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• Talent for Care and Widening Participation
• Widening Access and Participation (WAP)

Best practice and case studies

The national Talent for Care team at HEE is keen to share extensive best practice and case studies to help inform development of programmes and work across the country.  If you have something you would like to contribute, please get in touch via [email protected]

Widening participation directory 

The Widening Participation Directory provides case study examples from organisations supporting the diversity of the healthcare workforce.

The directory of best practice initiatives was developed in as an early response to the Widening Participation – It Matters! strategy and captures key Widening Participation developments being supported by healthcare organisations, education providers and other stakeholders.

There are over eighty examples outlining aims, actions, and outcomes of initiatives. We hope that sharing this excellent work will encourage you and others to implement positive change within their organisations. 

The directory is split into broad topics and hyperlinked to allow quick access to specific initiatives and easy access to sections and entries of most relevance.  

Talent for Care programmes and strategies

Some examples of how employers and STPs have implemented the broad scope of Talent for Care in their organisations.

Chesterfield Royal Hospital NHS Foundation Trust – they said, we did  - An example of the various initiatives undertaken at Chesterfield Royal Hospital including implementation of the Care Certificate and clinical apprenticeships.

Leicester, Leicestershire and Rutland – An evaluation of the Talent for Care programmes  - Examples of work done across the STP including the Health and Care Professions Annual Event and partnership work with the National Citizenship Service

Nene Clinical Commissioning Group – Talent for Care in Primary Care  - Examples of the work being done in Primary Care with a particular focus on learning disability and mental health.

The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust – Implementation of the Partnership Pledge  - Comprehensive information about how this NHS Foundation Trust was able to work towards the different intentions set out in the original Talent for Care Partnership Pledge.

South Staffordshire and Shropshire NHS Foundation Trust – Workforce Planning and Assurance.  A wide variety of information from the organisation’s Workforce Planning and Assurance Team including services such as Apprenticeship and Career Development Programmes, Work Experience and Volunteering Programmes, and Workforce Information and Assurance Reporting.

West Midlands Ambulance Service NHS Foundation Trust – Strategic Intentions Evaluation  An opportunity to see the work being done across an Ambulance Service NHS Trust and the variety of Talent for Care work being undertaken

Workforce Strategy Template  - An example of a template for developing a workforce strategy that includes widening participation as a key theme.  A further example is available here .

Apprenticeship Strategy Template  - An example of a template for developing an apprenticeship strategy, thanks to Dudley and Walsall Mental Health Partnership NHS Trust.

Birmingham and Solihull Mental Health NHS Foundation Trust – Apprenticeship Strategy 2017-20  - See an example of a worked up apprenticeship strategy from this Trust.

Schools and community engagement

Some examples of how employers in the NHS are engaging with their local communities to raise awareness of healthcare careers and attract people into the service.

Cambridgeshire and Peterborough Clinical Commissioning Group This project intended to educate the public in order to attract more young people and improve diversity within the workforce

Norfolk and Suffolk – Engaging staff to act as NHS Ambassadors A project that offered the opportunity for young people and NHS Ambassadors to talk about what is required to work in different roles in Health and Care

Apprenticeships

Some best practice examples of apprenticeship programmes, including integrated apprenticeships.

Northamptonshire Apprenticeship Project A joint initiative to bring together the work being done across the NHS organisations in Northamptonshire through a coordinated approach.

The Shrewsbury and Telford Hospital NHS Trust – Belong to Something See how this NHS Trust promotes and organises its apprenticeship opportunities.

The Coastal West Sussex Integrated Apprenticeship Programme

Developed with the aim of supporting growing workforce needs across health and social care and to encourage integration between the two sectors.

The Suffolk Integrated Apprenticeship Programme Developed with the aim of providing entry-level work experience in a variety of health and social care settings.

The Lincolnshire Integrated Apprenticeship Programme Developed to take account of Sustainability Transformation Plans and offer an entry route into the sector.

The Leeds Integrated Apprenticeship Programme Developed to enable apprentices to enhance care skills, understand the range of roles and responsibilities of support workers throughout the patient journey and gain an insight into operational challenges that might influence seamless integrated care.

The Blackburn with Darwen Council Integrated Apprenticeship Programme Designed to promote innovation and cross-sectoral learning across health and social care by providing apprentices with two different placements.

Apprenticeship videos

There is a huge range of apprenticeship case study videos available via our YouTube playlist.

Work experience and pre-employment activity

Some examples of work experience and pre-employment activity that employers are offering.

Heart of England NHS Foundation Trust – Prince’s Trust An example of the work the Trust is doing with the Prince’s Trust as part of Talent for Care.

Coventry and Warwickshire Partnership Trust – Unemployment to Employment This project works with The Prince’s Trust to support 18-26-year olds who are unemployed move closer to employment through Employability Skills and Traineeship Programmes

The Dudley Group NHS Foundation Trust – Work Experience See how this NHS Foundation Trust promotes and organises its work experience opportunities.

East Coast Community Healthcare – Rotational Work Experience This work experience approach allows candidates to experience multiple different clinical careers as well as also understanding the non-clinical support required through rotational placements.

Nottinghamshire Coordinated Work Experience Programme Work Experience can be accessed across the NHS Trusts in Nottinghamshire through one point of contact. Find out more about how this works with examples of the different process and documents required to run this work experience programme.

Norfolk Community Healthcare – Placements to support candidates overcome barriers into employment An innovative approach to supporting two placements which helped support candidates overcome personal barriers making it difficult for them to find employment

Sherwood Forest Hospitals - Aspiring Medic Work Experience An opportunity for young people aged 16+ who are studying a Science A or AS level to gain valuable knowledge from doctors, nurses and healthcare scientists on this Industrial Cadets accredited work experience opportunity.

South Staffordshire and Shropshire Healthcare – Work Experience Leaflet

See how one Trust has explained and promoted its work experience opportunities.

Birmingham and Solihull Mental Health NHS Foundation Trust – Work Experience

See how this Trust promotes and organises its work experience opportunities.

Volunteering

Some examples of how employers are making the most of their volunteer workforce.

The Dudley Group NHS Foundation Trust – Volunteering Programmes See how this NHS Foundation Trust promotes and organises its volunteering opportunities.

Developing existing staff

Cambridge and Peterborough Clinical Commissioning Group – Super HCA The intended outcome of the project was to upskill HCAs, build confidence and develop further skills. The course offered a networking opportunity to share knowledge with peers and an opportunity to improve policy and procedures in practice.

Health Careers

A number of real-life stories feature on our Health Careers pages.

NHS Employers

NHS Employers host a huge range of case studies and resources , including many relevant to the Talent for Care agenda.

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Development and spread of health literacy eLearning: A partnership across Scotland and England

Ruth carlyle.

1 Knowledge and Library Services, Health Education England, London UK

Annette Thain

2 Knowledge Services, NHS Education for Scotland, Inverness Scotland

Sally James

3 Public Health, West Midlands, Health Education England, London UK

With international health challenges, there are opportunities for collaboration between nations on health issues, including developing and sharing resources for teaching and learning. This article outlines collaboration across Scotland and England to develop a core resource for eLearning on health literacy. It describes the development of the resource with case studies of the implementation in Scotland and England, demonstrating the balance between shared development and tailored implementation. The eLearning was developed to increase awareness of NHS workforce and community partners, supplemented by training for NHS librarians and public health specialists to enable them to provide more tailored training on health literacy techniques.

Challenges facing health libraries and societies rarely stop at country borders. One such challenge is health literacy, or the ability to access, assess and use health information. Supporting people to develop and use health literacy skills and techniques is a global challenge (Nutbeam & Kickbusch,  2000 ).

The health literacy levels cited in the UK are based on work by Rowlands et al. ( 2015 ). This seminal study indicates that 43% of adults aged 16–65 struggle to understand and use written health information where the content consists of words. When numbers are added, 61% of adults aged 16–65 struggle to understand and use the health information (Rowlands et al.,  2015 ). In practice, most health information contains both words and numbers, such as the number of tablets to be taken and the number of times a day to take them. At points of shock or anxiety, such as diagnosis, health literacy levels can go down (McKenna et al.,  2017 ). As a result, anyone can struggle with health literacy at points of key interaction with health services.

If members of the public are to be able to have informed discussions about their health, then health and care practitioners need to be aware of health literacy and techniques they can use, so that they can select resources and hold conversations in ways that allow for differing health literacy levels.

The strategic leads for NHS knowledge and library services in Scotland and England respectively are NHS Education for Scotland and Health Education England. Health Education England's role in the education and training of the health and care workforce also includes education for the wider public health workforce. In 2018, staff across the two organisations agreed to collaborate on the development of a health literacy eLearning package that could be used in both nations and implemented through blended learning approaches adapted to needs of the health workforces in Scotland and England. The eLearning was intended as a core tool to spread awareness amongst the NHS workforce and community organisations, to be supplemented by more specific training on techniques for NHS librarians and public health staff to enable them to cascade more tailored training.

DEVELOPMENT OF THE eLEARNING PACKAGE

Collaborating across Scotland and England on eLearning provided opportunities for sharing knowledge and maximising the cost‐effectiveness of developing an eLearning product. The teams agreed that they wanted to build on the five core elements of the action plan for health literacy in Scotland, Making it easier (Scottish Government,  2017 ). This policy is consistent with good practice shared in England.

