How to present and win your case for education

This toolkit is aimed squarely at those health professionals who share our passion for and commitment to continuing professional development which enables them to deliver measurable health improvements for their patients with long term conditions. It has been designed specifically to help your voice be heard in a fast-moving, complex and often ‘noisy’ healthcare community.

Step 1

Proposition	Clearly and succinctly state your plan and objectives

What are you aiming to achieve?

How are you proposing to achieve it?

Think about the people who will be making the decision - what is their prior knowledge of this clinical area?

Step 2

Context / Strategic fit

Briefly describe the National picture relating to the clinical area

Focus on the size and scale of local need

Relate your proposal to your local health improvement plans and strategic direction of your Practice or PCO

Step 3

Benefit and impact of the education proposed	Who will benefit from your education?

Can you link it to the 10 High Impact Changes?

How will your education have an impact on your Practice’s performance in relation to target

How will your education show improvements in patient care and patient quality of life?

Step 4

Details of the proposed education	What education have you identified?

How will this education enable you realise these benefits?

Demonstrate your commitment and motivation

What are the timescales in which the benefits will be realised?

Step 5

Evidence	Why will your plan be successful?

What evidence can you present to support your plan?

Could anything jeopardise a successful outcome?

Step 6

Support for the plan	Provide clear evidence of support from some or all of the following: Nursing colleague, GP, Manager, Local nurses or GP’s with a special interest in the disease, colleagues in secondary care or others in the relevant care pathway.

Step 7

Cost	Clearly outline the real costs and timings

Quantify estimated savings where possible

Step 8

Next steps	Once your plan has been agreed - What will you do next and when?

Who else needs to know?

Decide and agree how you will feedback the benefits achieved through undertaking this education
Proposal to secure funding to undertake a 3 month distance learning diploma module in Atrial Fibrillation.

(Insert your name, position, practice details and contact information here)

This education will enable me to directly implement research evidence and guidelines into my clinical practice and consequently lead to outcomes which will benefit our patients, General Practice, and Healthcare Community. Opportunities for personal reflection and supported learning over this period of time will additionally ensure that these benefits are sustainable and provide lasting value.

The Department of Health’s Discipline of Improvement in Health and Social Care 1 (discussed in more detail in Section 3) describes 4 levels of knowledge and skills. I have used this model to establish my current levels of knowledge, understanding and experience. In this way I have been able to plan development of my competences within the remit of Agenda for Change in a way which is also meaningful within the Knowledge and Skills Framework (KSF) and Skills for Health (National Workforce Competences)2

I am keen extend my knowledge and skills up to an advanced level. This will in turn expand the Practice’s ability to offer greater access to patients, increase our ability to accurately review patients, and enable more patients with cardiovascular disease to be correctly diagnosed and effectively treated.

CONTENTS:

Concise description of the National and Local picture of Atrial Fibrillation, what it is, and the challenge it presents to (Insert name of healthcare community here) and it’s health improvement plans

Brief discussion on the potential benefit and impact that this education could bring to (insert name of Practice here)

Details of the educational module which will bring about this benefit

Supporting evidence relating to the likelihood of achieving positive outcomes

Local support for the plan and during the learning process

Costs

Next steps

The National and Local picture of Atrial Fibrillation and its relation to the local health economy of (insert name of your PCO here)

Atrial fibrillation is a cardiac rhythm disorder (also known as arrhythmia) in which the two upper chambers of the heart beat rapidly and irregularly. It’s the most common arrhythmia in clinical practice and is associated with increased long term risk of stroke, heart failure, and premature death. Whilst it accounts for one third of hospitalisations for cardiac rhythm disturbances, studies show that two thirds of patients are managed in primary care..

There are three different types of arrhythmia and each has a different management strategy and options which patients need to fully understand, not least because they may have more than one type but also because their atrial fibrillation may change from one type to another. Their compliance with treatment is vital - most patients need long term drug treatment) Atrial fibrillation leads to hospitalisation (e.g. for heart failure or stroke), and is a cause of costly cardiovascular morbidity (heart failure and stroke). Primary Care treatment aims to manage the condition to reduce these risks and improve patients’ quality of life. To optimise patient outcomes and target therapy appropriately it’s essential that a robust diagnosis is made.

As an interested (insert your role or position here) I am in a key position to have a positive impact on the burden of atrial fibrillation to patients and the General Practice economy by concentrating on better diagnosis, better treatment, better follow-up, better patient education and appropriate management strategies. To do this effectively I need to develop an appropriate level of knowledge, skill and experience.

National picture

Incidence and prevalence is increasing. The condition represents a growing clinical and economic burden.

Symptoms have a marked effect on patients’ quality of life. Many require long term treatment using drugs which can have significant side effects and need regular monitoring.

Risk of stroke is increased five fold in atrial fibrillation. It is an increasingly important risk factor stroke as age increases.

