#GPFUQ 143
Should GPs use their professional judgement or follow guidelines? Is it more
important to follow a pre determined performance pathway (like guidelines or
payments for performance) that links all aspects of work (e.g. effort, achievement,
values, purpose, and self understanding) to measures and comparisons of output?
Professional judgement like any practical wisdom is
a form of knowledge that is not formally taught and learnt but is acquired
mostly through experience and informal conversations. Wisdom develops through continuing
critical deliberation about what is the best thing to do in practice. This is
more than learning from simple reflection. In general practice it is the use of
a clinicians professional judgement that should help individuals manage the
uncertainties and risk in their lives. A
modern paradox is that GPs are trained
to use their judgement for the best interests of their patients but all the prescriptive
legislation and guidelines doesn’t allow them to use their judgement anymore.
#GPFUQ 144
How should GPs performance be
managed? If you can’t measure it
then how can they manage it? The outcome of the most important work in general
practice is more a journey than a destination. The role, and the expectations,
of primary care continue to expand, creating a need for a thoughtful process of
rethinking the work on a regular basis. Everyone needs to be working ‘at the
top of their licence’ most of the time. This will not happen without
performance management
Suggestions for action
·
Stop thinking that the job of a GP is an art form
·
Stop thinking that most GPs are above average
·
Stop working in isolation, without your work being
observed
·
Have annual in-house annual performance management of
GPs. Neither NHS appraisal nor GMC revalidation are effective or useful in performance
management.
·
Have in-house performance measures that are important
and relevant in your team. Choose measures that may be a problem and will make
a difference for patient care
·
Train, value and have career progression for
non-clinical roles as well as clinical roles.
·
Tell and thank your staff and colleagues when things
are going well
·
Aim for
communicating and coordinating care better for patients in the different
settings (health, social care, community, home), with better self care of
patients, targeted ‘at risk’ groups and better preventative health for the
population
#GPFUQ 145 Should GPs be
assertive advocates for overall patient care like quality and efficiency - not
just in their general practice
The best organisations are
more likely to tell people outside they are great. Good Practices exceed rather than
meet patient expectations
Suggestions for action
·
Make sure care is coordinated and /or integrated
across all elements of the system and the patient’s community, and that a
patients referral is tracked, results are tracked, the patient is informed of
the results and knows there was an interaction between his/her doctors. The
patients learns what to do next and somebody asks the patient if everything turned
out OK
·
Have an easy to use template and process that you can use to
report any problems with quality
·
Always ask 'is there something else you want to
address in the visit today. It’s a more effective question than ‘is there
anything else you want to address in the visit today?’
·
Don't be afraid of feedback and comparing results and
processes