The five core elements of Making it easier are techniques to support health literacy. To put these techniques into context, the team produced an opening section to increase awareness of health literacy and the impact of low health literacy before developing short sections on each of the techniques:

• Teach back – the person sharing information takes responsibility for ensuring that information is understood, by asking the person with whom they are communicating to share back what they have understood in their own words. The communicator may ask how the person receiving information would talk about what they have just heard. For example, how would they explain the health information to a family member. This establishes what it is that has been understood and whether the communicator needs to explain the information differently.
• Chunk and check – information is shared in short sections. The teach back approach is often used alongside chunk and check to find out what has been understood and whether the information needs to be shared differently.
• Use of simple language – healthcare conversations are often filled with jargon, so this is an encouragement to use simpler language. Where a medical term needs to be included, this should be explained.
• Use of images – images can be helpful to support understanding, but have to be used with care, as images can be understood in different ways.
• Routine offer of help – a routine offer of help avoids staff making assumptions about who needs help. With anxiety or the shock of diagnosis, someone who may appear to be highly confident and health literate may be in need of help.

As a collaboration across Scotland and England, the team working on the eLearning brought together health libraries leads in the two nations and public health specialists in England. This multidisciplinary collaboration ensured that the eLearning programme met the needs of the breadth of practitioners across public health as well as being a resource to be shared by health librarians working with colleagues both in healthcare and library staff in other sectors.

The eLearning was funded by the public health team at Health Education England, with inputs on the content from all participants. The team worked both by email and, pre‐pandemic, met in Manchester with the development agency. The aim from the outset was to keep the resource sufficiently succinct that busy health professionals would complete it, so no more than 35 min, and provide a tool that people could come back to for a refresher on techniques. The closing case study was set in a public library, to encourage use of health literacy techniques in community settings. To support application of learning, users of the tool generated a personalised action plan to apply the techniques they had learned and discuss the implications with colleagues (Health Education England,  2020 ; NHS Education for Scotland,  2020 ).

Whilst the 35‐min eLearning provides a good insight into techniques, it was designed to be supplemented by training to equip NHS librarians and public health staff to cascade more specific training. In both nations, use of the health literacy eLearning formed part of a blended learning approach.

SCOTLAND CASE STUDY

In Scotland, the eLearning module is hosted on Turas Learn, Scotland's national learning management system, therefore it is available to all health and social care staff (NHS Education for Scotland,  2020 ). As a content owner, NHS Education for Scotland can view a report of use and any comments left by learners.

Examples of comments left by learners are:

• It's an eye opener, very detailed, will recommend it
• I wasn't very sure what the course would actually be about, but I feel I have come away with communication skills that will help in other areas not just heath literacy
• It is very simple to follow and identify small changes I can make to help others
• Lovely practical and helpful resource. The new scroll down format was different. Enjoyed the videos and pictures.

The Knowledge Services Team in NHS Education for Scotland promote webinars on Turas Learn on the same page as the eLearning module. In general, a prerequisite for attending a webinar is the completion of the module. This provides learners with a blended approach to further explore how they can use the learning in practice.

The webinars last for 1 h and are delivered using Microsoft Teams. The aim is to encourage participants to share experiences or ideas of implementing the learning in their practice. At the start of the pandemic these webinars were promoted to support remote consultations. This was popular with over 253 people attending webinars in 2020–2021 and 220 attendees in 2021–2022.

Each webinar begins with a review of the tools and techniques and provides additional information on the impact of poor health literacy and therefore why it is important. The section on using plain English and avoiding jargon prompts discussions on letters and information leaflets sent to patients. Many participants leave the webinar pledging to review the letters they send out to patients.

The health literacy webinars are tailored to the audience and promoted in a variety of ways: as part of annual curriculum for professions, including pharmacists and General Practice Nurses; for team‐based learning, including dieticians; and general multidisciplinary sessions.

The Knowledge Services Team at NHS Education for Scotland ensures that the webinars are interactive, using quizzes, polls and ‘Chat, Hold, Send’ technique to encourage everyone to input their ideas.

The team shared materials with Health Improvement teams and others with responsibility for health literacy in the Scottish Health Boards to spread the learning more widely. The NHS Scotland librarians received training to deliver health literacy skills in the past and many provide in person sessions locally in their Health Boards.

Social care staff in Scotland are encouraged to complete Open Badges hosted on the Scottish Social Services Council website. The Open Badges are a digital record of achievements and skills. Learners must submit a reflection or result of an activity following the completion of the learning. The team in NHS Education for Scotland developed two badges to promote health literacy: level 1 covers awareness of the ‘Teachback’ tool; and level 2 is awarded on completion of the eLearning module. Through previous in‐person workshops, the team had already established interest in the use of health literacy tools and techniques to support communication in care settings and the Open Badges made learning available to a wider audience. Seventy badges were awarded in 2020–2021 and 32 in 2021–2022.

In Scotland, library and knowledge services use the ‘Knowledge into Action’ cycle as a framework promote their services and health literacy is a key component of the ‘Share’ activity (Davies et al.,  2017 ). This integrates health literacy into ongoing activity. The comparison between activity in Scotland and England is shown in Figure ​ Figure1 1 .

Number of learners using and completing the health literacy eLearning programme in Scotland and England

ENGLAND CASE STUDY

At Health Education England, the public health team and the national NHS knowledge and libraries services team worked together to develop a set of interventions to cascade health literacy training, focussing respectively on the public health workforce and on NHS staff and the public. The health literacy eLearning was integrated into the wider range of training materials, from ‘train‐the‐trainer’ to 1‐h and 15‐min sessions. The 1‐h session was accredited by the Royal Society for Public Health (See Figure ​ Figure2 2 ).

Health literacy training tools for spread and adoption in England, Ruth Carlyle and Sally James, September 2019 [Colour figure can be viewed at wileyonlinelibrary.com ]

The activity with NHS libraries was in two parts: cascading health literacy awareness and skills through NHS library staff to the NHS workforce; and working through partnerships with public libraries and community information providers to build the skills and confidence of members of the public. This formed part of the wider strategic framework for developing and raising the profile of NHS knowledge and library services (Lacey Bryant et al.,  2018 ) and increasing the role of NHS libraries in patient and public information (Carlyle et al.,  2022 ). NHS librarians trained the NHS workforce in their organisations, in some instances developing health literacy champions in clinical teams (Naughton et al.,  2021 ). In 2020–2021, nine trainers were trained to cascade training, with 18 trainers trained in 2021–2022. Over 800 people were trained by these trainers during 2021–2022. With the COVID‐19 pandemic, content from trustworthy sources was collated alongside health literacy training to meet immediate health information needs alongside developing health literacy skills for the longer term (Carlyle & Robertson,  2021 ). This collated content was promoted to public libraries alongside health literacy resources.

Health literacy for members of the public was developed by the national NHS knowledge and libraries services team through a National Health and Digital Literacy Partnership with the Chartered Institute of Library and Information Professionals, Libraries Connected (the strategic body for public libraries) and Arts Council England (Carlyle,  2022 ). This included the cascade of health literacy training to prison librarians, as residents in prisons have particularly acute health information and health literacy needs (Robertson & Naughton,  2022 ). Alongside the training, the partnership is funding a series of local pilots to test mechanisms to increase the health literacy of the public.

NHS knowledge and library services providing training to the NHS workforce and to colleagues in community information settings share learning through an online community of practice.

For the public health workforce, largely based in local authorities, a model for scale and spread of Health Literacy Awareness Training and the Health Literate Organisation Programme was developed across the public health system, with bespoke sessions to raise awareness and understanding, and build knowledge and competency. Four sessions on Health Literacy Awareness were delivered, with 333 public health practitioners in attendance, followed by five Health Literate Organisation programme sessions with 182 practitioners in attendance. The programme guided people through the component parts of being a health literate organisation, with attendees ranging from public health practitioners in local authorities, to prison healthcare staff, hospital trusts and care home staff.

Networking across the wider health and care system is facilitated through a dedicated growing on‐line community of practice (knowledge hub) to discuss and share resources, reflections and learning (over 100 members to date). The aim is to put health literacy into the heart of both NHS and non‐NHS organisations – people, processes, policies – with the emphasis on including service users in how they are communicated with and to. Building the workforce capability and competency in knowing what health literacy is, why it is important and what they can do to improve it is vital for addressing health inequalities; from creating written material that is understandable and helps people act in support of their health, to communicating orally so that people can understand and act on the information shared.

LEARNING AND CONCLUSIONS

When developing the module, the team spent a lot of time planning and refining the concepts, working closely with the instructional designers. The positive feedback from learners demonstrates that this time was well spent. It was useful to build into the contract that individual assets would be provided as separate items for reuse in other settings, these were an animation, a video and images for promotional materials.

The discussions with the instructional designers led to the successful integration of interactions to actively engage learners. It is important to help learners relate any learning to their practice.

• At the end of each section of the module, learners are encouraged to complete an action log. This can be downloaded for future reference. To make it quick to complete, some actions are suggested but the learner can add their own.
• The final activity in the module is a video filmed in a public library. The action is paused at various points and asks the learner to input a decision on a health literacy technique, again helping to reinforce the learning.
• At the start, learners are asked to record their confidence related to health literacy and this is revisited at the end to note improvement.

Setting the video in a public library served two purposes: first, it is neutral of any health or care setting; and second, it has provided Health Education England and NHS Education for Scotland with a video to use with public and school librarians to understand how they can use the tools in their role to support communication. This has been used successfully as part of a course delivered in Scotland.

