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The healthcare workforce must continually adapt to meet the needs of the society that it serves, and the need for all healthcare professionals to develop a range of generalist skills has been identified as a key priority for reform.

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The importance of generalism

Learning from the COVID-19 pandemic has reinforced how crucial these skills are in enabling clinicians of all disciplines to work effectively to better meet patient need and to improve the health and wellbeing of local populations. The enhance, or Enhancing Generalist Skills, programme, is the vehicle for delivering that vision.

Generalism has been defined in many ways, and in many contexts, but it is defined here as comprising holistic approaches to both the health and wellbeing of the individual, and also entire populations.

Generalist approaches to healthcare delivery augment and potentiate specialist capability, ensuring that all healthcare professionals are confident at managing complex care across multiple, intersecting and overlapping physical and mental health services throughout their careers. Current processes risk fragmented, duplicated, and disjointed care resulting in error, waste, inconvenience and potential patient safety implications. Generalist skills improve patient experience and quality of healthcare reducing the need for patients to move between multiple specialists. Clinicians with generalist capabilities are able to bridge organisational boundaries, are adept at participating in the collaborative leadership of multi-professional teams, and can work effectively across community, primary and secondary healthcare settings to provide person-centred care for a broad range of health conditions in response to patient need and local service demands. 

Generalist approaches also address the needs of the wider system so the enhance programme is also intentionally supportive of post-pandemic learning, reset and recovery and the need to supply emerging integrated care systems with the broader healthcare workforce they require. To work effectively in those systems, the 21st century clinician requires a deeper understanding of place-based, population health and the local communities they serve, not only to ensure patients have access to more streamlined, comprehensive care, but to play a part in addressing the wider determinants of health. They also have a fundamental obligation to work for social justice and the reduction of health inequalities, and through action, advocacy and allyship, ensuring that no one is disadvantaged or left behind.

Finally, as trusted professionals who make judgments about the deployment of considerable resources every working day, all those who work in health and care have a societal responsibility to take whatever action we can to promote sustainable practices and reduce the increasingly harmful impact of humans on the environment.

The enhance programme

enhance has been conceived as a development programme to be interwoven throughout conventional education and training. It combines supervised project activity and work-based learning, supported by local teaching with access to online learning resources.

The domains and cross-cutting themes outlined in this handbook are not intended to be restrictive but describe the broad landscape of generalism. The precise journey taken by the individual healthcare professional through that landscape will depend on their own education and training programme, their scope of practice and the nature of the generalist offer being provided by their institution, training provider, system or region.

Enhance is intentionally multi-professional in scope as its aims are of shared and universal concern if the aspirations of the NHS Long Term Plan are to be realised. Furthermore, the programme is only deliverable through interprofessional learning and working within multi-professional teams as the knowledge and skills required to deliver programme outcomes do not reside in a single profession, and a multi-professional faculty will be required. All learning resources are therefore of relevance, and will be made accessible, and promoted to the widest clinical audience. Indeed, several trailblazer sites are already taking a deliberately multi-professional approach in their local approaches to implementation.

Enhance is designed as ‘outcomes-based’ allowing you to determine your own route and pace, designed so that you will be able to evidence your learning and development in a range of ways, including reflective accounts, supervisor reports and testimony.

Importantly, enhance is designed to be delivered flexibly, sensitive to local context and population needs. So, the outcomes for the programme have been written in a way that they may be met in a range of settings, from coastal communities to the inner city. Enhance is also an inclusive curriculum where examples, resources and reading materials reflect the diversity of individuals, communities and populations served.

During 2021/22 various approaches to implementation are being piloted by regional ‘trailblazers’ who are also developing online learning material. The intention is that these pilot sites will inform a wider roll out in 2022/23 alongside a dedicated suite of resources on the NHS Learning Hub. 

Programme aim and outcomes

The enhance programme aims to support the next generation of clinicians to work effectively across health and care. They will provide personalised approaches to multimorbidity and complexity; advocate for social justice, seeking new ways to reduce health inequalities; be community and population-orientated in their approach, taking responsibility for resource stewardship creating sustainable processes and practice; and work and lead collaboratively, inclusively, and compassionately within multidisciplinary teams, organisations, and systems. 

So having completed the programme - in whatever way you do - you will be able to:

  1. Champion a person-centred approach to care that invites  and supports personalisation, empowerment and shared decision making.
  2. Work effectively and flexibly within and across different disciplines, contexts, and systems to ensure high quality, coordinated care for individuals with multiple long-term conditions and/or complex needs; this will entail complex decision making while managing risk and uncertainty.
  3. Promote social justice ensuring that everyone has access to high quality healthcare; this means working with and/or within local communities to identify, recognise and respond to the needs and priorities of specific populations to reduce health inequalities.
  4. Access, critically appraise and champion innovations and digital health technologies to promote and transform sustainable improvements in practice; this means acting as a catalyst for change within, across and beyond healthcare systems.
  5. Advocate for the adoption of sustainable healthcare practices at an individual and system level; this includes recognising and promoting the importance of social, environmental, and economic resource stewardship.
  6. Communicate complex information in a range of ways, for a range of purposes, to diverse audiences; this includes individuals (patients, carers, other healthcare professionals), communities and agencies involved in health and social care.
  7. Lead collaboratively, inclusively, and compassionately, creating shared purpose that enables multi-professional teams to deliver the best possible health outcomes for the individuals and populations they serve.

Programme domains

To help organise your learning, and to chunk up the programme and its accompanying resources into manageable building blocks, the enhance programme has been further broken down into six discrete domains.

Each domain has a small number of outcomes which drive the syllabic content i.e. the subject areas to be covered.

Domain outcomes are achieved through a range of learning activities which may be:

  • delivered (e.g. eLearning, short courses)
  • experienced (e.g. structured work activity and projects)
  • evidenced against (e.g. recognising other formal or informal learning)

The six domains of enhance are:

  1. Person-centred practice
  2. System working
  3. Complex multimorbidity
  4. Social justice and health
  5.  Population health equity
  6. Environmental sustainability

You will note that the overarching programme outcomes (e.g. communication) may span several domains. This is deliberate and simply reflects the complexity of the real world.

Generic Professional Capabilities

For doctors participating in enhance - typically those within the first five years of registration - generalism has a particular relationship with the ‘generic professional capabilities’ of the General Medical Council (GMC). The GMC requires that its generic professional capabilities are embedded in all medical curricula. These capabilities are then already ‘core’ to formal medical education and training and so have not been explicitly reiterated within the enhance programme; they are, however, woven through all aspects of the programme’s educational framework. The emphasis of the enhance programme and domain outcomes is on what is distinct about this programme i.e. the added value that goes beyond that which the GMC has already defined.

Cross-cutting themes

In addition to the areas covered by the six domains, the enhance programme has four cross-cutting themes. Although these are not explicitly expressed as intended programme or domain outcomes, they can be found throughout the programme and will require your attention.

The four cross-cutting themes are:

  1. Wellbeing
  2. Digital
  3. Leadership
  4. Transformative reflection 

You can view the full chapter here.