#GPFUQ 106 When was the golden age of general practice? The golden age is now, it’s always now. Make the most of it.
#GPFUQ 107 What makes a practice a happy place? All happy
practices are happy for the same reason; every unhappy practice is unhappy in
its own way. Find out what’s wrong and fix it.
#GPFUQ 108 Is it possible to know and remember all the published evidence
and guidelines? No, the only hope is electronic prompts to guide you in the
right direction at the time you need it ‘Just in time guidance’.
#GPFUQ 109 Is it less work for
a GP if you know the patient? No but it feels like less work. Increase
continuity in the practice- use the least number of people that can do the work
well.
Suggestions for action
·
GPs should have personal lists or allocate a 'regular long term doctor'
for selected patients
·
Preserve what is left of continuity of care even when this involves a
new technology such as e-mail consultations
·
Have own doctors available for telephone consultations each day ideally
with direct access via telephone system so its not required to speak to a receptionist.
This acts as good triage system - patients can be booked into same day slots if
necessary, can often be dealt with on phone and are often better dealt with by own doctor rather than the duty
doctor.
·
stop other people dealing with results when they don't know the patient
·
have an efficient and successful chronic condition management programme
where each member of the team plays their part and IT helps to ensure that
patients do not have to make unnecessary visits for check ups.
·
24/7 care – The care
card’. An ID badge (like staff wear) given to ‘at risk’ patients and/or attached
to their personal alarms like a baggage label to share information between primary care & secondary
care and facilitate better communication to provide the best appropriate care
for patients. Care card has patient password, ambulance control phone number to
access special notes on an online clinical record service and a feedback phone
number to report any problems that arise with the service.
#GPFUQ 110 What are the
major flaws with the process of GP revalidation?
The problems include
1. The theoretical basis for revalidation. In a nutshell science
dictates that you never prove anything is true (eg that a GP is competent) only
that something isn't true (eg that a GP isn't competent). All the requirements
and evidence are that we ask appraisees to collect information to demonstrate
they are competent. We should be looking for evidence of their incompetence.
2. The evidence base for the GMC requirements for revalidation. These
have no strong link with the incompetent performance of doctors
3. Changes in the rules. Explaining to appraisees why the advice you
gave them last year to plan their appraisal year is now wrong for when you have
to assess what they did in that year
4. The difference in interpretation of the requirements by the different
medical specialities, different areas in the UK and different individual appraisers.
There is increasing awareness and challenges by appraisees of this lack of
quality assurance.
#GPFUQ 111. Are examinations
of a GP’s competency fair tests? No examinations can ever be an infallible test
of complex competencies and predictor of an individuals performance. Its
unlikely that there will ever be a fair test of the examination process itself.
The questions are usually whether its good enough, (what’s its sensitivity), to
find the competent (or incompetent) GPs and whether its unfairness, (whats its
specificity) is acceptable? What’s
to be done? There must always be a quality improvement and assurance process of
examinations that invites and responds constructively to criticism of the
structure, process and outcome of the exam.
