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Computing essentials to support health promotion in primary care

Helping all practice staff to develop IT skills

Why was the initiative launched?
What was done?
Is it working?
Tips for success
To find out more contact:

Why was the initiative launched?

EQUIP (Education and Quality in Primary Care across North Essex) evolved in 1996 from Essex MAAG and GP Education in Essex. It is jointly funded by the Health Authority and by practices to meet the education and training needs of primary care staff and to improve the quality of audit. The philosophy is to use audit as an educational tool.

Questions about the use of computers and IT skills arose when the locally agreed health promotion programmes (including ischaemic heart disease and stroke) started to take shape. Data analysis would be essential for the audits and educational sessions. Obviously a task better handled electronically. Similarly, success with the introduction of disease registers in practices, another essential contribution, would depend on IT skills. Early discussion between the EQUIP team and practices suggested that practices needed help to enhance their IT skills to make these plans a reality.

What was done?

An initial training session on the care and treatment of patients with diabetes made clear what needed to be done. GPs were asked to analyse the records from a sample group of their patients as preparation for the session. This proved an impossible task for most GPs. As one said at the time, "We can find ways to enter data but it seems to be impossible to get it out". In many systems data was entered as free text with no facility to retrieve and analyse it. Something needed to be done to help practices handle data more effectively.

Evaluation of early training sessions on the management of coronary heart disease, diabetes and asthma provided EQUIP with a set of important signposts for IT training. The recommendations were reinforced by research at Anglia Polytechnic University. Training for staff in primary care should:

EQUIP worked collaboratively with the North Essex Practice Managers Forum to ensure that the training provided was practice driven. They were conscious that their success depended on the way they were regarded by local practices - as a supporter rather than critic or inspector. Two parallel programmes have evolved over time:

IT courses provided by EQUIP
Computers what are they
Hardware familiarisation for practice managers
Computing essentials for nurses
Word, Excel and Access sessions at different levels as well as more specialised sessions
Understanding databases
Data handling by computer in house provision
Data handling for audit clerks
EMIS training for nurses
Meditel training for nurses
Internet as a resource for GPs

Different funding sources for training of clinical and non-clinical staff presented difficulties. EQUIP had to find imaginative ways to assure funding. One clever method ensured that people attended: participants provided a cheque to guarantee a place - but the cheque was cashed only if the person or practice failed to attend! Care was taken to ensure that the parallel programme of clinical training and audits was in step with the computing courses. Many of the clinically focused workshops (like asthma in primary care) had sessions on IT issues.

EQUIP supports a major ongoing health promotion audit and the team recognised that efficient data collection would be important for its success. To help practices an audit clerk scheme was set up to provide grants of £500 per practice to cover additional hours for data collection and to support the creation of chronic disease registers. In-house training and support was made available for the audit clerks to help them understand and use of their practice systems, and to cope with doctors reluctant to use the technology on their desks. Accreditation from the Accreditation Consortium of South Anglia allows audit clerks to receive a nationally recognised qualification. Networks of audit clerks have been established within PCGs to support Clinical Governance.

Is it working?

The team does not rely on questionnaires to evaluate the computing sessions and courses. Rather it follows them up samples participants by telephone. They ask whether time spent was worthwhile, information received useful and, importantly, whether they would recommend the session to others. Changes have been made to respond to points made. For example, an early session for audit clerks was pitched too high and assumed an unrealistic level of knowledge! Further training on medical terminology was also needed for data collection for the health promotion programme.

Success was evident from the increasing numbers of practices finding the process of assembling data to support audits easier. The number of practices using audit clerks grew rapidly over two years and by September 1999 covered about 80% of the practices in North Essex. In the latest health promotion audit, 18,000 data entries were analysed and data gathered from practices covering 70% of the 870,000 North Essex population. Data is collected and fed back individually to practices every 6 months.

Tips for success

√ Find out what people want, make training needs-led.
√ Recognise that GPs, nurses and practice staff may have different needs.
√ Encourage multidisciplinary training and working - valuing the contributions of all members of the team.
√ Take training to practice staff - be proactive.
√ Ensure that course leaders are credible.
√ Be flexible - the same approach will not appeal to all.
√ Listen, and adapt and change sessions if required.
√ Don't allow course fees to become a deterrent, find imaginative ways to assure attendance.

To find out more contact:

Linda Grimstead
Manager, EQUIP, The Education Centre
Strutt Close, Hatfield Peverel, CM 3 2HB
Telephone 01245 380695 Fax 01245 380685

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