In both Scotland and England, the eLearning was placed on recognised platforms. This meant that it could be integrated into learning records. Providing eLearning in isolation, however, would not have ensured its use and would not have met the learning needs of local public health and library staff who wanted to cascade health literacy tools and techniques within their organisations or more widely. It was therefore essential to ensure that the health literacy eLearning was integrated into wider learning and development offers.

As the next stage, NHS Education for Scotland and Health Education England will review feedback to date and consult on changes needed to update the health literacy eLearning.

Carlyle, R. , Thain, A. , & James, S. (2022). Development and spread of health literacy eLearning: A partnership across Scotland and England . Health Information & Libraries Journal , 39 ( 3 ), 299–303. 10.1111/hir.12450 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

• Carlyle, R. (2022). Health and digital literacy: Addressing inequalities . Information Professional , April‐May , 33. [ Google Scholar ]
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• Carlyle, R. , & Robertson, S. (2021). Balancing long‐term health literacy skills development with immediate action to facilitate use of reliable health information on COVID‐19 in England . Journal of European Association of Health Information and Libraries , 17 ( 4 ), 12–16. 10.32384/jeahil17493 [ CrossRef ] [ Google Scholar ]
• Davies, S. , Herbert, P. , Wales, A. , Ritchie, K. , Wilson, S. , Dobie, L. , & Thain, A. (2017). Knowledge into action – supporting the implementation of evidence into practice in Scotland . Health Information and Libraries Journal , 34 ( 1 ), 74–85. 10.1111/hir.12159 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Health Education England . (2020). Health literacy eLearning . https://www.e-lfh.org.uk/programmes/healthliteracy/
• Lacey Bryant, S. , Bingham, H. , Carlyle, R. , Day, A. , Ferguson, L. , & Stewart, D. (2018). Forward view: Advancing health library and knowledge services in England . Health Information and Libraries Journal , 35 ( 1 ), 70–77. 10.1111/hir.12206 [ PubMed ] [ CrossRef ] [ Google Scholar ]
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• NHS Education for Scotland . (2020). Health literacy eLearning . https://learn.nes.nhs.scot/26672/health-literacy
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• Scottish Government . (2017). Making it easier: A national health literacy plan for Scotland, 2017‐2025 . https://www.gov.scot/publications/making‐easier‐health‐literacy‐action‐plan‐scotland‐2017‐2025/

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Making the case

Making the case for evidence-based patient information: the importance of evidence to support shared decision-making and how NHS libraries can play a key role

On behalf of Health Education England and as part of a Senior Leadership Programme, a group of health library and knowledge specialists across England worked together on a shared project exploring how evidence is used in the creation and review of information for patients.

The project titled, ‘Making the case: evidence-based patient information’ explores the real need for patients and the public to have access to high quality, reliable health information.

As individuals are being encouraged to self-manage and be partners in their care they need access to a range of resources tailored to their literacy level.

The aims of the project were:

• influence and advocate the importance of evidence for health information for patients, carers and the public in healthcare settings
• identify key learning to support others in influencing the evidence base of patient leaflets in their local NHS settings.

As health librarians, we play a key role in providing evidence for patient care as part of our service to healthcare staff.

We have skills in finding the evidence, appraising it and making it readily available in formats needed by our healthcare colleagues.

The need for patient information to be evidence based is driven by a number of strategic priorities including:

• patient experience
• self-management
• shared decision-making
• health system sustainability

The project focused on the production of patient leaflets within NHS Trusts.  These are usually written by local clinical staff for specific conditions or procedures.

We were looking at the current level of involvement by NHS KLS in the production and review of leaflets and the key stakeholders who play a role in this process.

Information was gathered from case studies of three NHS Trusts, through telephone interviews with NHS librarians delivering and supporting the production of patient information and a literature search on good quality patient information.

The findings of the work are outlined in the report, along with other useful resources highlighting:

• importance of KLS role in supporting evidence-based information
• key policy drivers
• influencing key stakeholders
• challenges of clinical language.

The report makes a number of recommendations including making patient information a part of our ‘offer’ as a service forming part of KLS existing role as champions of evidence-based practice within their organisations.

Key themes from the case studies and learning from networks were the significance of influencing skills and the importance of demonstrating the impact of this work and sharing best practice.

• Making the case; evidence-based patient information.’  A report of the findings
• Learning log
• Stakeholder map

Contact the Knowledge for Healthcare team on  [email protected]  for any of the resources in an accessible format.

There are other examples of best practice, highlighted to demonstrate the positive impact NHS libraries have experienced. It is another aspect of the work many NHS libraries are already engaged in as part of patient care.

If you have any queries about the project please contact a member of the project team:

Emily Hopkins, Health Education England Deena Maggs, The King’s Fund Victoria Treadway, NHS RightCare Vicki Veness, Royal Surrey County Hospital NHS Foundation Trust Jacqui Watkeys, Walsall Healthcare NHS Trust Suzanne Wilson, Northumberland, Tyne and Wear NHS Foundation Trust

Page last reviewed: 15 June 2021

• Open access
• Published: 21 September 2023

Student nurses as a future general practice nursing workforce. Implementing collaborative learning in practice: implications for placement learning and patient access. A mixed methods study

• Graham R Williamson 1 ,
• Adele Kane 1 ,
• Sharon Evans 2 , 3 ,
• Lisa Attrill 2 ,
• Fiona Cook 2 , 4 &
• Katy Nash 1  

BMC Nursing volume  22 , Article number:  326 ( 2023 ) Cite this article

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There is a global shortage of nurses, with particularly acute shortfall in General Practice Nursing in the United Kingdom estimated at as high as 50% vacancy rate by 2031 by some sources. There has previously been reluctance for General Practices to host student nurses on placement, but it has become imperative to increase placement capacity if practices are to be able to recruit a future workforce. Collaborative Learning in Practice is a means of organising placement learning for student nurses using a coaching model, that allows for leadership development, peer support and earlier engagement in patient care, and increases placement capacity.

This was a mixed methods study using qualitative data from focus groups to evaluate the implementation of Collaborative Learning in Practice, and routinely collected audit data on numbers of clinic appointments to investigate the potential impact an increased capacity of student nurses might have on patient access to services. The aims of this study were: to implement and evaluate Collaborative Learning in Practice in General Practice Nursing settings; to explore issues of interprofessional learning; to explore patient access to services related to increased student nurse capacity.

Our qualitative data indicated the following themes as important to students and staff: Peer Support; Interprofessional Learning; and the Importance of ‘own clinics’ for students to see patients. The audit data indicated that having students leading their own clinics increased the clinic numbers available by approximately 20% compared to when students were not in placement.

Conclusions

This study shows that student nurses increased clinic capacity and improved access for patients. Students valued their placement, felt that they were more ‘part of the team’ than in other placements and consequently had a greater sense of belonging. This was multifaceted, coming in part from the welcoming practice staff, in part from the opportunities for peer support engendered by the collaborative learning in practice model, and in part from the interprofessional learning opportunities available. General Practice Nursing placements for students are important for future workforce recruitment and can help meet Quality and Outcomes Framework targets for General Practices.

Peer Review reports

Collaborative Learning in Practice (CLIP) is a method of organising practice learning for student nurses that has become popular in the United Kingdom (UK) in recent years [ 1 ]. It originated in Amsterdam with initial UK development by the team at University of East Anglia [ 2 , 3 ] and support and facilitation from Health Education England [ 4 ] (HEE). HEE exists to provide leadership in education and training for the healthcare workforce in England. CLIP combines several previously novel features including students taking responsibility for patient care at an early stage of their programmes, under supervision of registered nurses (RNs, who in the UK are at least educated to Bachelor’s degree level). CLIP uses a coaching model as opposed to a mentoring model, in which the coach takes a more facilitative, structured and questioning approach to student supervision and assessment when compared to the more individualised approach of the mentor [ 3 ]. Students receive training prior to starting placement about how the CLIP model works. Once in placement, students typically work in small teams, often including third year students taking a leadership role at the head of a group of students including first, second and third years, as well as Trainee Nursing Associates who undertake a two year foundation degree programme leading to NMC registration, and unregistered nursing staff such as Health Care Assistants (HCAs) [ 5 ]. CLIP was initially implemented in hospital settings, where wards were required to increase placement capacity [ 2 ], and was found to have a positive impact on patient safety [ 6 ]. Latterly, CLIP has also been trialled in community settings [ 7 ], children’s mental health care [ 8 ], maternity care [ 9 ] and physiotherapy placements [ 10 ] in the UK. There seems to be no international equivalent term to CLIP, but the concept of Dedicated Education Unit (DEU) appears to offer similar potential for collaborative Interprofessional Learning (IPL) facilitated by clinical coaches [ 11 ]. Internationally, projects report success with a collaborative approach to IPL for community care in Singapore [ 12 ] and with dental students in Canada [ 13 ], and it is also clear that general practice is a fertile ground for IPL [ 14 , 15 ].

A common international thread through healthcare and nursing literature is that of staff shortages [ 16 ] [ 17 ]. As well as global shortages, the World Health Organisation’s (WHO) State of the World’s Nursing report [ 18 ] also calls for practitioners capable of working in community settings at the point of registration. In the UK, it is estimated that there was a shortage of 46,828 nurses in June 2022, meaning that in some regions approximately 20% of nursing posts are unfilled. Failure to invest in General Practice Nursing (GPN) recruitment and training is projected to see UK-wide shortfall of around 6400 nurses, more than one in four posts, by 2030-31. More pessimistic modelling indicates this could be as high as one in two vacancies unfilled in that time frame [ 19 ].

