Leeds Primary Care Student Leadership Placement Pilot

Aims and objectives

The overall aim of the Student Leadership Placement is to expand sustainable high quality practice learning opportunities across primary care for pre-registration Adult Nursing learners. There is a focus on expanding knowledge and demonstrating leadership skills through three fundamental aspects of community healthcare throughout the 10 week placement:

1. Public Health/health needs/health inequalities
2. Preventative healthcare
3. Digital health

In the first ‘structured learning week’ of the placement, the four 3rd year adult nursing students (Megan Preene, Erin Carr , Weronika Smyk and Sophie Gallant) accessed a variety of clinical teaching sessions which enabled them to gain a foundational knowledge of primary care. These sessions included; a placement induction and clinical systems overview, overview of primary care, ICB population health data and the Healthy Leeds Plan, Local Care Partnerships, Getting to know the primary care network, health and well- being coaching, social prescribing, digital health and inclusion. The four students were also asked to complete activities including a health needs assessment workbook, locality walkabout, case study activity and the NHS Health Check e-learning on e-learning for health.

In the 2^nd and 3^rd weeks of the placement the four students shadowed the practice nurse and healthcare assistant colleagues to learn more about their integral role in preventative healthcare. The four students were also supported to achieve their venepuncture skill, building on the theory and simulation gained in the academic setting and were shown how to navigate both clinical systems (ICE, SystemOne) which would play a central role in capturing the content of their health check consultations and would ensure service user bloods are obtained using the correct bottles and labelled appropriately.

Over the next 5 weeks of the placement, the four students (in pairs) led on three NHS Health Check Clinics per week in the general practice setting across the LS25/26 PCN and spent time each Tuesday in a third sector community hub (either Garforth Net or MHA Communities Rothwell and District). Spending time in the community setting gave them the opportunity to build therapeutic relationships with a diverse population group and enabled them to have meaningful conversations about health needs of service users, identifying what matters most to them.

In the final week, the 4 students were provided with further opportunities to shadow the practice nurse and worked with the project lead/PLF to review each consultation looking at what they had identified throughout their clinics. This gave the students the chance to reflect on their learning journey and the difference they had made to individual health and the overall PCN population health.

Impact

The final celebration event took place on the 27^th January 2023 and provided the project lead/PLF and the 4 students to share their learning and successes. Over the course of the 10-week placement Weronika, Sophie, Erin, and Megan were able to offer 380 NHS Health Check appointments, of which 299 were attended. They undertook manual BP’s, height, weight, venepuncture and were able to hold good conversations, identifying people with deteriorating health, making life saving interventions and improving health outcomes. An example of this is a male who attended the practice for his routine NHS Health Check, the students undertook the observations and when listening to his heart rate through the stethoscope, the students identified he was in atrial fibrillation, an ECG was performed, he was then referred urgently to secondary care and is now under regular review by cardiologists.  Another example is 2 women who attended for their routine NHS Health Check’s in the student led clinics, both women advised they had found lumps in their breasts, the students booked the 2 women for urgent appointments with the GP, they were both given a fast-track referral to the breast unit and are now receiving treatment for breast cancer. They were able to draw upon knowledge and skills to screen each service user for alcohol use, cigarette and tobacco use, mental health status, diet and lifestyle. They also demonstrated initiative throughout their clinics, obtaining additional bloods if there was request for them on the clinical system (i.e. folate levels, LFT’s) and booked in service users for outstanding health reviews-helping to reduce demand on the practice later down the line.

Throughout each consultation they were able to demonstrate complex communication skills such as motivational interviewing and active listening to identify if and when service users were ready to make changes to their health or lifestyle behaviours and provided evidence based public health information, signposting to services, and referrals when suitable.

Feedback

Feedback gained from service users, practice assessors and practice supervisors who supported the placement has been outstanding, demonstrating the positive value and contributions the four students made throughout each consultation and their time on the Leeds Primary Care Student Leadership Placement.

Educator feedback:

“I feel they have worked really well throughout their placement; we have had some really nice feedback from the patients and I have been really pleased with how they have taken on board advice and followed protocols for safely monitoring blood pressures and taking action with follow up if needed. They have also taken on board advice about how to manage irregular pulses and the need for ECG’s and ongoing assessment after incidental findings.

"We have had some positive outcomes too with regards to lifestyle changes and they have been successfully signposting patients to additional services for support. I hope the students have enjoyed their placement and I hope they do consider a career in Primary Care in the future.”

“Delightful student nurses and been very assertive and will ask questions and aware of their limitations. Good feedback from patients. Excellent communication skills. Effective use of Template. Good utilisation of education material and sign posting.”

"The four students candidly shared their learning and successes from with 30 key stakeholders at the celebration event, discussing initial expectations of the placement , the difference between their expectations and the reality of the placement, any surprises about the placement, suggestions to improve the placement, take away learning, challenges faced and how they overcame them, and the leadership skills developed. The feedback from the students has been overwhelmingly positive, with all four now working towards careers in general practice nursing."

Student feedback:

“This placement has been fantastic in achieving my proficiencies. For example, the management and autonomous working”

“As a final year student nurse I love that it encompassed the autonomous working and leadership skills I have picked up are amazing. It showed me what primary care looks like and the limits to my knowledge. Having my own workload really helped with realising how much knowledge I actually have”

“This placement offers learning and skills that are essential to the prevention and management of ill health. It allows student nurses to have valuable time with patients that is not rushed. This enables patients to feel valued and in turn encourages them to open up about their health concerns and receive the best possible care. It gives an excellent sense of what primary care involves and gives student nurses the opportunity to consider working in this field”

“This placement can make you do a 360 in your career. I had never heard of primary care or understood what the role of it was. It is so important in health care and anyone who has the opportunity for this placement should consider themselves lucky!!!!”

Legacy

The Leeds Primary Care Student Leadership Placement Pilot finished on 27 January 2023 and will be fully evaluated and written up for the Queens Nursing Institute and the British Journal of Community Nursing/General Practice Nursing. Following on from the success of this pilot plans are underway, working with other primary care networks and community teams, to roll this programme out in further. The Leeds Primary Care Student Leadership Placement is a finalist in this years Student Nursing Times awards, with one of the four students due to attend the judging panel in March to share their learning and plans underway to attend the awards ceremony at the end of April in London.  Whatever the outcome we are so proud of this placement and the incredible achievements of Megan, Erin, Weronika and Sophie.