#GPFUQ 81 Do GPs need to have a certificate of competence in
everything they do? No – GMC accreditation means that you are certificated as
competent to know if you need a certificate of competence in anything extra
#GPFUQ 82 How much retraining do
GPs need to do to keep them competent in procedures? Is obligatory re-training
needed or are we re-teaching grandmothers to suck eggs? A bureaucracy of
training and accreditation has developed that is not linked with personal
learning needs or effective learning e.g. how many cervical smears or IUCD coil
fits do you really need to do each year to remain competent? Training should be directly linked to an
assessment of your learning needs and produce effective learning. We should
stop obligatory retraining on things we remain competent at and keep it for
those things we may not be competent in because we don't do very often but do
need to know. The RCGP should research, and give continually improving guidance
on best practice on accreditation and reaccredidation of procedural medicine.
#GPFUQ 83 Why are there so many
part-time and non-partner GPs giving full time and GP partners advice? There is
a new career choice in GP – the non-practicing GP. This is someone who is not a
partner in a practice, and does not do more than 2 days of clinical work each
week as a GP. In the past it was
difficult for GPs to get paid for not working as a GP. There were a few
academic GPs who were usually benign but also lacked any power. The new
non-practicing GP career choice is to be an uber GP either as an academic, a
manager, educator or appraiser GP. Most remain benign but some of these
non-practicing uber GPs seem bureaucrats who set difficult standards for others to attain and may
have little tolerance for contrary ideas or opinions (see #GPFUQ 84).
#GPFUQ 84 What is dogmatic
General Practice? One where the GPs increase their effort after they lose sight of
the goal or can't change their mind.
The dogmatic GP displays selected strict standards and little tolerance for
contrary ideas or opinions.
#GPFUQ 85 What s the difference between your GP vision
and your GP mission. A mission statement gives your purpose, basically why
your GP service exists, what it does and for whom. It’s a guide that spells out
what your organisation is all about. The mission should focus on the here and
now. A vision statement outlines the goals and aspirations for the future. It’s
a mental picture of a specific target and should be as a source of inspiration
#GPFUQ 86 How do you become a GP
leader? It’s easiest if you are surrounded by followers. It also helps if they
want to follow you. They are more likely to follow you if you have charisma,
power or money. None of these will make you an effective leader. If you don’t
have charisma power or money then you have to build a history of success in
what you do.
I was in a group of Britons having political lectures at an
election time in the US. We were outraged because it seemed that the candidates
needed millions of dollars to have any chance of success. The Americans
dismissed our cynicism with ‘what sort of leader would he/she be if he/she
couldn’t raise a million dollars?’
As a leader you become
responsible for producing the culture (what we do) and climate (how it feels).
If you are a good leader you can increase your followers willingness to make
extra efforts (their free and discretionary effort) for you. The main types of
leadership are: Coercive – do as I say, Visionary – come with me, Affiliative -
People come first, Democratic - what do you think, Pacesetting - do as I do
now, Coaching - Try this. The least effective for most situations are the
coercive and pacesetting though these may be essential in emergency situations
#GPFUQ 87 What sort of GP team do you need? The team
that allows you be the best sort of doctor you want to be. All teams have a
weakest link. Removing the weakest link may just move the problem to the next
weakest link. You need to decide just how strong each link must be and stick to
that standard.
#GPFUQ 88 Why don’t care
pathways and plans seem to help improve care.
More extended teams cause more complications with communications.
Responsibility for patients and liaising with others becomes a problem. The care
of many patients with complex conditions or co morbidities involves many
people. In general practice all staff accessing and using the same electronic
health record makes care more efficient ‘everyone knows what everyone else is
doing’ and the care is usually coordinated by one member of the team. A more
formal multidisciplinary approach is needed.
Suggestions for action
·
Multidisciplinary team (MDT) working – institute regular review of
problematic patients with MDT.
·
Introduce case management, selecting case by case the best profession
for the particular patient. For a minority the GP will be / remain case
manager; for the majority it will be other professions.
·
Use fax/email in a timely manner so that MDT meetings with other
healthcare workers can be used well and avoid the whole team listening to
"detail" or "catching up" about specific cases rather than
real learning points or improving service
·
Inform patient and the MDT of MDT care plans
·
Engage experienced nurses to do more case management.
·
Integrate care managers work near the patient – don’t let them do care management from a distant office
·
Make sure there is a designated social worker attached to the practice
to improve collaboration with the social services to increase quality for
patients
·
Redesign clinical pathways with secondary care colleagues to make the
simplest possible pathway for patients
·
Review management of patients who get their "care" from
hospital services, and institute case management in primary care
·
Increase the use of voluntary groups e.g. Parkinson's society
·
Have some effective method to hand over information from the practice to
Out of Hours care and vice versa.
