The continuing professional development for health professionals ...

Continuing Professional Development
for Nurses and Allied Health
Professionals in Musculoskeletal
Settings: a National UK Survey
Jo Adams; Sarah Ryan; Hannah Haywood;
Helen Pain

Jo Adams
Continuing Professional Development for Nurses and
Allied Health Professionals in Musculoskeletal Settings:
a National UK Survey
Presenter Disclosure Information:
Declarations of interest: None
This speaker has no conflicts of interest

Continuing Professional Development (CPD)
‣ Includes “a wide range of learning activities through which
professionals maintain and develop throughout their career to
ensure that they retain their capacity to practise safely,
effectively and legally within their evolving scope of practice” 1
‣ Conducted to provide the best possible care for patients and can
include formal or informal activities
‣ CPD is a registration and professional requirement although
recommendations for the time spent on CPD varies. No specific
time requirements for UK AHPs to 35 hours over three years for
UK Nurses.

Profession
United Kingdom
Nursing
Requirements
35 hours every 3 years, evidenced in portfolio that may be audited.
Occ Therapy/
Physiotherapy/Podiatry
Australia
Nursing
Occupational Therapy
Physiotherapy
No minimum requirement, but CPD portfolio must be kept by all members of register. This may be
audited biannually.
20 hours per year Portfolio must be kept in case of audit.
No minimum requirement, but evidence of CPD must be recorded in portfolio and may be audited.
20 hours per year, recorded in portfolio which may be audited.
Podiatry 20 hours per year (plus extra 10 hours per year for those with medicine endorsements and extra 20
hours per year for podiatric surgeons), recorded in portfolio which may be audited.
USA
Nursing
Occupational Therapy
Physiotherapy
Podiatry
New Zealand
Nursing
Occupational Therapy
Physiotherapy
Podiatry
Individual states vary; some require Continuing Education whilst others do not
Varies between states, from no mandatory CPD requirement to a minimum of 40 hours every 2 years.
Varies between states, however the FSBPT recommend that every physiotherapist should obtain a
minimum of 30 continuing competence units every 2 years. Unit value of activity depends on
how well it meets established criteria.
Requirements vary in terms of number of hours of CPD. No general professional recommendations
were identified
60 hours of professional development in 3 years. Yearly audit of nurses renewing their practice
certificate.
Continuing Competence Recertification Portfolio has to be kept and may be audited on a 5 year cycle.
100 recorded CPD hours/3-year cycle; 50 practical CPD hours/3-year cycle; one
professional peer review/3-year cycle
Equivalent of 100 hours CPD activity (formal and informal)/4-year cycle, audited.
Table 1: UK, Australia, USA and New Zealand CPD requirements

Background
• Musculoskeletal health care professionals have expressed
concern at the increased difficulties in undertaking continuing
professional development (CPD).
• Timely with rise in extended scope practitioner roles
• Discrepancy when compared with requirements, provision and
funding for medical colleagues

Arthritis Research UK:
Educational Strategy Award
• To explore the current situation regarding CPD amongst nurses
and AHPs working with people who have musculoskeletal
conditions.
To include:
• An exploration of the challenges faced to take part in CPD
• Recommendations to be made on how to provide the best CPD
opportunities for health professionals in the UK who work with
people who have musculoskeletal conditions

• National UK electronic survey
Methods
• Phase II of a two part research project
• Phase I used three focus groups and two telephone conference calls to
explore patients, clinicians and managers experiences of CPD within MSK
services 2 . These findings informed the content and development of this
electronic questionnaire survey.
• Survey designed using Question Mark Perception, administered from the
University of Southampton and distributed via professional bodies and BHPR.
• Results were collected online and analysed in SPSS PASW 17 using frequency
data and χ2 analyses.
2
Haywood H et al (2011) An exploration of the experience of continuing professional development with nurses and
allied health professionals working in musculoskeletal services in England ARD 2011;70(Suppl3):753

Recruitment
• AGILE
• Aquatic Therapy Association of Chartered
Physiotherapists
• Arthritis and Musculoskeletal Alliance
• Arthritis Research UK
• Association of Chartered Physiotherapists in the
Community
• Association of Orthopaedic Chartered
Physiotherapists
• Back Care
• British Health Professionals in Rheumatology
• College of Occupational Therapists Specialist
Section – Independent Practitioners
• College of Occupational Therapists Specialist
Section – Rheumatology
• College of Occupational Therapists website, CPD
page
• Extended Scope Practitioners
• Functional Lower Limb Interest Community
• Harrison Training
• Head OTs and OT Leads in Hampshire
• Leaders and Managers of Physiotherapy Services
(formerly the Association of Chartered
Physiotherapists in Management)
• National Rheumatoid Arthritis Society
• Physiotherapy Pain Association
• Podiatry Rheumatic Care Association
• Rheumatic Care Association of Chartered
Physiotherapists
• Royal College of Nursing Rheumatology Forum
• Social Care Distribution from COT
• Society of Chiropodists and Podiatrists Faculty of
Managers
• South Central SHA AHP Leads
• UoS Faculty of Health Sciences, MSc Alumni

Results
Total 591
responses
Reviewed 586
responses
354 complete
responses
analysed
5 not MSK/
Other
193 incomplete survey
39 initial information
only

Professional groups
9.9%
0.6%
7.3%
Nursing
Occupational
Therapy
30.2%
Orthotics
Physiotherapy
51.7%
0.3%
Podiatry
Not answered

