GPs Get It Happening
The RCGP launched its Quality Team Development (QTD) programme in April 2000. The aim of the programme is to assess the performance of primary health care teams (PHCTs) and identify areas for development.
GPs participating in the programme will also find that it gives them a head start on implementing the new GMS contract, if it is approved by the profession.
QTD is expected to be accredited as a way of earning points under the proposed quality framework and, in turn, extra income.
Since its launch, 45 PCTs in England have registered with the scheme and seven local health groups in Wales.
The programme was introduced in Powys with the support of the local health group. The first PHCTs to join the Powys programme were in Brecon and Presteigne.
Several steps are involved. A local group is set up within the primary care organisation (PCO) to co-ordinate the project locally and liaise with the RCGP. This group identifies local assessment teams, which usually include a GP, nurse and practice manager from different practices.
The local assessors are trained for one day in a session run by the RCGP.
The PHCT completes a self-assessment questionnaire that has been prepared by the RCGP. It covers each aspect of practice work, including management of chronic illnesses, how the team works and patient involvement.
A different questionnaire is given to a sample of the practice’s patients about topics such as communicating with their GP and their views on access to appointments.
The PHCT prepares a practice profile, which consists of their practice leaflet and any protocols or audits that they have undertaken.
The information is compiled and sent to the local assessment team. The assessors visit the practice for a day to observe, interview team members, review clinical records and give feedback.
Despite its daunting appearance, two GPs in Powys, who have been through the process, told GP it was worth it.
Dr Kate Whitfield, a GP at Presteigne Medical Centre in Presteigne, Powys, says: ‘Initially, I was not that keen on doing it because I didn’t feel I would have the time. But once we had been through the process, I think everybody felt very positive.’
Dr Andrew Ricketts, a GP at Brecon Medical Group Practice in Brecon, Powys, agrees: ‘We were reticent at the start but having gone through the process it was worthwhile.’
Powys Local Health Board paid the fees to the RCGP and the actual costs to the practices were minimal. But both GPs agreed that the overall process was time consuming.
‘The self-assessment questionnaire is unwieldy and can put you off – it was about 80 pages,’ says Dr Whitfield.
‘It was quite an administrative task for our practice manager,’ adds Dr Ricketts. ‘As you go through it, it raises issues that you had not even thought about.’
Both practices were given 100 questionnaires, which they gave to patients who came in for appointments. The response rate was good and patients were happy to fill them in.
Being assessed by their peers was one of the highlights of the programme. ‘They were well prepared and asked searching questions,’ says Dr Whitfield.
‘But being assessed was not done in a threatening manner because we were being assessed by people who do the same jobs we do.’
Dr Ricketts said: ‘The day the local assessment team visited was quite daunting. However, we felt we were talking to like-minded people. They also worked in a rural community and therefore understood the problems of rural medicine.’
Feedback is provided orally on the day and later in a written report. The assessors identify strengths and areas to improve. The PHCT then uses this information to develop a practice development plan.
‘They gave both positive feedback and constructive criticism,’ says Dr Whitfield. ‘The areas to improve were all things we felt we could work on.’
The assessors told Dr Whitfield’s PHCT that they worked well as a team and had good access levels.
She said: ‘We have been worried about access because we have been struggling to recruit a partner. We did better on this than we expected.’
Areas to improve included delegating tasks rather than letting some members of the team take too much on. The assessors also said the practice’s IT needed progressing and gave pointers on how to improve their IT training.
Only six weeks after the assessors’ visit, the practice had implemented some of the suggestions. It has set up extra training for IT and has extended one of the receptionist’s posts to take up some of the data entry work that the practice manager was doing. This frees her time for more strategic work.
The feedback in Brecon was also useful.
Dr Ricketts says: ‘We were reassured that the assessors looked at our situation in another light. They recognised that we had done well in some areas and they identified areas that we could work on.’
The team was commended for the way they had tackled the issue of patient waiting times. The practice has an emergency surgery and a doctor on call all day to pick up any emergency work.
One area to improve was allowing more access to the computer system by the whole team, including the district nurses and health visitors.
The PHCT is now looking at ways to ensure patient confidentiality and will then give more access to increased numbers of staff.
The assessors also suggested formal meetings that involved the whole team.
‘We are a large practice with eight full-time equivalent GPs, a salaried GP and a large number of other staff so it is very difficult to have a full, formal team meeting,’ says Dr Ricketts. ‘We need to find some way of tackling that.’
Dr Ricketts and Dr Whitfield recommend QTD to other GPs. Dr Ricketts says: ‘The whole process was very constructive. Like all things in life, you get out what you put in. We put a lot in, and we have taken a lot out.’
‘There are so many things being imposed from above that GPs tend to feel backed against a wall,’ says Dr Whitfield. ‘But this is a process where you get assessment and feedback by your peers. I really think that has to be a good thing.’
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