To provide the Children and Young People Asthma Model of Care, clinicians are required to have either Tier 2 or Tier 3 Asthma training. The tier of training required relates to national standards from The National Bundle of Care for CYP with asthma.
Case finding desktop review and clinical baseline assessment – Tier 3.
Annual review – Tier 2 or 3.
Post-attack review – Tier 2 or 3.
Clinical assessment of high risk needs and attendance of borough wide multidisciplinary team meeting/discussion to discuss cases – Tier 3.
In the Model of Care, routine functions e.g. annual reviews, require that the member of staff is trained to Tier 2. For more involved functions e.g. making a diagnosis or dealing with high risk cohorts, the member of staff should be trained to Tier 3. This is in keeping with The National Capabilities Framework for Professionals who care for Children and Young People with Asthma.
All GPs should be at least Tier 2 and in any practice some should be Tier 3 with all diagnosis and high risk care passed to them. Any nurse or AHP carrying out reviews should be tier 2 and should have appropriate supervision from someone with Tier 3. If a nurse or AHP within a practice has a strong interest in CYP Asthma and wants to do more, they could upskill to Tier 3.
The existing online training modules all assume that the individual already has an appropriate level of knowledge and skill in the care of children and have access to appropriate levels of advice and support to carry out their role. For example, a new HCA couldn’t do the Tier 3 training module and then start diagnosing Asthma.
Tier 2 – Supporting Prescribed Care:
Greater understanding of the principles of asthma management and able to deliver prescribed care both routinely and in an emergency
Able to view Asthma as a chronic condition and identify risk factors for poor control
This is for professionals who will be supporting children known to have Asthma
Those who are expected to carry out an annual review, able to spot and initiate treatment for an acute episode, carry out a post attack review
They are not going to be making diagnosis, they are not going to be initiating new medications (but could make recommendation to tier 3 colleague that medication change is required based on concerns raised during assessment for example)
They must be clinical, must have an existing background and relevant training in looking after children
Tier 2 training modules are not designed to make someone with no relevant skills ready to manage children with asthma
There is also the expectation that those working at Tier 2 level have the correct support, mentoring and supervision and that systems are in place to ensure everyone works within their capability
Tier 3 – Diagnosis, Assessment and Prescribing:
Able to diagnose, assess and manage acute and chronic asthma
Able to address the factors that contribute to poor control
This tier is for those actually making diagnosis – it important as our data nationally and across London shows that we are both overdiagnosing asthma in some cases and missing the diagnosis in many more cases
In order to improve our diagnosis and hence ensuring that CYP with asthma are then in our system of call and recall we need to ensure that we have sufficient colleagues in each practice with the appropriate knowledge and skills
All GPs should be at least Tier 2 and in any practice some should be Tier 3 with all diagnosis and high risk care passed to them
Any nurse or AHP carrying out reviews should be Tier 2 and should have appropriate supervision from someone with Tier 3 - if a nurse or AHP within a practice has a strong interest in CYP asthma and wants to do more then they could upskill to Tier 3
In terms of length of time of the modules on eLearning for health:
Tier 2 – 3 hours (equivalent of a half day course)
Tier 3 – 6 hours (equivalent to full day course)
How to access training:
Training is made available through the NHS eLearning for Healthcare platform.