Should GPs use their professional judgement or follow guidelines?

#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