In general practice, staff use electronic patient records every day. So, our GP columnist wonders, why don’t we add creating a standard training programme or competency framework to our to do lists?

At our local extended hours hub, we recently took on a nurse who was a GP out of hours regular. Our manager asked her – “Do you know EMIS?” Yes, was the reply. Yet when she turned up for her shift, it quickly became apparent that while she’d heard of it and knew bits about it she’d never actually used it. Luckily the shift was quiet and there were some very experienced staff on, so no harm done.

My practice took on a new admin person a year or so ago who had worked previously in a GP practice that used EMIS. While she was experienced and knew her way around it, her former employer seemed to use it in a different way to us, and it took some time for her to get used to the way we worked.

At a recent practice meeting, one of our partners was surprised to learn he could look up a mobile phone number on a referral screen. He’s been using EMIS for 20 years.

We have a quite a few members of staff who need to write searches and do reports. Some are very bright and computer literate, but learning how to do them is often more of a trial and error approach than anything else.

Why no defined list of competencies?

Basically, the point I’m trying to make is that to my knowledge there is no structured training programme or competency framework for primary care EPRs or software in general. OK, I’m most familiar with EMIS so others may have this and I’ve missed it. But there is no defined list of competencies – for example: able to change a mobile phone number, able to issue a prescription, able to send a task, able to create a concept.

Years ago, everyone was encouraged to do Microsoft Office and Windows training. It had some catchy name that I cant remember. I don’t tend to hear anything about it these days. Perhaps it’s still running, or perhaps there is an assumption everyone can use IT now. Personally with the number of IT problems people appear to have, I still think it’s a good qualification to have.

But I wonder why it never developed to cover software that we use more often. To be fair, on EMIS’s site there are quite a few webinars you can join and watch on a variety of topics. Some are very good but there aren’t really what I mean.

Let me give an example. I’m the principal investigator at my surgery for a lot of drug trials that we do; some commercial, some academic. One recent commercial study required me to do an hour-long online training programme covering how to use their website.

Testing times

Now I’m probably one of the most IT literate people out there. I was writing 6502 assembly language aged 14. If there is anyone who doesn’t require a test on on how to use a browser-based piece of software it’s me. But the organisers of the study want everyone to pass the test, and be 100% correct on the way in which they enter data. So, everyone sits the test and has to pass.

Can you imagine that if we did that in our normal practice? My practice QOF lead tears her hair out that, 10 years into the programme, some of our staff still free code some information that should be coded. Imagine if everyone was trained the same way.

There are a range of ways of offering training and ensuring a consistent approach. Online seems the most sensible. When I taught myself how to program the iPhone I used a web service called It’s since been bought out, and there are of course other services available. When I used it, consisted of videos broken down into chunks, each chunk showing a feature. There was a great index and the ability to rewatch. The system didn’t have great tests built in, but others do.

Locally we are trying to work at scale, get practices to perhaps share staff or jointly employ them. Perhaps insource, but it’s difficult to do these if different staff and practices work in different ways.

I’m in the middle of putting in a bid to get some funding to work up a competency framework for IT – not just for EMIS, but for all the things we do in primary care. It’s with a view to creating standardised certification that means we can accurately judge the skills of two members of staff and use it as the basis of a training and education programme for them. I’m keen to hear people’s views or experiences – or just point me to one that already been done!