West Midlands - CPEP and Beyond

·CPEP and beyond!

Author: Dr Nicky Eddison, Dr Ros Leslie, Kelly Green, Helen Edwards, and Dominic McCutcheon Trust: RWT

In August 2020, Health Education England (HEE) announced that £15m would be made available through its Clinical Placement Expansion Programme (CPEP) to increase clinical placements in the NHS and support growth in nursing, midwifery and AHPs. Aligning with the NHS Long term plan1, we are the NHS people plan2, and the new white paper Integration and innovation: working together to improve health and social care for all3, to have a future workforce fit for the NHS.

The Royal Wolverhampton NHS Trust (RWT) was successful in its bid and used the allocated funding to increase its annual physiotherapy student placements. The funding facilitated collaboration with RWT, Keele and Wolverhampton Universities to pilot innovative placement models and share case studies and best practice. Increasing placement capacity in community rehabilitation teams and primary care, improving the student experience, and giving them vital skills for the delivery of future health care. Improving educator experience, enabling physiotherapy students to experience the patient rehabilitation pathway post-pandemic, and improving the patient experience. To enable the successful implementation of the programme the funding was used to recruit a link tutor. This position was vital in enabling the growth of placement capacity over the year.

Outcomes

The programme resulted in 72 additional placement offers (58% increase), 38 were apportioned to the University of Wolverhampton and 34 to Keele University. In total, RWT offered 196 placements during the 2020-2021 academic year.

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Despite the challenges posed by the COVID-19 pandemic we successfully piloted innovative placement models, increased placement capacity, and enabled physiotherapy students to experience the patient rehabilitation pathway during a pandemic by utilising innovative service models incorporating telehealth consultations, which allowed an increase from a 1:1 model to a 4:1 model in some specialities. All of which ensured that students developed the skills required for the delivery of future health care.

To explore how students experienced the placements an anonymous online survey was distributed to students who were allocated new or alternative placement models to increase capacity. Out of the ten students who responded to the survey 100% reported they would recommend the placement to other students. Reporting they found peer learning particularly useful. Those who had self-directed study days found this beneficial, reporting it allowed them the time to consolidate their learning and research areas that they found more challenging.

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Educators who trialled new or alternative placement models to increase capacity were also surveyed. Out of the five educators who responded, 100% reported they would recommend the alternative placement model to other educators. Those who offered a selfdirected study day a week found this day useful for both themselves and the students. They found it allowed them to catch up with administrative tasks whilst also allowing the students to catch up with reflections and consolidate their learning.

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Maintaining placement expansion

To enable the maintenance of the innovative placement model and expansion post-pilot the additional income from the placement tariff was used to embed the link tutor post within the physiotherapy workforce establishment. For our larger teams who can manage an overlap between placement dates or are providing a 2:1 model or greater, we plan to offer placements to both Keele University and the University of Wolverhampton. Work is also continuing to expand the community practice placements. To provide an additional four community teams able to facilitate regular placement opportunities as well as an additional three outpatient teams onto our placement rota. We have also embedded a successful Leadership Placement into our placement program by using a 2:1 model allowing students from both Universities to work collaboratively with one another whilst on placement. During the 2021-2022 academic year we have been able to offer 203 placements so far, with this number expected to rise further by offering ad hoc placements over the summer to students living locally but attending other universities not local to RWT.

We are also exploring the possibility of long-arm placements within care homes and hospice environments within Wolverhampton to allow students to gain experience in non-traditional settings.

Long-arm practice supervision is a process of supporting students in placements where their supervisor is located at a distance from the clinical practice learning area but is available for support. This means that the long-arm practice supervisor will not be with the student on a day-to-day basis so another named member of staff would support the student whilst they are on shift4.

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Keele University perspective: Kelly Green (Director of AHP Placements), Helen Edwards (Lecturer in Placement Support and Development) The successful clinical placement expansion bid from RWT was an extremely well thought out and planned project, facilitating physiotherapy students to undergo placements during an extremely difficult time during a pandemic, enabling all Keele students to progress or graduate into the workforce. The project encouraged wider collaboration and sharing of innovation and best practice across the Trust and Keele University but also encouraged higher education institutes (HEI) to work together to ensure physiotherapy students at both Keele and Wolverhampton benefited from exposure to placements at RWT. The project was managed through a steering group, ensuring all stakeholders' outcomes-focused not only on increasing the number of placements but also on the quality of placements, as described earlier in collating survey data to measure this.