Uncontrolled ventricular rate resulting from atrial fibrillation causes or exacerbates heart failure

Mortality rate of patients with atrial fibrillation is double that of patients in sinus rhythm.

A recent study calculated that in 1995, 534,000 people in the UK had atrial fibrillation and that the direct cost of healthcare for those patients was £244 million. This accounts for 0.62% of total NHS expenditure; hospitalisations and drug costs accounted for 50% and 20% of this figure. Projected to 2000, the costs rose to £459 million and did not include cost for any long term care after hospital admission.

Local picture:

Insert details relating to Atrial Fibrillation from your local health improvement plans and / or strategic direction of your Practice or Primary Care Organisation (PCO)

The benefits and impact of Atrial Fibrillation education

The Department of Health’s ’10 High Impact Changes’ for service improvement and delivery3 were initially assessed against 5 categories; this set of measures makes an excellent means to assess the benefits of this Atrial Fibrillation education:

The impact of gaining Atrial Fibrillation education on performance targets & patient outcomes:

The knowledge and ability to:	Contributes to organisational key performance targets by….	Leads to improvements in patient care and quality of life by….
Diagnose Atrial fibrillation

Ensuring disease registers contain accurate, up to date information as required by the QoF	Allowing people with atrial fibrillation to be identified early, ensuring access to the treatment which will control their symptoms and prevent devastating complications such as stroke
Provide guidelines based treatment of Astrail fibrillation	Carrying out effective reviews as required by the QoF	Patients can be confident that they are receiving the best available care and treatment
Deliver evidence based management of Atrial fibrillation	Ensuring treatment is in line with local and national clinical governance and is cost effective	Ensuring that all patients receive care targeted at their own individual needs
Underpin knowledge with practical skills and techniques relevant to the care of patients with Atraial fibrillation	Ensuring best practice in terms of opportunistic screening, risk stratification & patient education	Developing a partnership approach which enables patients to manage their own condition effectively
3. Details of the educational module which will bring about this benefit

I have identified the Education for Health Atrial Fibrillation distance learning module at Level 2 as the course which will best enable me to acquire the knowledge and skills to practice at an advanced level in Atrial Fibrillation

This particular course brings the following benefits to our patients, the practice and to me:

It is based on the latest research evidence and guidelines, is focussed on, and highly relevant to, delivering exceptional care to Atrial Fibrillation patients in Primary Care setting

It impacts least on my colleagues in relation to time out of the practice (distance learning with no face to face study days). On the other hand it is fully supported at every stage by means of a student help line for clinical and academic enquiries and a dedicated Education Coordinator.

It provides clear value for money - Education for Health is a non-profit making, registered medical charity which obtains no core funding. All money raised from student education is reinvested to develop and deliver new and innovative educational programmes for health professionals working with patients with one or more long term conditions

It meets my learning needs and style, and fits in with my personal life and situation. The fact it is distance learning means I can study at my own pace at times which suit me, my family and my practice commitments

It is highly regarded by Primary and Secondary Care Respiratory Specialists on a National basis, the Department of Health, and Patient facing charities such as the Long Term Conditions Alliance, for its adherence to and advancement of evidence based practice

It’s national accreditation by the Open University, and fact it is the preferred Atrial Fibrillation education of many PCT’s and SHA’s and Government health departments demonstrates it’s ability contribute effectively to local and national health improvement programmes

It is well established and can form part of a Degree or Diploma Programme in Respiratory Care or the Management of Long Term Conditions. The module is fully launched following a successful and highly evaluated pilot.

Current Level of knowledge and skills1
0

Knowledge and skills not yet developed	I have had no experience

Even though I know a few general principles, I have not developed any skills
1

Core knowledge and skills	I use this skill in my work but infrequently

I feel capable of applying some aspects, to some situations with appropriate and effective support and direction
2

Advanced knowledge and skills	I use this skill frequently in my work

I feel capable, confident, and with direction, I can apply this skill to most situations

I have a depth of understanding to be able to explain the basic principles to others
3

Expert knowledge and skills	I use this skill regularly in my work

I have the understanding and capability to apply and adapt this skill with confidence in complex work situations

I can act fully independently and provide direction, support and advice to others

I am confident that I could explain the principles, application, advantages and disadvantages to others.

The module realises the benefits of Atrial Fibrillation education for my patients and practice:

The course takes the form of a 3 month learning program which is timetabled into a series of units which cover different subject areas. These are supported by self assessment and reflective learning activities, and a recommended reading list. Assessment is by examination and coursework.

The units covered include:	Current level of skills….	Skill level after the course
Overview:

What is atrial fibrillation? Classification of atrial fibrillation; The impact of atrial fibrillation; the epidemiology of atrial fibrillation; causes of atrial fibrillation; signs & symptoms of atrial fibrillation; aims of management; role of the primary care nurse	Indicate details here

2
Pathophysiology

The anatomy and function of a healthy heart; the cardiac conduction system; what causes atrial fibrillation; what are the consequences of atrial fibrillation

2
Investigating and diagnosing Atrial Fibrillation

Clinical presentation – signs and symptoms of atrial fibrillation; clinical evaluation of suspected atrial fibrillation; primary care or secondary care: when is referral necessary?

