HEFCE, SHEFC, HEFCW, DENI, HSMU, Manchester University

Report 99/17

March 1999

Good practice in NHS/academic links

A report by the Joint Medical Advisory Committee to the UK higher education funding bodies

Health Services Management Unit, University of Manchester

This document contains the Contents, Preface and Executive Summary only. The full report is available in Word or RTF formats.

Contents

Preface
Executive summary
Introduction
Method of working
Key issues
Good practice in addressing key issues
Promoting good practice
Conclusions
References
Glossary of acronyms
Appendix 1 - Individuals interviewed
Appendix 2 - Members of the Advisory Team
Appendix 3 - Putting the 10 key principles into practice

Preface

The relationship between the NHS and universities is crucial in developing high quality medical and dental education and research, and to high quality patient care. Currently, a number of complex changes face both the NHS and universities in meeting their respective responsibilities. The Joint Medical Advisory Committee (JMAC) of the funding bodies for UK higher education therefore commissioned this study of good practice in NHS/academic links.

The study aims to identify issues relating to the interface between the NHS and universities, to highlight examples where these issues are being dealt with effectively, and to promote good practice. In particular, the study examines how institutions are addressing the competing pressures on staff time within a context of curricular reform and significant changes in the research environment.

In 1997 the HEFCE and Department of Health established two task groups to investigate specific issues. Task Group I has recently made proposals on the assessment of health-related research in the next Research Assessment Exercise (RAE) in 2001. The second task group is currently considering the practical steps which universities and NHS employers might agree locally in helping to reconcile the competing pressures on clinical academics in delivering research, education and patient care. The examples of good practice cited here will assist Task Group II in this work.

We were very much encouraged by the creative approach taken across the UK by universities and the NHS to respond to a constantly changing environment and to enhance the quality of teaching and research. We commend this report to you and hope that it will stimulate the development of further constructive partnerships.

Executive summary

1. In 1998 the funding bodies for higher education in the UK commissioned a study of good practice in NHS/university relationships. The study was undertaken by the Health Services Management Unit, University of Manchester. It was concerned with the ways in which the NHS and universities are dealing with the following three issues:

• competing pressures on staff time for teaching, research and service
• curriculum change and concomitant changes to clinical placement plans, including increased community placements
• research issues arising from the implementation of the Culyer reforms.

2. The study focused upon the development of good practice in five study sites (Aberdeen, Cardiff, King’s College London, Liverpool, and Sheffield) but also gathered examples from other locations. The main findings were as follows.

• The NHS and universities had taken steps to manage the pressures upon individual clinicians by making expectations explicit in job plans, by undertaking joint appraisals, by moving university staff on to NHS payrolls and vice-versa where this achieved a better match between their skills and the needs of their employer, and by rewarding clinicians who were actively involved in teaching and research with honorary titles.
• Pressures were managed at the organisational level through joint liaison groups which reviewed workloads and workforce issues, by aligning service and teaching needs to joint research strategies, by raising the profile of teaching, by the establishment of joint teaching business plans, and by ensuring that the NHS budgets supporting the excess service costs of teaching (service increment for teaching (SIFT) or additional cost of teaching (ACT)) followed teaching.
• There were many examples of good practice in the development of the new curriculum, which involved key stakeholders in curriculum planning and teaching. Departments had found innovative ways of communicating with interested groups (particularly primary care staff and students), and the skills identified in the General Medical Council (GMC) report, Tomorrow’s Doctors, were being fostered through new approaches to teaching.
• Teaching quality had received a boost through the Teaching Quality Assessment (TQA) exercise, and departments were good at supporting teachers and acquiring and acting upon student feedback.
• Community-based teaching had been established most rapidly where there was earmarked funding (eg ACT in Scotland) and the National SIFT Co-ordinators’ Group had played an important role in promoting positive change.
• Departments had been proactive in developing teaching in district general hospitals (DGHs). Students were enthusiastic about placements in these hospitals and the support and liaison arrangements were generally good.
• The responses for research and development after Culyer were patchy around the country. Some universities had established strong alliances and research networks, with NHS partners, while others had been slow to develop collaborative approaches. Some areas had set up primary care research networks and were developing the skills of NHS staff who had not traditionally been active researchers.
• NHS/university collaboration was strongest where interpersonal relationships were good at a senior level. Good liaison arrangements and cross-representation on NHS/university committees were also helpful. Physical proximity was a positive factor, where the NHS and the university shared a site and other facilities. Strong leadership and a commitment to joint working were crucial.
• Some universities had established liaison units to manage the NHS/university interface. These worked very well where they were led by a senior figure with good networks and political skills.
• There were examples of NHS/university collaboration where the aim was to develop a ‘whole culture’ of joint planning and joint problem solving which went well beyond managing pressures on service and academic work. Some organisations were working towards joint management arrangements.
• NHS regional offices were playing a very positive role in some areas, in promoting collaboration and facilitating research and development and joint educational initiatives. This worked well in regions which had senior figures with a lead role in education and training.

3. There were many examples of good practice across the country. Appendix 3 provides more detailed information about the initiatives being established in different areas.