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At the heart of general practice since 1960

Mother wants off-licence drug for toddler's self-limiting condition

Creative use of health care assistants can benefit patients and practices alike – Dr Peter Stott explains

Health care assistants (HCAs) have worked in primary care for at least 10 years. Along with nurse practitioners and practice nurses (RGNs) they form an important part of the 'nursing skill mix'. HCAs are commonly members of the district nursing teams and there are many are to be found in hospitals and in nursing homes, but as trained practice nurses become harder to find, HCAs are becoming increasingly important in general practice too.

HCAs work under the day-to-day guidance of a qualified nurse or doctor. In hospital, they take some of the day-to-day care from RGNs with duties that include washing, feeding, toileting and bedmaking. But in general practice they are expected to have somewhat higher level skills (see table 1).

Training

The training time for a qualified HCA is less than two years – considerably shorter than registered nurses. They can train part-time and once qualified they are usually employed on grade D. Most potential trainees are found from within the ranks of reception staff. Alternatively they can be recruited from auxiliary nurse posts in local nursing homes. HCAs can retain their original job roles while they are in training.

It is usual to pay potential HCAs their full current salary during training but practices that take the trouble to recruit and train them will find they rapidly become a motivated part of the primary care team with versatile skills that can be used in a highly cost-efficient manner. Patients like HCAs, particularly if they have known them in a previous role. They usually warm to the news that someone they know is training 'to be a nurse'.

Training will give HCAs a national vocational qualification in care at levels 2 and 3. NVQ level 2 will enable the nurse to take more responsibility and to find greater levels of job fulfillment. NVQ level 3 will meet the minimum entry requirements for entry into nurse training. This can be highly motivating to recruits of any age. Most courses provide level 3 training.

HCA courses

The HCA course will usually involve:

•An initial orientation module

•Distance-learning modules in specific health care topics (these will be linked to practical tasks within the practice)

•Training days in specific skills (eg venesection, blood pressure)

•Mentoring within the practice

•Tutoring by the college tutor/assessor

•Personal research on two or three specific topics.

Most PCTs have arranged appropriate courses with local colleges of further education (CFEs). Where this has not been done, practices should contact CFEs directly.

There is variation in the courses on offer and people are expected to work at their own speed. Part-time working is not a problem but a typical HCA course has to be completed within two years.

During training the potential HCA can work as a nursing auxiliary closely supervised by their mentor in the practice. The practice mentor can be a nurse or doctor who should have protected time to meet regularly with the student. The role of the mentor is important and not to be undertaken lightly, and mentors are usually advised to consult their professional body regarding their vicarious responsibilities.

Much of the work is practically based with workbooks and reports to be worked through together. Trainees will also receive personal support on a monthly basis from the NVQ assessor at their college and they will be expected to attend a number of joint workshops on specific topics.

Once HCAs start working relatively independently, protocols must be developed which both they and their employer must sign to guide all aspects of their work. Most practices will have existing protocols for their practice nurses which will need only minor modification.

HCA salaries

Pay for health care assistants in the NHS aged 18 or over starts at £10,000 a year. More experienced staff can earn from £12,000 to £16,000 a year. Additional allowances can be paid for working unsocial hours or for extra duties. But most practices wishing to retain skilled HCAs will need to consider paying reasonably high on this scale, while still retaining pay differentials between HCAs, RGNs and nurse practitioners.

Our experience

At Tadworth Medical Centre we now have two HCAs who both work part-time to cover the whole five-day working week.

Both started as receptionists and continued this job throughout their training. As they progressed, however, it became obvious that this dual role was not satisfactory. When they worked as HCAs the receptionists would expect them to perform reception duties as well. When they were receptionists, the nurses wanted them to help them with urgent ECGs and bloods. So as soon as they (and we) felt confident they both gave up their reception duties and worked clinically full-time.

Initially, the tasks we asked of our HCAs were limited to venesection, ECGs, support for nurse clinics and lifestyle advice. Each of these was undertaken as soon as appropriate training had been completed. Later, as they built their skills, they ran their own surgeries. Three years on, they perform a wide range of functions.

They have taken over full responsibility for the thyroid checks in the new contract and for data entry regarding diabetic and cardiac patients attending hospital.

Our HCAs were rapidly assimilated into our nursing team. This was made easier because one of our nurse practitioners became their mentor. Interestingly, the only hostility they encountered came from a local practice nurse group, some of whose members accused them of being part of a general 'dumbing down' of nursing standards. Fortunately, our HCAs are made of sterner stuff! One of them has recently announced her intention to move on to full RGN training.

Staff retention

Good HCAs are in high demand. Poaching by other practices and the likelihood of them moving on to further training are just two of the many risks that forward-thinking practices are now encountering. Allowing staff time for further education and paying for their training is acceptable when the staff stay and pay something back.

Unfortunately, without appropriately high levels of remuneration, many ultimately leave to take higher-level jobs or to join practices that do not provide training but pay even higher salaries.

Peter Stott is a GP in Tadworth, Surrey

1 Duties expected of a health care

assistant in general practice

•Lifestyle advice (smoking, weight loss)

•Simple examinations like blood pressure checks, weighing, temperature, height, urinalysis

•Venesection

•Simple dressings

•ECGs, peak flow and spirometry

•Maintaining stocks of drugs and vaccines

•Disinfection and sterilisation

•Audits, data entry and other tasks associated with the new contract

2 Contents of a typical HCA course

(East Kent)

Part 1

Unit 1 General orientation to health care

Unit 2 Health and safety

Unit 3 Infection control

Unit 4 Fire training

Unit 5 Working in primary care (confidentiality)

Unit 6 Role and responsibilities of the HCA

Unit 7 Professional development (practical procedures, chaperoning, etc)

Part 2

lStandards of care

lConfidentiality

lCommunication in the primary care team

lResources outside the primary care team

lTime management

Part 3

lClinical procedures (venesection, BP, blood glucose testing, well-person checks, lifestyle counselling)

Part 4

lEducation and training

lPerformance appraisal

Resources

•General details on HCA training

www.learndirect-advice.co.uk/helpwithyourcareer/ jobprofiles/profiles/profile193/

•Specimen job description for HCAs working in Primary Care

www.kentandmedway.nhs.uk/pdf/Professional_pages/ healthcare_assistants_induction.pdf

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