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The HEIs ran an engagement event for staff at RWT to educate and encourage the different placement models which had been accelerated due to COVID-19 and encouraged by the Chartered Society of Physiotherapy who state ‘There is no one-size-fits-all placement structure anymore as we need to change and adapt to meet the demand of increasing student numbers and the changes in the healthcare landscape’5. For example, 3:1/4:1 and hybrid approaches, where students rely less on a 1:1 Practice Educator approach and have self-directed study time to reflect, consolidate their learning and carry out service improvement projects. Keele students who took part in placements at RWT utilising these placement models, fed back that it encourages them to be more autonomous, an independent learner and use their initiative and the self-directed learning time, helping to develop their reflective skills and explore case studies in more depth. Educator support is crucial and HEIs have offered increased opportunities for collaboration, problem-solving and open discussion throughout the project, with the need to continue as the outcomes of the project are maintained.

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The role of the link tutor, funded by the clinical placement expansion project, was key to success, being a consistent link between Practice Educators at RWT and the HEIs, increasing effective communication and problem-solving skills. RWT’s project plan ensured this was not a short-term goal and there is sustainability of all the work achieved in 2021-22. The Physiotherapy placement expansion project at RWT creates innovative opportunities for our students which will enhance their skills and exposure and will increase further, as the project is maintained and continues to evolve.

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University of Wolverhampton perspective: Dominic McCutcheon (Head of Practice Placements, School of Nursing and School of AHP and Midwifery) One of the key ambitions of the NHS Long Term Plan has also been to develop sustainable growth in the NHS workforce. A reduction in the number of NHS hospital beds in the last 30 years and movement of services out of hospitals has led to an increased need to examine placement learning opportunities needed for graduates to gain the clinical exposures to meet their programme outcomes. The total number of NHS hospital beds in England, including general and acute, mental illness, learning disability, maternity and day-only beds, has more than halved over the past 30 years, from around 299,000 in 1987/88 to 141,000 in 2018/9, while the number of patients treated has increased significantly6. Enabling growth in placements in this historical context but also under the pressures of a pandemic have been challenging, however, this project has shown that adaptable thinking and target resource of a clinical educator and training can make all the difference.

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The collaborative work undertaken with RWT and the Universities including the University of Wolverhampton has not only led to an increase in placement offers but also allowed creative thinking about the types of placements including the development of leadership placements and utilisation of different models such as team-based and hybrid approaches. This builds a rich legacy of supervision and assessment models for allied health professionals, including role emerging placements and long-arm supervision. From our learner perspective, 100% of students received a placement allocation and 100% would recommend the placement to a peer. The project has demonstrated an appetite for exploring diversification in the models used to support educators and students in the clinical setting. It also demonstrates where targeted funding can have a significant impact on placement offer growth.

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References 1. The NHS Long Term Plan. Published Online First.; 2019. https://www.longtermplan.nhs.uk/ 2. NHS England. We Are the NHS : People Plan 2020/21.; 2020. https://www.england.nhs.uk/wp-content/uploads/2020/07/We-AreThe-NHS-Action-For-All-Of-Us-FINAL-March-21.pdf 3. Smith, Helen. Integration and Innovation: Working Together to Improve Health and Social Care for All.; 2021. Accessed April 19, 2022. www.gov.uk/official-documents. 4. NHS Employers. Clinical placement supervision models. Accessed June 22, 2022. https://www.nhsemployers.org/articles/clinical-placement-supervisionmodels 5. The Chartered Society of Physiotherapy. Student placement innovations showcased in new CSP films. Accessed June 22, 2022. https://www.csp.org.uk/news/2021-05-17-student-placementinnovations-showcased-new-csp-films 6. The King’s Fund. The number of hospital beds. Kings Fund. Published 2019. Accessed June 22, 2022. https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/hospital-beds

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