Post-Certificate of Completion of Training (CCT) Fellowships
Education and skills
- Health Education West Midlands
31 March 2014
The complex challenges facing the NHS of an ageing population, presenting with multiple co-morbidities, requires a “cross fertilisation” of knowledge, practice and ideas. The Post-Certificate of Completion of Training (CCT) Fellowships programme aims to catalyse this at local level. The programme was developed by Health Education West Midlands (HEWM), supported by WMAHSN.
The planned outcomes are:
- To enable the retention of generalist skills and the development of specific and enhanced skills to fit new settings of urgent care
- To enhance the function of the GP within the Emergency Department (ED), Medical Admissions Unit (MAU) and ambulance service teams
- To develop ways in which the GP can apply enhanced urgent and acute skills to support the identification, introduction and maintenance of community-based alternative care pathways.
- To raise GP interest in emergency medicine career paths
- To support and follow the national policy drive for improving joined-up care, spanning GPs, social care and A&E departments - overseen by a named GP
- To understand better the needs of patients, why they are attending ED and how the GPs role could be adapted to improve ED avoidance
- To develop innovative ideas/share best practice of meeting the emergency medicine agenda in primary care
- By the end of 2015, to have up to nine fellowships in place, working between general practice and A&E departments, with evaluation delivered by partner universities.
- HEWM successfully delivered a two-phase test of concept pilot, recruiting seven West Midlands GP Fellows, between January 2014 and November 2015
- In March 2015, Warwick Medical School delivered an interim evaluation report, covering Phase 1 of the Pilot. The evaluation confirmed fitness-for-purpose and scope for scale-and spread of the proposed Fellowship model
- The programme team prepared a project brief to extend the scope of the Fellowship, with four variations of the Urgent and Acute theme: Primary Care Paediatrics, Mental Health (including Veteran’s Health), Frail Elderly Community Care and Medical Education and Leadership. The brief was delivered to Health Education West Midlands for consultation on 21 August 2015
- The extended programme proposal has been endorsed by HEE Medical Director Prof Wendy Reid and HEE Board Chair, Sir Keith Pearson
- To demonstrate suitability for national scale and spread, the project team are collaborating with a team representing the three London LETBs and Health Education Kent, Sussex and Surrey (KSS), following a request for collaboration in providing a Pan-London and KSS Urgent and Acute Care GP Fellowship. The West Midlands model was accepted by the four Postgraduate Deans and development led by the Health Education London and Southeast Director of Education and Quality. The four LETBs have worked collaboratively with HEWM, to launch their Primary Care Fellowship in Urgent and Acute Care - as a pan-London and KSS test of concept - from September 2015
- Overall, the Fellowship has proved popular with the GPs who have participated in the scheme, whether as Fellows or through providing host practices, and with the teams in which the Fellows have been placed
- Through a variety of mechanisms the scheme is enhancing the services provided within the ED, MAU and ambulance settings, and has successfully supported the Fellows to develop a broad range of knowledge and skills related to urgent care
- The Fellows have become more adept at making best use of community-based alternative care pathways, so supporting patients with acute care needs to remain outside hospital. This was widely seen to be supporting improved joined-up care across GP, community and ED settings. In addition, the pilot also revealed numerous factors that may be important to the future success of the scheme, whether in the West Midlands or nationally
- For the Fellows themselves the scheme was felt to have been an exciting and challenging opportunity, unlike anything that they had encountered before. Their experience of the Fellowship was very different to what they had expected, and in the main surpassed expectations
- Participating in the scheme had extended their scope of practice and enhanced their self-confidence, academic and leadership skills in ways that they had not anticipated. Not only did they feel confident to undertake a future role that spanned primary care and emergency care, but they felt better able to lead and educate their primary care and secondary care colleagues in how best to utilise community-based services and help patients avoid unnecessary admissions to secondary care
- The success of the pilot provides evidence that can inform future NHS strategy and policy. The Fellowship has proven feasibility and provides a model for up-skilling GPs to work in an enhanced way across primary care, urgent care and emergency care settings, supporting admission avoidance and making greater use of community-based alternative care pathways. It successfully challenged the traditional barriers that result in patients receiving fragmented, inappropriate and often unnecessarily costly care
- The Fellowship supports the development of a new sub-specialty of GPs with the leadership, clinical and academic skills to drive forward implementation of the national policy drive for improving joined-up care across the NHS, and supports the future innovation and sharing of best practice.
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