Country of work
14%
4%
England
2%
Northern Ireland
Scotland
80%
Wales

Number of responses
Sector of work
350
300
250
291
• Multiple responses were
allowed for this question.
• Many worked in more than
one sector.
200
150
100
50
0
55 57
3
46
NHS
Local
authority
Private sector
Sector
Charitable
company
Self-employed

Workplace setting
1% Community
30%
Inpatient
61%
8%
Outpatient
Not
Answered

Number of responses
Level of experience
325
300
275
250
225
200
175
150
125
100
75
50
25
0
78
219
5
1
17
32
< 2 2 - 5 > 5
Years of experience working in musculoskeletal settings
Manager
Nonmanager

Number of Responses
The services in which people worked
200
180
160
140
120
100
80
60
40
20
0
124
90
70
57
175
122
• Multiple responses were allowed.
• Many worked for more than one
service.
• 122 worked for another type of
service not listed, many of which
were in addition to at least one of
the services listed.
Rheumatology
Orthopaedics
Elderly Care
Pain Service
Musculoskeletal Outpatients
Service
Other
• Other services reported included
general podiatry (n=13) and adult
services (n=33).

Number of responses
CPD activities undertaken in the last 12 months
350
300
250
200
150
100
50
0
225
61
312
111
164 147 138
294
156
255
20
short formal courses
extended formal courses
reading professional papers
shadowing
conferences
CPD network/group
mentoring
reflection
e-learning
in-house training
other
CPD Activity

Number of responses
Number of responses
Identifying learning and professional
development needs
400
350
300
250
200
150
100
50
0
Identify my own
341
253
177
120
Supervision
Performance review
Training review
Methods used to identify CPD needs
Other
32
400
350
300
250
200
150
100
50
0
Post and job description
286
Needs of service
331
Needs of local community
208
Anticipated future needs
282
232
159
KSF
Published competencies
Sources used to identify CPD needs
Other source
18

Number of responses
Reasons for doing CPD
250
200
200
150
100
50
132
100
79
63
60
16
23
10 1
0
Improve patient care
stay up-to-date
maintain skills
HPC/NMC requirements
confidence in own practice
further my career
service development
stay enthusiastic
Reasons to undertake CPD
develop personal interests
other reasons
• 124 people gave more than
the three main reasons that we
asked for, therefore 230 results
were analysed.
• A higher proportion of
managers (45%) than nonmanagers
(20%) cited service
development as a reason for
undertaking CPD (p

Number of responses
Barriers to CPD
250
200
150
100
50
0
Lack of funding
207
181
92
103
13
18
Lack of study leave
Lack of confidence in ability
Commitments outside work
Too many other tasks
Negative attitudes to CPD
Lack of appropriate courses
96
Other
15
• Other barriers identified
included difficulty
attending courses that
were held far from the
respondents place of
work/residence (n=12).
• Travelling costs for some
may be prohibitive if
there was a long
distance to travel.
Barriers to CPD

Specific Issues
Funding
Specific Issues
Time
Support

Funding
• 12% received full funding
• 56% received partial funding
• 21% received no funding
NHS
Non-NHS
• NHS vs Non-NHS
– Proportions are
significantly different (p

Time
• Hours of own time spent on CPD:
– 1-4 hours per month: 61%
– 5-8 hours per month: 27%
– more than eight hours each month: 12%
• Employers were thought to regard informal CPD as a legitimate use of work time by 70% of
respondents.
• Pressure of other work-based and external commitments were the most commonly cited
barriers to accessing CPD after lack of funding.
• Self-employed vs non self-employed:
– Proportions are significantly
different (p

Support from employers
• Negative attitudes to CPD at work was reported as one of the three main
barriers to CPD by only 7%.
• An employer who was very or fairly supportive of CPD activities was
reported by 86%.
• A higher proportion (95%) of non-NHS employees stated that their
employers were fairly or very supportive, compared with 84% of NHS
employees (p

Support from professional bodies
•The proportions of people from each professional group who
believed their professional body to help them meet the CPD
requirements of the HPC or NMC was significantly different
(p

Summary
• To improve patient care is a frequent reason for CPD.
• Managers are more likely to do CPD in order to improve service delivery than
non-managers.
• A lack of funding and having too many other tasks to complete at work were
the two most common barriers to undertaking CPD activities.
• Over half of the people who answered the survey received partial funding for
CPD activities and 21% received no funding at all.
• Most people felt that their employers regarded the use of work-time for informal
CPD activities was legitimate, but the pressure of too many other tasks to
complete during work was a significant barrier to undertaking CPD activities for
many.
• Overall there was a positive feeling that employers were supportive of CPD,
and each professional body was seen to be helpful in meeting the CPD
requirements by the majority of respondents in each profession.

Thank you to:
• All participants for taking part in the focus groups and online survey
• Our Expert Steering Committee
• Alan Borthwick, Senior Lecturer, Faculty of Health Sciences, University of Southampton.
• Mark Cole, Lecturer, Faculty of Health Sciences, University of Southampton.
• Janet Cushnaghan, Research Fellow, The Medical Research Council Lifecourse
Epidemiology Unit, University of Southampton.
• Elaine Dawson Nurse Practitioner, The Orchard Practice, Christchurch.
• Carolyn Evans, Strategic Service Manager, Hampshire County Council; COT/BAOT
Council Member (elect) Social Care & Community Services.
• Mandy Kness, BA, patient representative.
• Arthritis Research UK for acknowledging the pressures on Nurses’ and AHPs’ CPD time
and funding this study.