By Robert Campbell

Visiting my local dental surgery recently I was impressed by the content of the picture frames on the walls. There were practice staff training certificates in abundance and, importantly, a large collection of framed certificates issued by the General Dental Council to all the staff employed by the practice except the receptionists. Your local pharmacy will probably display certificates for the duty pharmacist and possibly the counter assistants. Any GP surgery, including yours, will probably boast a veritable art gallery of certificates.

GPs and practice nurses can display their registration and qualification certificates and practice staff may have certificates in first aid, call handling, CPR training or any other relevant subjects. If you employ a pharmacist their certificates will be on display too.

Health Care Assistants – Risks and concerns

It worries me that some of the clinicians and health workers seeing patients are unregistered and have no demonstrable qualifications or are not registered with a professional body. I believe Health Care Assistants fall into this category. The Care Quality Commission, Royal College of Nursing and the various defence unions all express concern and offer advice about the risks to patients posed by unregistered workers.

What do HCAs do?

The NHS careers website states that HCAs in GP surgeries have a broad range of duties including:

• Carry out patients’ health checks – height, weight, pulse and temperature.
• Sterilise equipment.
• Restock consulting and treatment rooms.
• Process pathology samples.
• Take blood samples.
• Health promotion work including ‘claimable’ health checks.

Most importantly they should record findings in the patient’s clinical notes.

But who trains them and to whom are they accountable? HCAs should only work under the supervision of practice nurses, never alone, and a doctor who employs a HCA is responsible for their actions. The worry is that, rather than carrying out duties which don’t require interaction with patients, HCAs are employed to save money on practice nursing costs. Whilst I have met and worked with some good HCAs, I find it concerning that numbers employed in general practice are increasing.

Certification – A way forward

A certain amount of studying and training is available to HCAs. Some may undertake study for a Care Certificate; some may register with the Royal College of Nursing. A HCA who is to take blood samples will need to attend special training sessions, whilst those who are already trained in CPR could train in dealing with anaphylaxis.

But even with all this there does seem to be major lagging behind in terms of qualifications and registration, especially in comparison with, staff who work in dental practices for example. I’m pleased to see that the RCN is developing a proposed nursing associate role and is carrying out a consultation. Meanwhile, a National Care Certificate is available through Health Education England. The RCN also offers workshops for new HCAs and HCAs may join the RCN under the supervision of a practice nurse.

So have you been framed?

Before your next Care Quality Commission inspection are you satisfied that all your health workers’ and registered clinicians’ practice certificates and proof of qualifications are framed and available for inspection? Records should be kept of all training given, appraisals, references and DBS checks. Finally, are certificates and diplomas on the walls of the consulting rooms or in the public area?

You’re going to need a bigger wall!