A central drive in the popularity of CLIP is that it increases placement capacity, with clinical areas in our previous studies supporting approximately three or four times the numbers of students in CLIP placements than at other times [ 2 , 6 ]. Elsewhere it is noted that CLIP functions using a coaching approach to placement learning, as distinct from the mentoring approach in evidence when there was only one student alone in placement [ 3 ]. It is argued from qualitative findings, that introducing student nurses to direct responsibility for patient care and leadership from their third year ought to lead to better preparedness for registrant practice [ 1 , 3 ], but this has yet to be more formally evaluated with new graduates.

Access to GPN placement experience for students has traditionally been problematic when practices have not seen a direct benefit or financial incentive to host them [ 20 ]. The National Health Service England (NHSE) Sonnet Report on the strategic value of GPNs asserts that education and training are vital to the future GPN workforce, and that student nurses bring particular benefits to practices [ 21 ]. It is axiomatic that student nurses are the future workforce of any organisation, and that recruitment needs to be strengthened [ 22 ]. This is represented in the NHSE GPN 10 point plan, designed to increase recruitment and retention of GPNs [ 23 ] and in our region much work has been done with GPs, GPNs and practice managers to enable students’ access to placements within local Primary Care Networks (PCNs). When this study began, PCNs were groups of practices designed to develop and deliver existing primary care services to patients, involving proactive and coordinated multidisciplinary care, and synergies commensurate with economies of scale [ 24 ]. In the UK, GPs are in a unique position as part of the NHS, existing simultaneously as independent contractors. GPs are incentivised to deliver services benchmarked to a national standard, through a national GP contract [ 25 ], which is assured through the Quality and Outcomes Framework [ 26 ], and this includes detailed standards relating to patient access and standards of expected care.

Research has indicated that student nurses do not necessarily see GPN as an appropriate job destination on graduation, but also that exposure to GPN can have a positive influence on their perceptions of it as a first destination [ 27 , 28 , 29 ]. As a result, Health Education England (HEE) has developed a Workforce Plan [ 30 ], which specifically calls for a greater visibility for GPN in nurse education, increases in the numbers of student nurses accessing GPN placements, and proposing GPN roles as a first destination, as well as appropriate education pathways for careers after registration.

Having outlined the international, national and local context of shortages of nurses in GPN settings, pressures to recruit nurses and make GPN an attractive first job destination, we argue that it is appropriate to implement and evaluate CLIP in GPN placements in our regions, and this paper reports a project undertaken to address those issues.

The aims of this study were threefold.

To implement and develop CLIP in GPN settings and evaluate that implementation.

To explore issues of interprofessional learning in GPN settings.

To explore issues of patient access to services relating to CLIP and increased student nurse capacity in GP practices.

Design and setting of the study

We placed 31 student nurses into six GP practices in three PCNs; this being 15 students in Winter 2021 and 16 students in Summer 2022. Previously (pre-CLIP) one or two of those practices might have had one or two students in total. This was a mixed methods study using qualitative data from focus groups to evaluate the implementation of CLIP, and routinely collected audit data (meaning anonymous monitoring data that would have been collected out-with this research project) on numbers of clinic appointments to investigate the potential impact that an increased capacity of student nurses might have on patient access to services. We used a mixed methods approach because it was an appropriate study design to access the beliefs of students and staff across several locations and times in our qualitative Microsoft Teams focus groups (FGs), coupled with quantitative data about patient access to GPNs. This study took place in GP surgeries in three counties in the Southwest of England. Students and staff all received training about CLIP and their roles, including supervisory training for staff. One important characteristic regarding these students’ placements is that students received training in venepuncture immediately prior to their placements, meaning that they could take blood from patients in phlebotomy clinics. After a period of familiarisation, students were also able to lead their ‘own clinics’ under indirect supervision (called ‘CLIP clinics’) from an early stage in the placement, honing their skills through the ethos of coaching within CLIP placements. There was a weekly Friday meeting where students and supervisors met to debrief, reflect on their learning, and set learning goals for the following week. How this was organised varied between practices, but it typically meant that student nurses would be seeing patients independently, with their student status known and available for patients, so that they could undertake simple procedures like blood tests, hypertension checks and uncomplicated dressings that otherwise would have been undertaken by other staff, registered or unregistered. Direct or indirect supervision from Registered GPNs was always available, however these GPNs were not routinely in the same room as the students, although they could be present immediately if required. Opportunities for discussion and debriefing of students were available through the working day, as well as at the Friday meetings.

Data collection and analysis

Data collection took place during two periods: January 2021 and July 2022. These were periods when student nurses were on placements in the GP practices.

For Aims 1 and 2, we conducted separate Microsoft Teams FGs with students and GPN staff to explore their experiences of CLIP working and interprofessional learning. Focus groups are semi-structured discussions with groups of people who explore issues of joint interest, and rely on interaction between group members to share experiences as part of offering understanding of the topics in question, as group interaction encourages respondents to explore individual and shared perspectives [ 31 ]. MS Teams on-line platform was enabled to generate transcripts. These transcripts were anonymised by omitting any identifying features such as names and locations and the recordings locked so that they are not accessible except to the lead researcher. The qualitative data analysis involved the following steps: familiarisation and construction of initial themes or concepts; indexing, labelling, and tagging the data to construct links between categories by sorting them according to levels of generality and employing a hierarchical structure so that themes and subthemes start to emerge; followed lastly by descriptive analysis, where the themes are refined, finalised and agreed between the research team [ 32 , 33 ]. As a step to reduce potential bias and enhance rigour, this data analysis process was undertaken independently by two researchers, who then met to discuss and agree the final themes and subthemes based on inferential reasoning [ 34 ].

For Aim 3 regarding issues of patient access to services, we used routinely collected audit data, anonymised at source from one GP practice as a case study, to quantify the difference that having student nurses in CLIP made in terms of patient access to appropriate appointments.

Ethical issues

The project had approval from the Faculty of Health Research Ethics Committee and permission to proceed via the UK Health Research Authority (HRA) Integrated Research Application System (IRAS). This was extended from an earlier qualitative study to include all the data collection methods used in this study. IRAS project ID: 259485. All potential participants were contacted by professional email addresses and given the Participants’ Information Sheet which included details of the study, and a consent form. Students and staff were given the usual guarantees for confidentiality, anonymity and right to withdraw, and were asked to sign written consent to take part in the MS Teams FGs. Study information and consent to participate was re-iterated prior to the FGs, and the initial minutes of the recordings document that all those who participated understood and consented to the study. No participants subsequently asked to withdraw data. This study was funded by Health Education England with an ad hoc grant.

Characteristics of participants

The student nurses were all female except for one male. All the GP placement staff were registered nurses with experience in student support as well as in GPN. All staff were female. We conducted two FGs with student nurses, one in January 2022 and another in July 2022. Of 31 students invited, seven attended in Jan 2022 and another five different students attended in July 2022. With regards to staff data collection, we conducted two FGs with placement staff, one in January 2022 and another in July 2022. Of 42 GPNs invited, five attended in Jan 22 and a further six attended in July (one staff member attended both groups).

Qualitative findings

Table  1 summarises the final themes and subthemes from the qualitative data analysis. Indicative quotes are included in the following analysis. These are coded so that anonymity is maintained, referring to the status of the respondent and which FG they took part in, so for example the suffix ‘Staff FG 1 Participant 2’ indicates that the quote comes from the second staff member speaking who was taking part in the first FG.

Theme 1: peer support

This theme was central to the discourse in staff and student focus groups in both time periods. It is clear from our findings that these students had spent most of their previous placement experiences working in environments where they were the only student or, if there were other students, they did not engage much with them. Students had felt inhibited in their professional relationships with RNs and other staff, and valued the opportunity that this GPN CLIP placement offered them to interact with other students, share their experiences and work collaboratively, whilst knowing that there was appropriate supervision available close by. The subthemes that emerged in this theme were Psychological support; Helped with learning and Leadership for third years. Regarding Psychological support, the following quotes are indicative of how students and staff perceived the benefits of CLIP with its increased capacity:

It’s nice when you’re working alongside other students, and you know that you’ve got that Friday where you’re all together in the same place and you just kind of offload to each other about the week. And it’s like a way of having a massive, deep group brief as a group, isn’t it? Yeah. Because we’re all in the same position. (Student FG 2 Participant 2).

This was echoed by staff:

They also encourage them to support each other a lot more, so they formed that sort of close relationships. So, if there was a problem on a shift or even outside of a shift… they really did communicate well between themselves. (Staff FG 1 Participant 1).

It was clear that students also valued being able to learn from each other and that being together facilitated that, in line with a second subtheme of ‘Helped with learning’ shared by staff and students across both FGs:

I felt learning from other students was brilliant. I think it boosted my confidence massively. (Student FG 1 Participant 2).

And this was reflected in the staff data:

I think that the way they do CLIP now and the way they collaborate together [is much better]. I see them learning much more than I used to…having them to bounce off each other. I think it teaches them a little bit more, to be fair. (Staff FG 2 Participant 1).

