Embedded Knowledge and Library Specialist Roles within Primary Care Training Hubs. Evaluation of the vanguard pilot 2021 – 2023.

Challenge:  According to Next Steps for the 5 Year Forward View, 93% patient consultations take place in primary care. Despite this, staff working in primary care have had limited access to NHS knowledge and library services and limited time to undertake in-depth searches of research evidence to inform their decisions. Health Education England, now NHS England, ran a proof-of-concept study with funding for 2 years to explore the impact upon primary care of placing an embedded librarian and knowledge specialist in 15 Primary Care Training Hubs across England.

Key findings: The introduction of embedded librarian knowledge specialist roles has improved equity of access to evidence and knowledge for a wide range of staff and learners working in primary care and ICBs at the selected project sites.  They have delivered numerous benefits linked to the priorities of Primary Care Training Hubs, ICBs and the wider NHS. These roles have underpinned the education and training experience of staff but also led to improvements in using evidence from research to make informed evidence-based decisions about patient care and service delivery.   

If the 1:3.85 cost benefit ratio is applied, the pilot delivered a net economic benefit to the NHS of at least £2,351,250 per annum.  If there was a minimum of 1 embedded knowledge specialist in each of the 42 integrated care systems in England, to meet the evidence and knowledge needs of primary care and ICB staff, this would lead to a net economic benefit for the NHS of at least £6,583,500 per annum.

Outcomes:  The pilot ended September 2023. 9 services succeeded in securing a degree of local funding to continue for a fixed term. The remaining 6 have stepped down the embedded service.  1 new service was established.  Access to the nationally procured collection of digital knowledge resources remains in place for all primary care and ICB staff and learners.  Learning from the pilot can be applied to efficiently enable the primary care workforce and ICB staff to maximise use of evidence and knowledge as provided by NHS librarian knowledge specialists.

The following recommendations are based on this evaluation:

1. ICB leaders, clinical specialists and knowledge service teams work together to advocate for the benefits, positive impact and value of NHS knowledge specialists working in primary care.
2. Primary Care Clinical Directors are asked to consider how well they and their staff are using evidence and knowledge to inform their decisions?
3. Primary Care Leaders are asked to promote digital knowledge resources including BMJ Best Practice, the national clinical decision support tool, and to work closely with their local NHS knowledge and library services.
4. At least one dedicated librarian/ knowledge specialist is appointed into each primary care hub to underpin the use of evidence, upskill teams to use digital knowledge resources and facilitate knowledge sharing to inform productivity and innovation. ICBs and Primary Care Networks are invited to work with the local knowledge service as part of their workforce planning.
5. NHS organisations to work with NHS England and local services to review funding arrangements, ensuring equitable provision of high-quality knowledge and library services.

Equivalent of 897 working days saved by knowledge specialists undertaking searches.

• Sourcing and summarising research evidence to inform patient care, service redesign, service priorities education  and research.

• Effective facilitation to share best practice, know-how, managing knowledge. 

• Clinicians’ time released back for direct patient care. 

• Keeping the whole primary care and ICB workforce updated about the latest evidence and trends in healthcare via tailored horizon scanning alerts. 

 678 sessions delivered.

• Education sessions to upskill workforce in digital literacy, study and search skills training.   

• Research skills support for Fellows.  Awareness of health literacy techniques for good health conversations with patients/clients.

5383 people receiving information skills training

• Interacting with all roles working across primary care. 

2481 resources enquiries

• Improved access to high-quality research evidence via promotion of centrally purchased digital resources. 

1357 articles supplied

Direct supply of books and articles to the primary care workforce  – no additional fees. 

Year on year increase in BMJ page impressions 2021 – 2023 15,000 to 25,000

Maximise value of centrally purchased digital knowledge collection including the clinical decision support tool.  During pilot, use of centrally purchased resources increased due to the work of knowledge specialists providing training and ongoing promotion. 

An investment of 55K p.a. per training hub results in a 73k economic net benefit.

Benefits 

• Saving staff time. 
• Improving patient care. 
• Supporting staff recruitment, retention and wellbeing. 
• Enabling informed decision-making. based on research evidence. 
• Meeting statutory requirement to use and promote evidence from research. 
• Avoids unnecessary duplication and waste. 
• Is inclusive and enables equity of access.