When was the golden age of general practice?

#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.