One further subtheme that emerged from the data concerned the leadership roles that third year students were able to perform with more junior students:

It was good for me as well as a third year… when I first started on the GP surgery, I didn’t really know what I was doing. And then having [junior students] coming to us and asking us questions about what we thought, that boosted my confidence, “no, actually, I do know what I’m talking about, and I’m ready to maybe be a [registered] nurse”. (Student FG 1 Participant 4).

And this was echoed in the staff data:

If a second year is struggling with something that the third will give them encouragement, you know, that’s quite a benefit…it depends on their background but they all will support each other. (Staff FG 2 Participant 2).

Theme 2: interprofessional learning

Within the IPL theme, the first sub theme concerned the Breadth of Experiences that were on offer in the GP placement when students were able to link up and work with a wide range of professionals, and in different ways than might be possible in an in-hospital placement or another community setting. For example, students listed themselves as spending time with and learning from: GPs, Advanced Nurse Practitioners, Dieticians, Community Midwives, District Nurses, Physiotherapist, Podiatrists, Specialist Elder Care Nurses, Pharmacists, Well-being Coach, as well as un-registered healthcare staff. Students planned these liaisons themselves, and these were seen as good learning experiences by staff:

[Students] having access to the clinics and PCN staff… they can plan their own week without us having that responsibility of making sure they’ve actually got something allocated every day. If they haven’t got a CLIP clinic on, they have taken responsibility for their own allocation, their own learning objectives. (Staff FG 1 Participant 2).

And students noted how different their participation in learning was in the GP setting compared to hospital placements:

As soon as you go into hospital [placement], you can’t really do anything. So, you’re just sort of watching it. (Student FG 2 Participant 5).

In all cases this IPL was facilitated by students’ exposure to ‘Multi-Disciplinary Case Management’. The staff were clearer how this operated and what nursing involvement could be:

We have an 11:00 o’clock meeting, which, anybody [any healthcare professional or student] can come to … we can talk about patients or talk about the home visit that somebody might doing… it’s good for all sorts of things, but it’s good to hold the team together and it does help with the students. They [students] just bring another dimension to it and other you know, it’s another voice. (Staff FG 1 Participant 4).

Students detailed how they were involved in IPL as they were given project work to do, and this student shows how students collaborated and learned from the experience of investigating patient journeys, eventually meeting one patient:

The first week or second week we were given a couple of case studies to look at and then we actually met one of them [patient]… We could ask questions and different things in relation to how he felt he was supported by the surgery and other community people [healthcare professionals]. We also had another patient…and we had to sort of determine how he was diagnosed; it was over three or four years. And it’s amazing that he’s still alive today to be honest. But yeah, I met him in the GP surgery. I think the week before I left. (Student FG 1 Participant 1).

The third subtheme relating to IPL and the students’ experience of working in GPN CLIP placements was how they felt a greater ‘Sense of belonging’ in the teams in which they worked.

This student makes it clear how she felt more valued in her GP placement, and this type of dialogue was echoed by almost every student in this study:

The staff treat you a lot differently in primary care than in acute. We like the staff, but that the GP surgery and [name] are amazing. They’ve all been so lovely, including the doctors as well. And I think that makes a massive impact to your experience. (Student FG 2 Participant 1).

This quote from a staff member illustrates how the students were valued and how staff worked to make them feel welcome and that they belonged:

[The GPs] love it to be fair, one of our partner GPs, he can’t wait to call in a student [nurse] and teach them about ECGs… The GP and the other clinicians, they like sharing what they know and encouraging them. Yeah, they really enjoy it. And the reception team do as well. They like having young people around because most of us are ‘getting on a bit’ now. (Staff FG 2 Participant 3).

Theme 3: importance of ‘own clinics’

Throughout the dialogue from staff and students, the issue of ‘how’ students worked in the GPN placements was mentioned. This was in their ‘own clinics’ (called ‘CLIP clinics’) and from that concept flows several other factors and benefits that accrued to staff and patients and impacted on the way in which staff worked with students. This had implications for students’ confidence as independent practitioners, as well as having an impact on their relationship to GPN as a potential job destination, and for improving patients’ access to certain services which students were able to deliver. In this overarching theme, staff and students in their respective FGs discussed ‘Enhanced responsibility’, but there was a distinct dichotomy between staff and students in other subthemes, such that it is justified to report staff and student data separately for the only instance in this paper. Staff discussed how students working in their ‘Own clinics’ meant they were using supervision at a distance in a coaching approach, but staff did not discuss any impact that the placement may have had on students’ job choices on qualification. Students discussed how this GPN placement has fostered a desire to work in GPN, but they did not discuss coaching as a placement learning strategy.

The first subtheme ‘Enhanced responsibilities’ relates to how students and staff perceived that GPN placements for these students had offered them enhanced opportunities to take responsibility for patient care that often were not available from in-hospital placements, largely because they were seeing patients in their ‘own clinics’, as well as because they were undertaking a range of activities with patients that are elements of the GPN role, many of which are listed below:

We found that [having our own clinics] an amazing experience…we did lots of things. And as the weeks went on, we added different stuff to our clinics, so it started out with… basic blood pressure, hypertension reviews, diabetic reviews and in the end, we were doing maybe more complex dressings assessments, ECGs, flu vaccines. We were doing a lot. We found it really good and nice to learn in our own space. (Student FG 1 Participant 2).

This was echoed in the staff perceptions:

I think for all the practice nurses as well, we were quite concerned that [students] would be running a clinic, seeing their own patients. We wouldn’t be in the room; it’s just something about having control, isn’t it? Now we find it brilliant, because we spend the first couple of weeks training them up and working with them so that we are familiar a bit more with their capabilities. (Staff FG 1 Participant 4).

It was clear from staff data that they were using a ‘coaching’ approach in which students were facilitated to be at the centre of care delivery within their competencies, and that the students being independent in their ‘own clinics’ was central to that, as this exchange shows:

If you’ve got multiple students in general practice, it has to be a coaching approach because you don’t have the capacity to be able to mentor, you can’t just have one person on a 1 to one because we don’t have the capacity for that. (Staff FG 2 Participant 2). I agree with that. Yeah. You it is. It’s naturally a coaching thing. Our students sit in with us for the first couple of weeks before they have their own clinics. (Staff FG 2 Participant 3)

Students discussed how this placement and exposure to GPN had helped them to identify its ‘Validity as a job destination’, which was their second subtheme. This dialogue took place in focus group 1:

You know, I never considered general practice nursing. Yeah, after the after [this] placement it is an option that I would consider now, definitely. A lot of students they don’t consider that when they graduate. (Student FG 1 Participant 6)

Having reported qualitative data regarding Aims 1 and 2, we will now report results for Aim 3 relating to patient access and audit data results.

Patient access audit data results

Regarding Aim 3: in one PCN that included two practices in one South West County, between November and December 2021, student nurses in this CLIP placement ran an additional 200 clinic appointments, so the total number of clinic appointments rose from 1060 to 1260, an increase of 20%. Students in these clinics saw patients for blood tests, long-term condition monitoring reviews, observations including hypertension reviews, simple dressings, ECGs. (Students did not review medications in their clinics). Also, 65 additional COVID vaccinations took place when student nurses were available. Anecdotal evidence from the PCN data manager indicates that having student nurses in CLIP meant that some patients were able to access same day appointments for blood tests when otherwise there could be a two week wait. This was supported in the FG data analysis.

Data synthesis regarding patient access and skill mix

Although not well developed enough to stand as a coherent theme or subtheme of the qualitative data, staff and students did allude to issues of patient access and skill mix in the focus group discussions, in ways that support our analysis of the increased clinical appointment opportunities detailed above. As this study took place at the end of COVID-19 pandemic in the UK, when physical access to GP services had been restricted for many months (even though it was available in ways other than direct contact), this was an issue being discussed in the media in the UK. Staff discussed how students could see patients in person and spend much more time with them and outlined how student nurses taking their ‘own clinics’ could free up other professionals to do other things. Students did not go into detail about this but were clearly able to take on activities such as venepuncture for the patients attending ‘their’ clinics that might otherwise have been the preserve of HCAs or phlebotomists. The extent to which student nurses had an impact on the skill mix in the practices in which they were placed is also unclear. However, it was clear from the audit data that there was an increase in capacity of clinic appointments available.

This paper has detailed our mixed methods study concerning the implementation of a CLIP placement learning approach in GPN settings. Our findings indicate that the project was successful in increasing capacity, and that students valued their time in general practice, believing that it enhanced their learning by enabling peer support, interprofessional working and beneficial responsibility when practicing in their ‘own clinics’. It is also clear that these findings are despite the impact of COVID and because staff were able to facilitate students’ learning effectively. Although running their ‘own clinics’ would appear to individualise students’ practice, when opportunities were facilitated or available for sharing and group working (in Friday CLIP sessions and MDT meetings), students took these opportunities to work together and support each other. Peer support has been a consistent theme in our own research [ 2 , 7 ] and that of others [ 3 , 9 ] as a key benefit of CLIP. Indeed, it is noted as being central to effective clinical learning in international literature [ 35 , 36 ] with particularly strong benefits for third year student nurses because they can rehearse leadership roles in the small teams of students in which they learn [ 35 ]. Going through formative professional experiences with other people at a similar stage in their development is powerful in fostering effective learning, and can contribute to individual students’ decisions about whether they stay on their programmes of study, graduate and enter the workforce [ 37 ]. In our study this is coupled with a greater sense of belonging, which was a product of the reportedly more welcoming cultures in these GP surgeries in which the students were placed. Belongingness is a driver in human motivation that influences health and well-being, and when successful, the attachment an individual student nurse experiences to a particular placement is powerful in fostering learning and interpersonal relationships. In our study, the warmth that students experienced from placement staff helped them to perceive themselves as being integral to service provision [ 38 ]. Conversely, research has indicated that placement incivility from staff mitigates against a sense of belonging in students [ 39 ], and that when students’ sense of belonging is low, that is a predictor of stress in placement [ 40 , 41 ] which in turn is a factor in their decision to leave their programmes of study [ 42 , 43 ]. Based on our study findings, we believe that staff in these GP practices worked hard to make students feel part of the team and engender a sense of belonging, and that this personal support from placement staff was beneficial to student’s learning and overall satisfaction.

