It is rare for me to say that I have enjoyed reading a 92-page government review but The Cavendish Review is the exception. And apart from my irritation that general practice is nowhere mentioned it is an excellent and easy to read document.
It does not, however, help with the practicalities of implementing the Care Certificate for any new HCAs, which is a CQC requirement post April 2015. It does explain why the Care Certificate came into being.
In the wake of the Francis review, Camilla Cavendish was asked to undertake a review of what could be done to ensure that unregistered staff in the NHS and social care treat all patients and clients with care and compassion. Her review came up with 18 recommendations. The only one with a direct requirement on general practice is that new healthcare assistants starting after 1 April 2015 need to have undertaken the Care Certificate.
What is the Care Certificate?
The Care Certificate is a competency framework to ensure a HCA has been assessed against national standards. These standards are:
- Understand your role
- Your personal development
- Duty of care
- Equality and diversity
- Work in a person centred way
- Privacy and dignity
- Fluids and nutrition
- Awareness of mental health, dementia and learning disability
- Safeguarding adults
- Safeguarding children
- Basic life support
- Health and safety
- Handling information
- Infection prevention and control
The standards must be assessed and signed off by the employer. The assessor must have necessary experience to judge whether the HCA has demonstrated the required competences. Full details are on the Skills for Care website.
The Care Certificate is transferable, so if a HCA has completed it elsewhere they do not need to repeat it. On average, it takes 12 weeks for a HCA to complete the certificate.
Staff who are already working as HCAs, and who have been trained according to the common induction/minimum training standards, are not required to complete the Care Certificate.
However employers are required to assess the skills and training needs of new staff and, based on this assessment, they may decide to provide training in all, or some, of the standards required by the Care Certificate to a new member of the practice team.
The most useful document I have found to help employers assess competence is the Care Certificate Framework for assessors.
This provides a list of the types of things a HCA would need to be able to demonstrate to meet each of the 15 standards and how the employer should assess competence.
Much of this is what would normally happen when practices train new HCAs. The requirements of the Care Certificate mean this is documented in a more formal way.
The guidance emphasises holistic assessment. It says while each standard is independent many are also inter-related. For example communication is an independent standard but communication skills will be used when the worker is interacting with patients and service users across almost all the other standards. Therefore, the guidance suggests it is more efficient to use the same evidence to meet different standards where possible.
So while at first glance evidencing 15 standards seems a lot, most if not all are inter-related and it will probably be a case of evidencing what you already do.
Nurses will be the obvious supervisor for most of the standards but it can be the practice manager or GP as needed.
Recording assessment decisions
Documentation of assessment and evidence of practice is the responsibility of the HCA and their employer. The evidence may be recorded in a workbook, portfolio or online.
A national Care Certificate Workbook is available from Skills for Health and Skills for Care. The workbook has 15 downloadable resources with an introduction and glossary, and can be downloaded here.
There are various toolkits available that will help you monitor achievement against the care certificate, but you will need to pay to access these. The RCN's First Steps for HCAs is another useful resource.
Any documentation used in gathering evidence for the Care Certificate should be portable so it can be used as evidence when a HCA changes roles or moves between employers.
All practice staff should have PDPs. You should ensure that there is documentation in the HCA’s PDP that a particular competence has been covered and a record from their supervisor that they have observed this in the HCA’s practice and are satisfied that the HCA understands and demonstrates ability in this area.
All of this may seem overly bureaucratic but it means that practices can demonstrate that they have assessed HCA competence for the purposes of CQC regulation and also as a marker of quality and patient safety.
The aim of the Care Certificate is to improve patient safety and, while some of the issues raised in the Cavendish review (unsupervised and untrained staff having direct patient contact) are rare in general practice, the certificate will help to standardise and strengthen the role of HCAs in primary care, which can only be a good thing.
How to implement the changes
It may be worth looking at you local networks (nurse and practice manager forums and GP training groups) for ideas on how best to do this locally. Another suggestion would be to contact your local education lead (if you have one) or Health Education England on how to localise the process and share ideas.
It is important to allow time for both for the learners and the assessors in the early stages to familiarise themselves with the process and understand the requirements so these changes are genuinely embedded in practice. While time is always short in general practice and there isn’t any funding for this, the long term benefits will be better trained and more engaged staff.
One other note to mention, the guidance is clear that certificates of attendance, attendance on study days or e-learning without assessment of what has been learnt is not evidence toward achievement of the Care Certificate. It is therefore better to look at what you can evidence in house before looking at courses to provide elements of this training.
There are many resources and support tools available on the Skills for Care website.
- Fionnuala O'Donnell is a practice manager in Ealing, West London, and a CCG board member.