BEING A CLINICAL LIBRARIAN IN PRIMARY CARE

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BEING A CLINICAL LIBRARIAN IN PRIMARY CARE

• Carsten Mandt
• NHS Greater Glasgow Primary Care Division

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Background The Organization

• NHS Greater Glasgow Primary Care Division (NHSGG
  PCD)
• Serves a population of about 1 million people
• Circa 6,000 directly employed staff plus 2,500
  contractors and their staff
• Yearly budget of about 440m
• Working together with five different local
  authorities
• Primary Care and Mental Health/Learning
  Disabilities Services

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Background Library Resources

• NHSScotland e-library (www.elib.scot.nhs.uk)
• Free provision of 4000 fulltext electronic
  journals, 1000 electronic books and 100
  databases of journal articles
• Maria Henderson Library, GG PCD
• Print collection of ca. 200 journals and ca.
  10,000 books
• Contracted staff are not automatically covered
  but can join as external members with a slightly
  restricted membership

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Background The Role

• Conceived in 2002 by the Clinical Governance and
  Library Services Managers
• New post to support Clinical Governance and the
  use of evidence based care
• Provision of expert information support for
  clinical, research and management decision making
  and policy setting within designated
  multidisciplinary teams

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Background Job Description

• Attend team meetings and help identify
  information needs
• Perform expert literature searches
• Current awareness services
• Training staff in literature searching and
  critical appraisal
• Managed jointly by Clinical Governance and
  Library Services Managers
• Funded by Clinical Governance

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The Role in Practice

• Clinical Librarian not part in the day-to-day
  business of the wider library service
• Mutual support for some aspects of library work
  (mainly literature searching, training and
  promotional activities)
• Access to Clinical Librarian Service is distinct
  from access to other library services

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The Role in Practice

• Access to Clinical Librarian initially through
  Clinical Governance Manager
• Ensure that librarian workload remains manageable
• Ensure that projects with wider impact are
  prioritised
• Link between Clinical Librarian and clinical
  teams and key practitioners
• Service delivery is responsive and pro-active to
  meet users needs when and where they arise

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The Role in Practice

• Use of electronic communication whenever possible
• After pilot year, the post was moved over
  entirely to Clinical Governance Department and
  now has no formal ties with library service
  although informal collaboration and mutual
  support remain

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Services Provided

• Literature searches
• Monthly electronic guidelines newsletter,
  updating on British and international guidelines
• Support for journal clubs
• Training literature searching, critical
  appraisal (e.g. one-to-one or as part of journal
  club)

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Service Utilisation

• Anecdotal evidence suggests that services have
  been beneficial to those who have used them
• However, overall uptake of services has been
  fairly (s)low and some parts of the organisation
  have not yet taken advantage of service
• Uptake has been higher in Mental Health compared
  to Primary Care Services
• Involvement with contracted staff has been
  particularly low

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Service Utilisation

• Only small amount of work is regular and ongoing
  (e.g. guidelines newsletter), the majority is
  project-based
• Initially, focus was on supporting development of
  guidelines, ICPs and other policy documents
• Over time, focus has shifted towards smaller,
  more localised service evaluation, (re-)design
  and development projects in individual clinical
  teams, services or primary care localities, as
  well as supporting central clinical governance
  functions (such as clinical risk or audit)

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Challenges

• Organisational barriers due to size and
  geo-graphical spread of services/staff ? less
  uptake of available services
• Staff working in different parts of city
• Do not always have regular access to
  internet/intranet/e-mail (or the necessary
  skills)
• Remoteness of library services
• Communication problems
• Involving staff groups who have not traditionally
  used Divisional library services (e.g. GPs,
  practice nurses)

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Challenges

• Seeming reluctance to practice evidence-based
  health care
• Lack of support for clinical staff spending time
  on EBP and CPD (time off, backfill etc)
• Lack of appropriate skills (literature searching
  and critical appraisal) - and confidence in using
  theses skills
• High cost (time) for clinicians and managers
• Alternatives to local library services for some
  clinicians (e.g. BMA)

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Challenges

• Providing the right information quickly, at point
  of need, without compromising the quality of the
  information
• Clinicians lack of time, and often skills, to
  handle the information appropriately themselves
• ? Require help to find and appraise evidence
• Librarians lack of in-depth clinical knowledge
• ? critical appraisal of papers by librarians
  alone can be problematic
• ? Partnership working is required between
  clinical staff and librarian

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Current Developments

• Revise procedures to provide a more timely and
  appropriate response to clinicians information
  needs and to cut down the costs involved for
  clinicians or managers
• Explore ways to utilise electronic communication
  channels further as IT infrastructure and skill
  levels improve in the organization (e.g. use of
  electronic journal clubs)

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Current Developments

• Move towards further integration with clinical
  governance
• Tie clinical librarian in with clinical audit and
  critical incident review processes
• Liaise more closely with clinical governance
  leads in primary care and mental health to
  overcome some of the barriers that prevent staff
  from using services
• Align the post more with organizational/NHS
  priorities