It must be noted that our students and staff did not report significant disadvantages or negative issues related to their placement experiences, certainly nothing sufficient to constitute a theme or subtheme in our data analysis. We attribute this to the fact that placement staff, students and university personnel have considerable experience of implementing CLIP and facilitating placement learning using it, as CLIP has been used previously in our region. We have evaluated these developments in our programme of HEE-funded research and noted more critical dialogues in those research publications [ 2 , 6 , 7 ].

It also appears from our findings that there was a clear recognition of the potential for GPN placements to foster interprofessional learning, and that students were exposed to this on a regular basis. Communication, leadership and training are essential for successful IPL [ 15 ], which has long been identified as a feature of community practice settings in the international literature, is discussed as an essential component in multi-disciplinary working [ 44 ], and has been linked to beneficial outcomes for patients including wound healing [ 45 ], medicines optimisation [ 46 ], holistic care and identification of social determinants of health [ 47 ], and in managing multimorbidity [ 48 ]. In our study, student nurses valued opportunities to learn from a myriad of healthcare professionals and reported that they were welcome to contribute to formal and informal IPL experiences. IPL has been shown to benefit critical thinking, teamworking and cooperation amongst student nurses and other neophyte professionals [ 49 ], and so we argue that our GPN settings functioned as exemplars of how interprofessional care can be achieved because they fostered a team vision and shared goals, and sense of belonging to the team [ 50 ].

Lastly, our study uncovered evidence that increasing the capacity of student nurses across a PCN could improve patients’ access to the services that they were able to deliver (under supervision). These services included blood tests, patient monitoring reviews, simple dressings, observations and ECGs. In the one PCN from which we received data, an additional 20% clinic appointments were created, and an additional 65 COVID vaccinations took place when student nurses were available. We were not able to formally evaluate this across the region, but having student nurses made a difference to patient access, may alter the skill mix so that RNs and HCAs can do other things, and this can help meet the Quality Outcomes Framework (QOF) and the GP contract [ 25 , 26 ]. For example, the QOF guidance for 2022/23 [ 26 ] contains detailed requirements to optimise access to general practice and includes activities including continuous quality improvement and network participation to improve access, which would be helped by GP practices accepting greater numbers of placements for student nurses in CLIP configurations. Specific disease conditions and patient groups are listed in the outcomes [ 26 ]: regarding obesity and weight management, the concomitant multimorbidity that obesity generates could benefit from student nurses’ involvement in taking observations, advice and referrals as part of their own ‘CLIP clinics’; and the greater number of clinic appointments available would improve access for these patients. We argue therefore that our student nurses help to improve access for patients and that this is in line with the GP contract and QOF requirements [ 25 , 26 ]. This shows tangible benefits for GPs, GPN leaders and practice managers to develop placements for nursing students and to increase their capacity. Advice and guidance are available on how to make such placements effective [ 51 ]. Support from Registered GPNs as a profession for the expansion of placement provision for student nurses and consensus that GPN recruitment depends on expanding placements [ 21 ] and central direction from NHS about capacity development [ 23 ].

Limitations

Although this study had a relatively large sample size and geographic distribution, it must be acknowledged that it took place in one UK region, with students from one University School of Nursing and Midwifery, and with GPN staff, most of whom were (broadly speaking) active in their engagement with CLIP and supportive of what the project was trying to achieve. This is a feature of much qualitative research; however, we believe that we have taken the necessary steps to ensure transparency and rigour in relation to the data collection and analysis processes we have undertaken.

In relation to the quantitative audit data, we acknowledge that this is from one PCN only. Efforts were made to obtain similar anonymous audit data from across the region, but this was unsuccessful. We therefore make no claims that the magnitude of the improved access is generalisable, however we do believe that additional students running their own CLIP clinics (under supervision) would make a difference, with patients able to access some services quicker than if the students were not there.

In the context of international shortages of nurses, and of UK national shortages of GP practice nurses potentially reaching a ‘worst-case’ scenario of 50% vacancies unfilled by 2031 [ 19 ], it is imperative to attract more registered nurses to this occupational group. Students in our study discussed how their GPN experiences had made them see it as a potential job destination, partly because of the better sense of belonging that they encountered, but also because of the range of activities they were able to undertake and the relative autonomy they enjoyed. Even though we are pleased to report that three of the 31 students in this study have subsequently secured their first registered nurse jobs in GPN, we have not formally quantified an impact on first job destination in this study but, like previous studies [ 28 , 52 ], our findings indicate that a placement could change student nurses’ attitudes towards community working and encourage them to apply there as a first job destination on graduation. We recommend further research in this area with students approaching graduation, and those newly qualified for less than a year, to evaluate how best this can be achieved.

Our study also shows that a strong element in the placement was IPL, and so we argue that GPN placements might be considered as an exemplar of IPL in healthcare education [ 12 ], and that this could have substantial benefits to patients in the future, although again we have not quantified this. We recommend further research with a focus on IPL and GP surgeries, and the impact that using CLIP as a model for placing all student healthcare professionals might have.

Lastly, we demonstrated that having an increased capacity of student nurses in a placement could improve access to services as students were able to lead their own clinics (under supervision). This is likely to have benefits to patients’ access, but we have not collected data from patients about their experiences with students, and we therefore recommended further research to illuminate what patients think about seeing students. ‘Access’ is a problematic area in the UK currently, and any improvements would be welcome, particularly if they reinforce care given by PCNs, support recognition via the QOF and GP contract [ 25 , 26 ], and enhance the standing of general practice [ 23 ].

Data Availability

The datasets analysed during the study are available from the corresponding author on request. Data are not public for reasons of confidentiality.

Change history

27 october 2023.

The Reviewer Report on 13 Aug 2023 has been removed.

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Acknowledgements

We would like to thank all the staff and students who took part in the study for their time and considered comments. We would particularly like to thank Alison Williams, Advanced Nurse Practitioner and Nurse Manager, Redgate Surgery, Somerset, UK, who operated on the project steering group as well as supporting the implementation of CLIP. We would also like to thank Dr Pamela Rae, Research Fellow, University of Plymouth School of Nursing and Midwifery, who served on the steering group and undertook one focus group before she moved to different project work. We would like to thank Jane Bunce, Quality Manager at Health Education England for continuing support for CLIP implementation and research.

This study was funded by an ad hoc grant from Health Education England.

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Graham R Williamson, Adele Kane & Katy Nash

School of Nursing and Midwifery, University of Plymouth Cornwall Campus, TR1 3HD, Truro, UK

Sharon Evans, Lisa Attrill & Fiona Cook

Strategic Lead for General Practice Nursing, Cornwall & Isles of Scilly Integrated Care Board, Plymouth, UK

Sharon Evans

Practice Nurse and Nurse Prescriber, Okehampton Medical Centre, Devon, UK

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Contributions

Study design: GW, AK, FC, LA, SE, KN. Data collection: GW. Data analysis: GW and AK. Drafting and revising of the manuscript: GW, AK, FC, LA, SE. Approval of the final version: All authors read and approved the final manuscript.

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Correspondence to Graham R Williamson .

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Ethics approval and consent to participate.

All individuals have provided informed consent before the data collection. All participants were over 18 years of age. Participating students and staff were assured that the information provided would remain anonymous. Approval for the study was obtained from the Faculty of Health Staff Ethics Committee of the University of Plymouth, and from HRA IRAS project ID: 259485. All methods were performed in accordance with the relevant guidelines and regulations.

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Not applicable.

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The authors declare that this research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest. We acknowledge that all parties have to some extent been involved in the implementation and evaluation of CLIP in their work roles. Graham Williamson is an Editorial Board Member for BMC Nursing.

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Williamson, G.R., Kane, A., Evans, S. et al. Student nurses as a future general practice nursing workforce. Implementing collaborative learning in practice: implications for placement learning and patient access. A mixed methods study. BMC Nurs 22 , 326 (2023). https://doi.org/10.1186/s12912-023-01501-8

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• Allied health professions
• Return to Practice: allied health professionals, healthcare scientists and practising psychologists

Case studies

We have a number of written case studies from across the professions. Access them using the link or see below for a sample. 

Our most recent  case study comes from Lolly Trehern who is an Operating Department Practitioner. 

Lolly was working as a Band 5 Operating Department Practitioner (ODP) before leaving to go on maternity leave and then be at home with her child. 

In this case study, Claire Ridgell, who is an Occupational Therapist , tells you about her return to practice.

Claire has returned back onto the HCPC register after starting to work as an OT again.

Dr Katherine Peter is a Clinical Psychologist and shares with you her journey in returning to practice.

Dr Katherine Peter qualified in 2007 and after taking a break, returned to practice in 2021.

In this case study, Beverley Matharu shares her current return to practice in the NHS.

