THE TRAINER'S TOOL KIT

QoF CQC reflection

This is what one practice submitted…

Written Reflection Relating to Practice QOF and CQC

CLINICAL
Trends and Patterns

  • See our latest QoF achievements here:  http://qof.hscic.gov.uk/search/index.asp  ; type in BD10 into the search box and select Ashcroft Surgery, Bradford.
  • There has been yearly increases in requests for appointments and work diverted from secondary care.  The practice has the same list size but the workload has increased dramatically since last re-approval.  Despite this, QoF, DES and LES targets have all been delivered well.  This has been through collaborative team work which encourages GP trainees to actively participate.

From the current set of paperwork, we have achieved 518 points from a maximum of 545.

Specific areas for change or improvement within your practice as a training practice

The main clinical area we need to improve on is diabetic care (mainly foot checks and retinopathy screening).  We scored 64 from a total available pot of 86 points.  We have a new diabetic lead within the practice.  No doubt this area will improve over the coming year.

Any areas of concern highlighted by QOF or CQC

None highlighted in QoF.  Still not CQC’d yet.

ORGANISATIONAL

Trends and Patterns

a)    Records and information

The practice has up to date clinical summaries for over 80% of the patients.
The practice has a system for summarising new patient records within 8w of registration.
The practice has a system for acting on information received about patients.
The practice has a robust system for transferring information to other doctors/organisations (e.g. OOH)

b)    Information for patients

The practice supports patients with appropriate health literature (stopping smoking for example) from a variety of sources (physical/electronic leaflets and online material). 

c)    Education and training

All practice members receive annual training in Basic Life Support, Info. Governance & Fire Safety.
All doctors maintain a record of up to date Child and Adult Safeguarding training.
All GPs and nurses participate in peer appraisal.
The practice maintains a register of who is up to date and who is not.
The practice has a system for handling patient complaints and sharing learning points from discussions.
The practice has a system for reviewing Significant Events and highlighting points for learning and change.   In addition, the practice regularly reviews deaths, patients on the terminal care register, child and adult protection cases. 

d)    Practice Management

The practice has clear and accessible pathways for Adult and Child protection.
The practice offers a range of appointments to patients.
The practice has a system to ensure regular inspection, calibration & maintenance of medical equipment.
The practice has policies which include a staff manual, employment policies, equal opportunities, bullying & harassment and sickness absence – to which staff have access.

e)    Medicines Management

The practice possesses equipment and in-date drugs appropriate to emergency care in general practice.   In addition, there is a system in place for checking the expiry dates of emergency drugs on an annual basis.
The number of hours from requesting a prescription to availability for collection is 48 hours.
The practice meets a prescribing advisor at least annually to review and improve prescribing.
The practice has a medication review process for patients who are on repeats (which is recorded in the medical notes).

All our protocols and policies are available here:

http://www.ashcroftsurgery.co.uk/our-protocols-policies/policies-and-protocols-entire-catalogue/

Specific areas for change or improvement within your practice as a training practice

We re-profiled our nursing team last year, to increase HCA time and nursing skills.  We created a new admin role specifically for the nurses to help with nursing admin work which is on the increase.  Looking to increase the skill mix and develop our doctor team with introduction of an employed in-house pharmacist, and Advanced Nurse Practitioner.   

Any areas of concern highlighted by QOF or CQC

None highlighted by QoF.

Still yet to be CQC’d

How we alter the timetable depending on trainee needs

The Sessions

  • The number of sessions in the GP trainee’s timetable is dependent on whether they are full-time or part-time.
  •  If they are part-time, we try to ensure as much overlap as possible between the trainer and the trainee (at least 50%).   Attendance at the Scheme’s HDR is scheduled in. 
  • We then make fine adjustments to the timetable if there are particular trainee needs
    • For example, surgeries might start later or finish earlier if there are child care issues.
    • If a trainee is struggling or has acute social/home issues, we may temporarily put in some appointment blocks to make surgeries feel less pressured.
    • If the trainee needs to be away on certain days (e.g. academic GP trainee), we will provide for that.
    • The trainer approves these finer adjustments.
    • If the trainee is nearing their AKT exam, some of the tutorials may be put in with other GPs to increase knowledge levels.
    • If the trainee is nearing their CSA exam, some tutorials are changed to CSA mock practice with the Trainer, with more “sit and swap” surgeries.

Appointment Length

  • GP ST1’s usually start on half-hour appointments and we gradually work them down to 15 minute appoints.
  • GP ST3’s usually start on 20 min appointments and we gradually work them down to 10 minute appointments.

Increasing Clinical Exposure

In order to get GP trainees trained up to real world General Practice, we involve them in

  • Home visits
  • Various Reports
  • Death Certification
  • Clinical Tasks
  • Projects to help us reach targets

Ashcroft Surgery, Bradford, 201

Educational Practice Events

REGULAR MEETINGS/EVENTS AT ASHCROFT SURGERY, BRADFORD

DR MEHAY & PARTNERS

The practice holds a number of meetings and GP trainees are expected and encouraged to attend.  These are….

  • Doctor meeting
    Weekly meeting discussion various hot topics, messages from various organisations (eg CCG updates) and practice issues – in attendance are Doctors, Nurses, GP trainees, Practice Manager and Asst PM – others by invitation.
  • Protected Learning Time 
    Every Thursday – Doctors, GP trainees, Nurses, and admin as required. Regular things include Significant Events, Mortality reviews, Palliative Care reviews, Child updates, Prescribing reviews.
  • GP Trainee Tutorials
    2 tutorials per week each lasting 1.5h. 
    In addition, the GP trainee attends another weekly Wednesday 1.5h tutorial focused on clinical topics, devised by the scheme.
    GP trainee also attends Half Day Release every Tuesday pm.
  • Avoiding unplanned admissions meetings
    2 per month – one GP & case manager & PM attends
  • Ashcroft Nursing Home Weekly Ward Round
    Nominated GP goes.   GPR occasionally invited to join to learn.
  • CCG/CCF meeting
    1 per month – GP & PM – GP trainee invited if they show interest.
  • Committee of Reps meetings
    1 per quarter – GP & PM – GP trainee invited if they show interest.

Chris Rushton, Ashcroft Surgery, Practice Manage

Induction

ePortfolio

path: REFLECTION

Consultation Skills

Teaching & Learning Skills

The Quality of Care: EBM, Stats, QIA, Projects, SEA, Prescribing & Referrals

Organisation, Management & Leadership

The Final ST3 Year

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