Scottish Government

6 Staff Competencies and Training

99. The framework for emergency care described in Section 3 will be underpinned by the need to have competent staff at each level of care. Competency development is created through training, practical experience, maintenance of skills and updating of skills as illustrated in Figure 2.

Figure 2: Competency Cycle

100. Emergency clinical skills of health care workers rapidly decline unless put into practice on a regular basis. This causes problems for health care professions in terms of skill development and skill retention where the numbers of acutely ill or injured children and young people are small.

101. Currently there are a number of emergency care training courses provided by different organisations. These provide training in basic and advanced life support but are limited in terms of many aspects of emergency care for children and young people. In addition the review questionnaires indicated wide variation in which emergency care staff attend which course.

102. An integrated multi-professional competency based training and education package would help address this problem. Such a training package should be recognised by the relevant professional bodies.

103. The system detailed in Table 1 describes the different competencies that staff should have to provide emergency care for children and young people. The level of competency required will depend on the level of emergency care delivered at a specific site. This should be determined through assessment of local needs and should be agreed strategically throughout each NHS Board or Region (depending on the appropriate planning level). For example a rural minor injury/illness emergency care site may need to provide a higher level of care for children and young people than a similar facility in an urban setting due to remoteness from major care centres.

104. It is also important to recognise that competency retention requires a practitioner to maintain and update his/her skills. This can be achieved through a number of different mechanisms including collaborative training, flexible interactive learning packages, interactive skills based scenarios, tele-education, e-learning, work based secondments and work shadowing.

Table 1: Multi-Professional Competencies for Emergency Care for Children and Young People

105. The programme development of this tiered multi-professional competency framework could be taken forward by an emergency care development group under the sponsorship of NHS Education for Scotland.

106. This emergency care group would be multi-professional and its objective would be the design, development and delivery of training courses on emergency care for children and young people.

Developing Roles for Health Professionals

107. Independently a number of training initiatives have been developed for some emergency care professionals. The majority of these are not focused on providing emergency care for children and young people. It is important that this need is addressed. A summary of the training initiatives is provided below:

• Higher Paediatric Fellowships in General Practice were established by NHS Education in Scotland in 2002. These offered opportunities for General Practitioners to increase their skills and knowledge in children and young people's health needs. If support for this continues it will allow the development of a Practitioner with Special Interest ( PwSI) in Paediatrics, enabling these GPs to develop knowledge, skills, experience and confidence in managing the problems of children, young people and their carers in the community. These GPs could also be a resource for other professionals in primary care, supporting them and linking them to specialist services. They could be particularly useful in remote and rural areas and it would be essential to support these PwSI to continuously maintain and develop their skills, knowledge and experience.
• Emergency Nurse Practitioners ( ENP) have also developed in recent years. These emerging expanded roles enable independent assessment and treatment of patients in accordance with agreed protocols. However there are currently no ENP courses specifically related to children and young people running in Scotland. This has been identified as an educational gap which requires to be scoped for future educational provision.
• Paramedics are registered with the Health Professional Council and their training is accredited by a number of bodies including the Institute of Health and Care Development ( IHCD). Their role is rapidly evolving to include enhanced assessment/diagnostic and treatment skills (supported where necessary by telemedicine) that can prevent unnecessary hospital admissions. In some areas of Scotland 'Pathfinder Paramedics' are already working in greater partnership with General Practitioners, out-of-hours services and minor injuries services as semi independent practitioners to create unique solutions to local issues. With further expected changes in health care predicted, it is likely that the role will continue to develop - in the generalist emergency care environment as well as in community based care and in highly specialised roles within multi-professional care teams.
• Nurse Consultants are growing in number. However, there is only one children's nurse consultant in Scotland. This Emergency Care Framework offers an opportunity to expand this group in order to provide leadership and direction for Emergency Care Nursing of Children and Young People in Scotland. A direct link with the NHS Education in Scotland Nurse Consultant succession planning project will ensure that Children's Nurses are aware of the routes into consultancy and are supported to contribute to both the Emergency Care initiative and to the wider children's agenda.

108. These developments should be taken forward in a co-ordinated multi agency manner. It is important that these practitioners have their skills recognised and that development takes place within a co-ordinated framework. In this way appropriate skills can be deployed and utilised to optimise emergency care for children and young people.