Beverley is a Biomedical Scientist and qualified in 1984 but left the NHS in 1998. Here she shares her journey in returning to practice.

We also have a number of handy postcards, which you can view by clicking here.

​Case study excerpts

Sumeet, returning physiotherapist.

At the beginning of 2022, HEE supported a number of returners on a leadership programme. Sumeet is one such returner. 

Sumeet is a Physiotherapist, he qualified in 2016 and worked as a rotational physiotherapist before leaving to work in a local authority public health team. Currently he works as a youth worker specifically working with young adults who have disabilities, is in the final stages of his return to practice journey and has shared his experiences on the Leadership Programme with us.

Why undertake the Leadership Programme

“I wanted to complete a leadership programme as I had personal goals around developing my leadership skills and wanted to be able to integrate leadership skills when I return to work as a physiotherapist. I also wanted to see a project through from inception to delivery as this was important to me.”

Sumeet’s leadership objectives

“My main leadership objectives were to develop an understanding of how national programmes can influence local service delivery as well as developing skills around effective teamworking with people I have only met virtually.”

Projects Sumeet has been involved

“I have been involved in supporting a series of webinars for the Return to Practice Programme, these webinars have been developed to support returnees on their journey to return to practice and will be uploaded to SharePoint once completed.

“I am planning on being involved with delivering the agenda of a series of webinars that we have been working on as a resource to help those currently planning on returning to practice.”

Sumeet’s advice and experience

“Through the Leadership Programme I have further developed my own skills around teamworking as well as self-directed learning - specifically developing my planning and goal setting skills. I have learnt a lot about how to effectively structure online collaboration successfully.

“The programme has been very flexible and there is great deal of support from the HEE staff and from other returners. The remote working set-up is excellent and has been really good for keeping in contact with my peers throughout the programme.

“It has provided me the opportunity to work and communicate effectively with new people and use action learning sets as a way of developing my peer and self-learning skills. I undertook self-reflective sessions and work collaboratively with my peers to come up with solutions to any problems that arose.”

“One thing I have found challenging is being able to separate things out and keep track of everything whilst working full time as my work email is the same as the email I have for the programme, but I’ve managed.

“The coaching sessions have been very helpful and have enabled me to develop the ability to reflect and learn from some of my experiences in the NHS. They have also given me a view of some of the current changes that are occurring in the NHS.

Read our other leadership returner case studies. 

Sandra Roper, physiotherapist

I have found that physiotherapy is something you ‘are’ rather than something you do.

I qualified in 1992 and after spending some years working in orthopaedics I left to have a family thinking that it would be easy for me to return once my children started school. But things turned out a little different from what I expected and after spending a number of years running my own retail training business and then moving into operations management for a charity, I was left wondering whether I would ever get back into physiotherapy.

Feeling unsure about where my career was going now the kids were older, I went for a coffee with a friend who asked me “What drives you?” I knew the instant he asked.

I wanted to be involved in something where I could help people rebuild their confidence in themselves. I wanted to be part of something where I could impart specialist knowledge in a way that it came across as common sense to who I was speaking. I wanted to enable people who were either hurt, ill, or injured to hope for a future again.

I knew I was describing who I was as a physio!

I contacted the CSP and from there found out about the return-to-practice programme run by HEE. Having been out for over 15 years I was required to complete 60 days of updating, and to do that within one year, and I wanted to do this all as supervised practice.

First, I got in touch with a physio I had met at a CSP event and spent a week shadowing her at St Nicholas' Hospice to check that it all made some sense to me - and I loved it! So, I contacted my local hospital and had an MSK placement all set up, and was about to hand my notice in, when the covid-19 pandemic hit, and the placement fell through. It was a horrid time for a whole load of reasons, but I was really determined so I started looking at the formal and private study options that I could use for completing my updating hours and got stuck into online study around my full-time job. I was hooked!

After several months and quite a few emails and calls, plus presenting on HEE webinar about RtP, I secured a supervised placement on the wards at the West Suffolk Hospital in Bury St Edmunds. They were so accommodating despite being in the second wave of the pandemic. I spent a couple of weeks each across orthopaedics, respiratory, community and medical wards and gained a huge amount of experience in a concentrated amount of time. It was full-on going across the different specialities like that, but I can thoroughly recommend it if you feel you’ve been out so long that you just need all-round experience to get yourself back into the mindset.

When the West Suffolk Hospital advertised for a band 5 position just as I had received confirmation of being back on the HCPC register I applied without hesitation; and was offered the job! I am now thoroughly enjoying being back on rotations. I would say to anyone considering returning  – ask yourself what drives you? Is that what you get from being an AHP? And if the answer is ‘yes’, then go for it with all you’ve got! Write those emails, pick up that phone, search out that podcast, that online seminar, that course, that book, and get back to doing what you love!

You are already qualified! You just need to get back on that register!

Elsa Franca, podiatrist

I am a Podiatrist that qualified 16 years ago in Portugal. I've been off the register for 8 years. Returning to practice would have been a daunting experience was it not for the magnificent support I've received throughout this 6 month journey. This experience was absolutely enjoyable and valuable thanks to The RTP HEE programme! I strongly encourage anyone considering returning to practice to explore this route and I am certain the outcome will be brilliant! I am now back on the register with several job offers so far.

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Analysis of survey data about equality, diversity and inclusion in healthcare science

We were asked by Health Education England on behalf of NHS England and Improvement’s (NHSEI) Healthcare Science Equality, Diversity and Inclusion Workforce Group (Chief Scientific Officer’s Office) to analyse a large online survey that they had carried out on equality, diversity and inclusion in the healthcare science workforce.

The survey included a mixture of quantitative and qualitative questions, and covered a range of topics including recruitment, career progression opportunities, retention, leadership, and health and wellbeing. 

We analysed 569 survey responses. These came from healthcare scientists working across the 4 different scientific ‘divisions’, including clinical bioinformatics, life sciences, physical sciences and biomedical engineering, and physiological sciences.

As part of the analysis we explored whether protected characteristics (including ethnicity, age, gender, caring and parental responsibilities, sexual orientation and disability) were linked to certain experiences. Due to the large number of survey responses that we needed to analyse, looking for patterns or themes within the qualitative data was challenging. 

We used the import spreadsheet feature in Dovetail which enabled us to create separate fields for each of the protected characteristics that had been captured in the survey. This made it possible to filter the qualitative data by these attributes and see where there were patterns. For example, we were able to look at responses from those who were disabled and those who were not and see where their experiences differed.

Our findings are now being used by NHSEI’s Healthcare Science Equality, Diversity and Inclusion Workforce Group to inform recommendations on how to address the issues that were raised in the survey.

“We had developed a national EDI survey for our NHS Healthcare Science workforce to better understand the lived experience of our frontline colleagues. We received a wealth of both quantitative and qualitative data all of which we wanted to ensure was captured to fully inform and added value to our EDI framework. Lagom worked with us to ensure the wealth of data was fully analysed and reported. The team were very engaged, responsive, and supportive of our very specific needs. It was a pleasure to work with great professionals with wealth of data analytics expertise.” Jagjit Sethi – Regional Chief Healthcare Scientist

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HIT Training Ltd (HIT) is the leading specialist training and apprenticeship provider for the UK’s hospitality, catering and retail…

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NHS England is responsible for the national postgraduate trainee recruitment system (Oriel), which is used to recruit postgraduate trainees.  The…

• Introduction

The Programme

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Building an inclusive culture within the NHS workforce

NHS England (previously Health Education England) originally approached RightTrack Learning in 2012 to create a series of bespoke Equality, Diversity & Inclusion awareness workshops.

Throughout the decade-long partnership, RightTrack Learning have continued to support the NHS organisation on their D&I journey by:

• Continuously designing ED&I awareness training content which aligned with their core objectives
• Writing and implementing thought-provoking scripts based on real-life topics, via live actors and recorded videos
• Creating follow up resources to keep the learning alive after the sessions

NHS England is responsible for the delivery of education and training for postgraduate medical and dental and multi-professional services within the NHS. Although a national organisation, NHS England operates through local presence, splitting its activity into regions with RightTrack Learning supporting the delivery of training for multiple regions and departments over the 10-year partnership.

With the complex nature of the people-facing organisation, RightTrack Learning have worked closely with David Turner, Quality Lead at NHS England North East North Cumbria, to create tailored training content. Supporting NHS England’s ED&I journey, RightTrack Learning ensured that all training content aligned with the vision and key objectives. A team of experienced script-writers developed scenarios, played out by live and recorded actors, which were impactful, organisation-specific and based on key messages which NHS England wanted to get across to the delegates.

The course was delivered through a mixture of face to face and virtual means, involving the senior teams at NHS England North East North Cumbria, and the senior teams at all local hospital trusts within the region.

Key learning objectives for the sessions included:

• Develop awareness on equality legislation
• Understand bias and how it can show up in our communications and decision making
• Learn about privilege and how our personal experiences can create blind spots
• Recognise our responsibility in challenging discrimination, using practical tools and techniques

The training enabled participants to engage with real-life scenarios, covering topics including complex legal challenges in disability, to daily on the job scenarios reflecting patient, staff and learning discrimination dilemmas. Recorded and live actors were used throughout the sessions, giving attendees the opportunity to test out different ways of handling sensitive conversations, whilst also allowing them to reflect and learn in a safe space.

