Barriers for IPE & Solutions Liz Anderson

1. Barriers for IPE & Solutions Liz Anderson

2. Aim of IPE • NHS Plan- UK vision “rapid, effective, efficient, patient centred care of a high quality, delivered by teams” • The Curtis Report Canada “Develop a team of health professionals, replacing the desperate relationship that exists today”

3. References • Gilbert J (May 2005). Interprofessional Learning and higher education structural barriers.. Journal of interprofessional care; Supplement 1: 87-106. • Oandasan I, Reeves S (2005). Key elements of interprofessional education. Part 2: Factors, processes and outcomes. Journal of interprofessional care; 1: 39-48. • Carlise C, Cooper H, Watkins C (2004). “Do none of you talk to each other? The challenges facing the implementation of interprofessional education. Medical Teacher; Vol 26, (6): 545-552 • Freeth D, Reeves S92004). Learning to work together: using the presage, process, product (3P) model to highlight decisions and possibilities. Journal of Interprofessional Care, Vol 18 (1) 43-55. • Freeth D, Hammick M, Koppel I, Reeves S, Barr H. 2002. A critical review of evaluations of interprofessional education. LTSN, Centre for Health Sciences and Practice. Occasional Paper No2.

4. Barriers • Higher Education Institutions (HEI’s) • Service • Students • Developing evidence base

5. Barriers within HEI’s • Terminology • Definitions of what IPE actually is • Discipline specific language • The use of language, all IPE demands discourse

6. Barriers within HEI’s • Impact of change • People, teachers (practice and academic) hold onto historical stereotypes • Professional associations, limit visions, set the competencies for practice • Specialisation in healthcare, higher specialist of medicine and nursing more secular

7. Barriers within HEI’s • Economic and legislative • Economic pressure, leaves disciplines closing doors and looking internally • Curricula barriers, impact on IPE not fully understood • Regulation, can produce conflict of interest as it is the individual profession that is regulated

8. Barriers within HEI’s • Economic and legislative (cont) • Salary differentials, on qualification, attraction of funding to support training also reflects this • Accreditation, pays little attention to IPE • Academic demands “ changing a college curriculum is like moving a graveyard- you never know how many friends the dead have until you try to move them”

9. Barriers within HEI’s • Economic and legislative (cont) • Policies, influence curricula? Change in policy effects what is in or out • Funding, available to support placement learning • Research, costs • Organisational structure, and alliances of the University • University legislation, the faculty

10. Solutions Creating a culture for IPE • Develop cross disciplinary working which is truly interprofessional • Create a unified focus for the work • Owned agreed strategy, (what when and how) • Challenge conventional rules • Find and agree funding • Acknowledge the workload in design and teaching • Align regulators and professional bodies to the strategy • Align strategy with service • Good leadership

11. Barriers within Service • Some staff pay lip service to the principles of IPE • Antipathy around professional roles & autonomy • Lack understanding of basic concepts • Limited staff, resources, time • Attitudinal barriers

13. Prince Philip House - a multi-agency health and community centre.

14. Primary Health Care Team GP Surgery Police Office Mental Health services Community Drug and Alcohol Services Community Dentistry Speech & Language Therapy Services Community Physiotherapy Podiatry Services Paediatric Services Neighbourhood Co-ordinator for the Primary Care Trust School Nurse Pregnancy Testing Refugee & Asylum Support Somali Advice & Support Somali Environment Project Swahili Advice & Support Community Health Liaison Officer The University of Leicester Information Advice & Guidance Services The Teaching Centre Community Rooms St Matthew’s Charitable Enterprise Trust Coffee Bar / Play Area The Learning for Better Health Research Project Parent & Toddler Group Welfare Benefits Advice Prince Philip House - services available © Lennox

15. Barriers within Service LCC: Environ- ment & Leisure Services Youth Workers Primary School Pharmacist Housing Office SRB Projects Prince Philip House Sure Start Tenants’ Association St Matthew’s Area Forum Churches Children’s Action Group © Lennox

16. Barriers within Service • Time to work smarter “ A patient had been referred from one health authority to another….they kept being reassessed and passed on to another one and finally the patient said “ Do none of you talk to each other? I have been asked the same question a hundred times? Carlise C, Cooper H, Watkins C 2004

17. AREA FORUM & Tenants’ Association Leicester City Council Local Strategic Partnership Priority Groups Economic Regeneration Community Safety Young People’s Forum Early Years Forum Eastern Leicester PCT Community Development Workers St Matthew’s Charity Co-ordinating Group Prince Philip House Regional and National Bodies University of Leicester Business-in-the-Community Eastern Leicester Primary Care Trust

18. Solutions? • Education • Post qualified IPE • More resistant to attend than pre-qualified • Start IPE earlier • Ensure it impact on practice • Better management and understanding of team working in practice • Joint posts between education and practice • ? A learning organisation

19. New Hope • Mental Health Agenda • NSF (1999) • Community Mental Health Teams • Children's Agenda • Every Child Matters • Common Core

20. Student Barriers • Undergraduates • Arrive with set views • Focus on profession specific skills • Unaware of modernisation within health and social care • Resistance, especially the mature learners and graduate entrants • Teaching diverse groups challenging • Quality of what delivered turns students off

21. Students • Post-qualified, little joined up thinking • Skills escalators • New PQ framework social work • Modernising medical careers • More resistant • Attending IPE associated with seen as working in a failing team? • CAT point driven

22. Solutions • Ensure excellence in design of IPE • Aligned teaching • Biggs 3 P model presage , process and product • Freeth D, Reeves S (2004) • Key issues in planning IPE • Nasmith, Oandasan, Purden (2003). In Oandasan and Reeves (2005).

24. The Leicester Model immersion into patient & professional experiences analysis relating professional perspectives’ theory & policies become change agents through feedback consider solutions to problems identified

25. What's your experience ?