GP mythbuster 57: Health Care Assistants in General Practice

The role of non registered health care professionals and has grown in recent years as practices consider how to improve access to services.

These roles include Health Care Assistants (HCAs) and Assistant Practitioners. In this mythbuster, ‘HCA’ covers both Health Care Assistants and Assistant Practitioners.

HCAs have a duty of care and a legal responsibility to the patients they see. HCAs are not registered with a professional body. They are accountable to their employer to follow their contract of employment. Employers have a responsibility to train, supervise and have oversight of their HCAs. This is until the competence of the HCA can be shown.

Employers accept vicarious liability for their employees. They are accountable for the actions and omissions of the employee. It is vital that employers make sure employees only work within the limits of their competence. If a registered nurse is responsible for delegating tasks to an HCA, the registered nurse is responsible under the Nursing and Midwifery Council (NMC) Code of Conduct for the safe delegation of that task.

The potential isolation of the primary care environment presents different challenges for HCAs. They may have previously worked within larger teams in social care or hospitals. The scope and nature of the HCA’s responsibilities vary between practices. They depend on the individual needs of the practice.

Tasks may include:

• blood pressure management
• venepuncture
• recording ECGs and
• health promotion such as smoking cessation.

The Royal College of Nursing (RCN) provide guidance on accountability and delegation to non-registered health care staff.

Regardless of the task being undertaken, the principles of delegation remain the same:

• HCAs should be trained and assessed as competent
• the HCA’s job description should specify their role
• the practice should make sure they have appropriate medical indemnity for the HCAs they employ. The cover provided should be enough to cover their scope of practice.
• There should be clear guidelines and protocols in place. The support worker is not required to make a standalone clinical judgement.

In general practice, HCAs will be carrying out care for patients independently. They should have access to a registered nurse or GP for advice and support when needed. The level of supervision needed will depend on the task being undertaken. The degree of risk must have been assessed. The patient has a right to the same standard of care, whoever delivers it.

Tasks

Administration of vaccines

HCAs can administer vaccines to patients in certain circumstances. HCAs are a valuable part of the team, especially in the annual flu vaccination campaign. Specific training and assessment of competence must have taken place.

The RCN supports HCAs to administer specific vaccines to adults and the nasal influenza vaccine to children. This is only if they are appropriately trained and have the support of a registered health care professional. For example, a GP or nurse in primary care. The RCN does not support HCAs administering other vaccines. These include the remainder of the childhood vaccination programme or travel vaccines. This is due to the clinical decision-making involved.

In all cases, Patient Specific Directions (PSD) should be in place. A PSD is a specific, written order by a qualified prescriber. The prescriber retains responsibility for safe administration of the vaccine.

Only registered health care professionals can administer vaccines under a Patient Group Direction. They are not appropriate for HCAs.

Public Health England have updated guidance on minimum training standards for HCAs administering vaccines.

Find out more about Patient Group Directions (PGDs) and Patient Specific Directions (PSDs) in GP mythbuster 19.

Sample-taking for the cervical screening programme

Taking samples from women for the screening programme involves more than the practical task. It specifically includes a level of judgement on the appearance of the cervix. This is not appropriate for HCAs. The contract between NHS England and GP providers says only qualified staff should perform this procedure. The training for sample-takers is insufficient for those without previous clinical background.

Care Certificate

Employers appointing HCAs should include Care Certificate standards in their induction process.

A 2013 independent review by Camilla Cavendish investigated how care assistants and support workers in health and social care could be better valued and supported.

Since the review, Health Education England, Skills for Care and Skills for Health have developed the Care Certificate. The certificate contains 15 standards. It outlines what health and social care workers should know and be able to deliver in their daily jobs. It aims to address inconsistencies in training and competencies. Staff should have the same introductory skills, knowledge and behaviours to provide safe, high quality and compassionate care of the highest standards.

We expect to see evidence of how induction programmes include Care Certificate standards. This is for HCAs employed since April 2015.

Find out more about the Care Certificate on Skills for Care’s website.

CQC inspections of GP practices

When we inspect or assess GP practices, we check that staff have the skills, knowledge and experience to deliver effective care and treatment. We consider this as part of how effective a GP practice is. GPs should show how they have trained HCAs for all aspects of their role. GPs should show how they assessed HCAs’ competence, when they started the task and throughout their employment. This could be done by a range of methods and could involve a combination of:

• directly-observed and recorded clinical encounters
• external training events/updates and
• in-house reflection on practice with a mentor who has appropriate expertise.