Standard 1: Professional and competent staff

The General Practice commits to:


To meet this standard the practice commits to:


Self-Assessment


Practice Guidance


1.1 Ensure that each individual staff member understand their role and responsibility for Advanced Serious Illness and EOLC  


 


 

1.1a Ensure individuals can demonstrate an understanding of which skills relate to their role
and consider staff training requirements to support Advanced Serious Illness and EOLC core Standards.

  • Agree as a practice, which clinical and non-clinical staff are involved in caring for people with ASI and EOLC needs.
  • Training needs assessment for staff.
  • Relevant Learning action plan for staff with SMART objectives.

Over the continuous improvement cycle of the Daffodil Standards, for example, 3 years:

  • Agree realistic practice SMART objectives (Specific, Measurable, Achievable, Realistic and Timely); for reviewing training needs of staff
  • Discuss and agree as a practice the key skills anticipated necessary for different staff roles. Reflect using Skills for Health EOLC Core Skills Education and Training Framework [PDF].
  • Reflect on how previous experiences, attitudes, beliefs and personal barriers may affect the way staff work – cover issues affecting each standard for example,non-identification of patients and carers, shared decision making, communication etc.

Consider staff understanding of how to handle:

  • Complaints and complements
  • Incidents, errors and near misses
  • Ethical, legal and safeguarding issues, such as consent, confidentiality, capacity and duty of candor
  • Conflict in difficult situations
  • Compassionate Communication and interpersonal skills
  • Communication and information needs of people with disabilities, sensory loss, cultural and language variation
  • Reflect with staff to make sure they have achieved or have a plan in place to achieve training on standards, which relate to their role. This may be done together during a practice meeting with reflection on cases or as part of an appraisal.
 1.1b Individuals have completed training on each Advanced Serious Illness and EOLC core standards that relate to their role.  Over the 3 year cycle:
  • Evidence of training and learning completed and impact.
  • Demonstrate practice support staff to achieve relevant agreed learning needs over the 3 year cycle.
  • Demonstrate reflection and learning about training, learning events, case studies etc. and show resulting impact or changes made in practice.
  1.1c Demonstrate the application and impact of using Advanced Serious Illness and EOLC core Standards.

 

 

Examples include:
  • Case history(s) presented at MDT meeting.
  • Patient/ carers and professional feedback presented at MDT meeting.
Practices should consider what type of reflection works for staff. Emphasis should be on rich discussion, reflection and steps needed to make continuous improvement – not

unnecessary paperwork. If changes are being made, then agree how you will know that an improvement is made. Who's involved, SMART aim, what to monitor in real-time practice and regular review process.

  • Case histories can include learning around each standard when relevant. This can apply to both clinical and non-clinical staff, for example, staff experience of identifying a patient or carer, learning from a sensitive conversation etc.
  • There needs to be a mechanism for obtaining feedback from patients/ carers and professionals who will not be present at the MDT meeting. The process for this can be decided at the practice.
1.1d Demonstrate assessment, induction training on standards, appropriate to role, for all new staff.
  • Induction procedure.
  • Consider mentoring opportunities.
 
  • The induction procedure should be pitched to the appropriate level for different staff. It would discuss the principle commitment to quality improvements as well as the ambition that 'every contact counts', including respect and dignity.
  • Share practice's supporting documentation and where possible, there should be a face to face discussion which should allow reflection on how previous experiences, attitudes and beliefs and personal barriers may affect the way they work.

  • Examples include, as a regular discussion point discussion about patients who have died during a practice/ GSF meeting; liaising with local hospice to enable visit to hospice as part of induction. Process may vary to be relevant to the staff member.

1.2 Ensure all staff understand the feelings and communication needs of people approaching the end of life and their families/carers 

 

1.2a Improve the understanding and sensitive communication of individual staff and the team collectively, around dying, death and bereavement.
  • The practice has access to a range of methods to increase understanding of experiences of people and carers at the end of life.

For example, articles, books, resources.

  • The practice demonstrates reflection on sensitive communication, appropriate to people's needs.
  • Understand the importance of sensitive communication skills and any specific communication needs, for example, for people with disabilities, cognitive impairments, sensory loss or if their first language is not English.
  • Help staff access training on the requirements of NHS England's Accessible Information Standard, for example, Health Education England's free e-learning module.
  • Share list of forums, books and resources. Give staff the opportunity to read and discuss experiences of people and carers at the end of life, living with personal illness, loss and personal care giving.
  • Consideration inequality groups such as LGBT, BAME, LD, dementia and children.
  • Consider both associated positives and negatives of death and dying, age range, gender, mix of patients and carers.

 

1.3 Have a practice lead for the Advanced Serious Illness and EOLC standards 

1.3a  Appoint a clinician (or group of clinicians in federation setting) with relevant leadership, skills, knowledge and understanding to do this role.
  • Lead known to whole team.
  • Where possible, has time allocated.
  • Coordinate agreed ambition for phased improvements via the standards, in the practice.
  • Agree admin lead
  • Regularly review the time allocation and job plan (that is, what they will do to coordinate phased improvements via the standards, in the practice over 3 year cycle). Create expected Lead Plan.
  • Consider responsibilities, objectives and outcomes of the role, across each standard. Should include agreeing induction process for staff and monitoring for new evidence related to EOLC.
  • Consider how to engage with Patient Participation Group.
  • Consider connecting with other practice EOLC leads.
  • Consider how to share learning and delivery at scale with wider colleagues.
1.3b Lead(s) responsible for coordinating implementation of the Standards. An action plan/Gantt chart for implementing these standards over a 3 year cycle.

Lead to consider:

Next: Standard 2: Early identification >

QI 1: Continuous Improvement

Yearly SWOT (strengths, weaknesses, opportunities and threats) analysis of the practice's ability to provide high quality, safe and compassionate care for people affected by Advanced Serious Illness, and End of Life Care.

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