Through a situational learning approach, drawing on experiences from the clinical floor and office, it equipped junior doctors and other staff to more confidently engage with complex ED&I scenarios.

The awareness and confidence of the teams trained has increased, especially when dealing with complex cases. Across the multiple sessions delivered to NHS England, RightTrack Learning have received positive comments such as:

David Turner, Quality Programme Lead at NHS England North East North Cumbria said:

“ED&I is part of the duty of our role, and objectives to our committee. We wanted to go beyond the required statutory and mandatory training, making this the next step as part of our advanced learning programme.

“Through situational learning resources, the training allowed us to understand and immerse ourselves in real-world situations and the complexities we might face, making us better equipped to approach them in future.

“The courses with RightTrack Learning always evaluate really well with our participants, which is incredibly important when evidencing NHS return on investment. It is often the people you might think will be reluctant to engage that tend to give the courses the highest praise. We rarely receive negative feedback and find those attending leave with more confidence and awareness dealing with complex situations as they’ve had a safe space to ask the difficult questions.”

Blog The Education Hub

https://educationhub.blog.gov.uk/2024/03/26/how-were-upgrading-school-buildings-across-england/

How we're upgrading school buildings across England

We’ve allocated over £17 billion since 2015 for keeping schools all over the country in good condition. That includes £1.8 billion for the 2024-25 financial year.

Most of the funds are given to local authorities, large multi-academy trusts, and large voluntary aided school groups, to invest in maintaining and improving the condition of their schools.

Other funding is targeted on essential maintenance projects at small and stand-alone academy trusts, other voluntary aided schools, and sixth-form colleges.

Schools and sixth form colleges are also allocated their own capital funding to spend on smaller projects, or improvements to facilities, such as ICT.

We regularly monitor the condition of school buildings across England, and our recent condition survey shows that over 95% of the grades given to the different elements of buildings assessed were As and Bs – meaning they’re in a good or satisfactory condition.

What are you doing to keep school buildings safe?

We have allocated over £17 billion since 2015 for keeping schools in good working order, including £1.8 billion committed for 2024-25.

Included in this funding for 2024-25 is £1.15 billion in School Condition Allocations (SCA). This is funding for local authorities, large multi-academy trusts, dioceses, and other large voluntary aided school groups, to invest in maintaining and improving the condition of their schools.

Almost £450 million has also been made available for the Condition Improvement Fund (CIF) programme this year. This includes support for over 850 essential maintenance projects at small and stand-alone academy trusts, voluntary aided schools, and sixth-form colleges.

The fund also provides Urgent Capital Support for these schools where there are serious issues that threaten immediate school closure.

Also included in the funding this year is over £200 million that has been allocated directly for schools to spend on projects to meet their own capital priorities. This is called Devolved Formula Capital (DFC).

We are also investing in new and refurbished buildings at over 500 schools through our   School Rebuilding Programme .

Our approach with this investment is working - over 95% of school building elements surveyed as part of the Condition Data Collection (CDC) between 2017 and 2019 were in good or satisfactory condition (condition grade A or B).

Only a very small percentage - 0.3% - of building components needed replacing straight away (Grade D).

As a department we are most concerned by the grade Ds - which refer to materials that are due to be replaced – for core elements of buildings.

Early indications in our successor survey, Condition Data Collection 2, (CDC2), alongside feedback from responsible bodies, shows that in almost every case where a Grade D component was identified in the first survey has now been addressed.

What is the School Rebuilding Programme?

Over this decade, our  School Rebuilding Programme is transforming over 500 schools in the most need of renovation.

Schools are selected for the programme according to their condition.

A  list of confirmed projects  is available, including information on when each was announced.

How are you supporting schools where there is RAAC?

Last year, to ensure schools continue to be safe for staff and pupils, we changed our approach to managing a building material found in some school buildings and other education settings, known as Reinforced Autoclaved Aerated Concrete (RAAC) .

The new guidance advises education settings to vacate areas that are known to contain RAAC, unless or until suitable mitigations are in place.

We’ve supported schools with confirmed RAAC with additional funding for mitigation work where needed, such as propping and temporary accommodation on site.

We are also working to permanently remove RAAC from school and college buildings across England.

This is being funded either through grants or the School Rebuilding Programme.

Schools and colleges where removing RAAC will typically be on a smaller scale, will receive grant funding, while those where works to remove RAAC are more extensive or complex will be funded through the School Rebuilding Programme.

It’s important to remember that only around 1% of schools and colleges in England have confirmed RAAC in some areas of their buildings.

What about schools where there is asbestos?

Asbestos management in schools is regulated by the Health and Safety Executive (HSE) and we follow their expert advice.

The HSE advises that, as long as materials are in good condition, well protected, and unlikely to be damaged or disturbed, it is usually safer to manage them in place.

However, if the asbestos is found to be at a significant risk of disturbance or accidental damage and it’s not safe to leave where it is, it is the duty holder’s responsibility to make sure it is removed by a trained specialist.

We’re working with the sector to promote best practice and  guidance  so that schools are aware of their duties to keep children and teachers safe.

We previously run an Asbestos Management Assurance Process (AMAP) - a voluntary survey we launched in March 2018 to understand the steps schools and those responsible for their estate were taking to manage asbestos.

Over 20,600 schools in England responded and it showed that most schools continue to follow core statutory duties.

We are now collecting Information from schools on how they are managing asbestos through our Condition Data Collection 2 (CDC2), which started in 2021 and will complete in 2026. It is expected to cover all state funded schools.

Whose responsibility is it to maintain school buildings?

It is the responsibility of those who run our schools – typically academy trusts, local authorities, and voluntary-aided school bodies – who work with their schools’ day-to-day to manage the safety and maintenance of their schools. They should alert us if there is a serious concern with a building they cannot manage.

We provide access to funding, targeted towards where it is most needed, to help them carry out these responsibilities, alongside a package of other guidance and support.

We provide additional support on a case-by-case basis if we are alerted to a serious safety issue.

What about the old schools that were built in the 1960s, will these be replaced?

31% of the floor area of the school estate is modern – having been built since 2000. The age of a building does not mean it is at the end of its life.

While schools can expect reasonable wear and tear, buildings that are well kept can be fit for purpose beyond their original design.

To support schools that do need buildings replaced, our School Rebuilding Programme will transform buildings at over 500 schools over the next decade, prioritising schools in poor condition and with evidence of potential safety issues.

What are you doing to ensure the sustainability of schools?

As part of our climate change and sustainability strategy, we are assessing emissions and the risk posed to schools by the impact of climate change, like flooding.

This will allow us to set targets and act efficiently, cost-effectively and with the least disruption.

Any new or refurbished school delivered centrally by the DfE will be designed to be Net Zero in operation and include a wide set of adaptive measures to respond to climate change.

We have also published guidance for settings on how to become more sustainable and worked closely with other departments to support access to government funding for schools and colleges to help reduce or eliminate their carbon dioxide emissions.

From May 2025, all schools will be able to access a new Sustainability Leadership digital hub and support service.

You may also be interested in:

• List of schools affected by RAAC and what you need to know about the new guidance
• What is the School Rebuilding Programme and how is it benefitting pupils?
• School funding: Everything you need to know

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Small Study Suggests Ozempic Relative May Slow Parkinson's

Small Study Suggests Ozempic Relative May Slow Parkinson's

By Robin Foster HealthDay Reporter

THURSDAY, April 4, 2024 (HealthDay News) -- Could a medication similar to the blockbuster weight-loss drugs Ozempic and Wegovy slow the ravages of Parkinson's disease?

A new, small study suggests it could: Over the course of a year, a group of French researchers followed 156 people with early Parkinson’s who were randomly given lixisenatide, a GLP-1 receptor agonist made by Sanofi, or a placebo.

What did they discover? Parkinson’s symptoms like tremor, stiffness, slowness and balance got worse in those taking the placebo but not in those taking the drug.

Experts said the findings are a good starting point for future research on the drug's powers against the movement disorder.

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It is not a slam dunk, but it is “nibbling at the edges of disease modification,” Dr. Michael Okun , a Parkinson’s disease expert at the University of Florida who was not part of the study, told the New York Times.

Dr. Hyun Joo Chu , from the National Institute of Neurological Disorders and Stroke, said the study was “very important,” but she cautioned the early research was only designed to test a hypothesis.

“There are many, many examples of very promising Phase 2 trials,” she told the Times. “People get very excited, and then it doesn’t pan out.”

Not only that, but more than half of the patients suffered from nausea and vomiting, possibly because the researchers started with the highest dose instead of gradually increasing the dosage. When a third of patients had side effects that became intolerable, the investigators halved their dose.

For the researchers, led by Dr. Wassilios Meissner of the University of Bordeaux and Dr. Olivier Rascol of the University of Toulouse, it wasn't that far-fetched to think a GLP-1 drug might slow Parkinson’s.

Studies have found that people with type 2 diabetes are at increased risk for Parkinson’s disease, Rascol told the Times . But that increased risk drops in those who take a GLP-1 drug to treat their diabetes.

He added that studies of brain tissue from deceased Parkinson’s patients have revealed abnormalities related to insulin resistance, which is what GLP-1 drugs treat.

While the researchers said they want to do a larger and longer study, Sanofi withdrew the drug in the United States and has started withdrawing it worldwide. The move was made for business reasons, a company spokesman told the Times .

More information

The National Institute on Aging has more on Parkinson's disease .

SOURCE: New England Journal of Medicine , April 4, 2024; New York Times

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