day tasks of running the primary care group); and stakeholder (everyone at the coal face who might be covered by the primary care group). Then we could ask what skills, in particular, would be needed by the defined type of (primary care group) participant?
Conference ranked needs
We used a conference composed mainly of group sessions to review the Delphi and to finalise the list of skills and areas of knowledge needed by primary care groups. Given that the list was long, they needed to decide what skills and areas of knowledge were the main priorities? As already mentioned, in the long run primary care groups will need to plan their own education and training curriculum. The purpose of this exercise was to establish what needed to be considered immediately. Lastly, considering the priorities, how should the skills and areas of knowledge be delivered? There are many styles for learning and many ways in which education can be delivered. Style, location, method and resources all need to be considered. In the long term, much of this will depend upon the financial resources and personal skills for training within the PCG. Initially, though it would be helpful for primary care groups and policy makers to consider what early training might consist of.
We found there were three broad areas of skills and knowledge required by primary care groups: creating the primary care group as a corporation and making it work together as a team; planning and management; and public health skills. The training should be delivered at primary care group level using a coordinated curriculum, should be led by the group and use existing sources such as health authorities and trusts. An audit of existing skills should be conducted to determine the education and training needs. There may be some specialised skills that the primary care group will require as the functions of the primary care group become more obvious. Networking and cross fertilisation between Primary care groups will be important to share ideas, experiences and functions.
The Primary care group Resource Unit is funded by a grant from Anglia and Oxford R&D Department.
A full copy of our report is available at http://strauss.ihs.ox.ac.uk/pcgru