2
Management of complications of Atrial Fibrillation

The importance of antithrombotic therapy; risk factors of stroke in atrial fibrillation; selecting antithrombotic treatment on the basis of individual risk; current prescribing patterns; drugs used for thromboprophylaxis

2
Management of Atrial Fibrillation

Principles of treatment; rate control strategy; rhythm control strategy; rate control or rhythm control? Paroxysmal atrial fibrillation; permanent atrial fibrillation; persistent atrial fibrillation; acute-onset atrial fibrillation; drugs used to manage atrial fibrillation; drug interactions that you should be aware of; non-drug therapy for atrial fibrillation

2

Organisation of care

The national policy agenda; organisation of care within the practice; auditing care of patients with atrial fibrillation
Supported self-care

Understanding behaviour change; motivation and compliance: a concordant approach; communicating with patients; specific aspects of self-management for atrial fibrillation; support for patients in medicine taking; sources of information

4. Supporting evidence relating to the likelihood of achieving positive outcomes

An increasingly robust evidence base shows measurable improvements in the health of patients with long term conditions when the ability to diagnose, treat and provide follow-on care is underpinned with reflective, evidence based, and practical health professional education which takes place over time. Education of this quality enables change in practice to become embedded and sustainable.

The most significant research evidence relates to a randomised control trial4 conducted by Education for Health which showed that patients being cared for by health professionals who had undergone standardised, accredited education showed significant improvements in their health related quality of life and health outcomes.

In addition Education for Health is collating a wealth of case studies which show that nurse education is fundamental to the success of initiatives which aim to improve patients’ quality of life and health outcomes and decrease medical encounters.

Recently the SAFE study showed that opportunistic screening of elderly patients is effective and will help prevent stroke in high risk patients. Education for Health will teach nurses practical strategies for such screening.

5. Support for the plan

Provide clear evidence of support from some or all of the following: Nursing colleague, GP, Manager, Local nurses or GP’s with a special interest in the disease, colleagues in secondary care or others in the relevant care pathway

6. Costs

Type of cost:	Item:	Actual cost to practice:
One-off costs	I place on Education for Health Atrial fibrillation (level 2) course. Includes all distance learning materials, and full access to the Student help line

Open University Accreditation and Certification Fee	£395

£10
On-going costs	None	None

TOTAL: £405

7. Next steps

The next Atrial Fibrillation course starts on (insert dates). To register I will need to send a completed application form and payment / invoice details by (insert date)

The course completes on (insert date)

2

© Education for Health April 2008

Education for Health Charity No. 1048816. www.educationforhealth.org.uk

Impact on wider systems:

Effective clinical governance and risk management

Impact on career:

Job satisfaction, career development

Impact on Colleagues in Care pathway:

Confidence in competence, fewer referrals

Impact on Outcomes:

Reduction in health service utilisation, QOF achieved

Impact on Colleagues: More effective delegation supports shift in services

Impact on patients: Improved access to care, diagnosis and treatment

3 months Level 2 Atrial Fibrillation education

Benefits to Stakeholders

References:

Discipline of Improvement in Health and Social Care (Penny 2005)

For information on Agenda for Change and the KSF visit the DoH website – Policy – Agenda for Change

10 High Impact Changes for Service Improvement and delivery. www.modern.nhs.uk/highimpactchanges

Sheikh et al. Clinical and Experimental Allergy 2007;37:90-99

The Case for Atrial Fibrillation Education at Level 2:

Worked example for those wishing to undertake education with Education for Health

Education for Health has created this document as part of our response to the National Survey of the Roles and Training of Respiratory Nurses in the UK published in October 2007. By freely providing the toolkit and worked examples of the toolkit in practice, we aim to provide as much support as possible to health care professionals wishing to study with Education for Health or other education providers.

Information in this document has been researched and prepared by Clinical Lecturers at Education for Health. It contains evidence based, disease specific information and relates entirely to studying this particular module with Education for Health.

This Business Case has been provided for the use of healthcare professionals working with patients with long term conditions. It is provided freely and in a way which can be personalised to health professionals’ unique circumstances. Space has been left for health professionals to insert details from their own local health improvement plans. Indeed this information is vital if the case for education is to be presented strongly, clearly and effectively.

Worked examples similar to this are being prepared for every module offered by Education for Health. The complete list can be viewed and downloaded from www.educationforhealth.org.uk/pages/businesscase.asp

Health professionals will also find that the toolkit can be easily adapted to make their case for education in other disease areas or with other education providers. The toolkits are offered in Word in order to facilitate this.

For more information please contact: Candy Perry, Head of Corporate Communications & External Affairs c.perry@educationforhealth.org.uk

How to present and win your case for education

Managertimpile

2007-11-20

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