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16th August 2013

On Reflection

There are so many pressures and stresses in General Practice life that the choice of subject for a writer is overwhelming.  I asked a friend in general practice today what `hot potato` I should focus on and his answer was “Money!  Everything revolves around money right now”.  He is right, the news for GPs is overshadowed by the threat to pensions, the threat of fines from the ICO for not informing patients of how their personal data will be shared, fund pooling by CCGs and the cutting of fees to GP Appraisers.  However, this is not the only topic to hit the headlines.

Apparently, 8,500 doctors have failed to engage in the process of Revalidation.  The press have made a story out of this figure and are screaming gloom and doom for the NHS again.  However, it is possible that many of that cohort of doctors are reaching retirement age and will fall out of practice before their revalidation date.  It is equally possible that some people are just playing ostrich and have firmly stuck their head in the sand. Whatever your position on Revalidation, the GMC will remove the Licence to Practice from any doctor not cooperating in the process.

It is a daunting thought that you will need to prove to a higher authority that you are a good practitioner.  Many will feel threatened by the possibility, and many of you will go into `freeze mode` when it comes to collecting supporting information for appraisals.  The trick is to start now, or tomorrow at the latest.  Out of the six types of information  `Quality Improvement Activities` is proving most confusing, but take away the jargon and it is really very simple.  This is about reflection:  reflection on quality of care; reflection on quality of service and reflection on why people come to a doctor in the first place.

As healthcare practitioners, it is the norm for people to come to us with problems that need solving.  These problems may not be directly associated with their health, but life circumstances can affect health too.  When patients are stating their concerns about their bodies, they are also talking about their inner selves and how they feel about themselves.  They want us to see them as individuals rather than a body to be fixed. Quite rightly, they expect us to help them with decisions about their health care and what can be done for both the outer body and inner self.  There is a danger associated with all the pressures we are under, and that is forgetting what it is that people value about us as practitioners.  A number of studies, as well as a number of authors of books on the subject, remind us that people actually value the simple things.  They care less about qualifications and technical knowledge and more about our ability to reduce pain, increase mobility and increase quality of life.

Quality Improvement Activities are all about showing how we value this need and how we continue to learn, through reflection, how to improve our clinical service.  How do we do this?  Simple, through straight forward Clinical Audit.  The `Audit` word can either strike terror into some hearts or cause an acute case of yawning in others.  However, it is just a process, but a process which is the most effective Learning and Development tool in healthcare.  Audit is a process of reflection and quality of improvement.

Everybody assumes it will be boring, and I don`t know how to make this bit more interesting, so let`s just do it. The currently accepted definition of Clinical Audit appears in `Principles for Best Practice in Clinical Audit (2002)` and was endorsed by the National Institute of Clinical Excellence: “Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, process and outcome of care are selected and systematically evaluated against explicit criteria. Where indicated changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery”. 

OK, that`s pretty long-winded and feels complicated already! My own shorter version might be – “bench marking how your quality of care compares to best practice and modifying it accordingly"

Audit is actually a reflective learning process, aimed at improving your own personal practice and enabling change - it is not just a counting exercise.  However, although the changes that are enacted are primarily personal, they can also be disseminated through the work environment. It is a way of gaining insight into your own personal practice of healthcare whilst meeting external standards. It is also about setting your own standards.

If you were a professional athlete, you would constantly be competing against your own `Personal Best`, and I`d like you to see this as a way of setting your `PB` in practice. Audit can be small personal projects, but quite often includes collaborating with colleagues, presenting results to others and seeking peer review of results. Although Collaborative Audit is not compulsory, Audit Projects are more useful for providing evidence (such as in future revalidation), if they are collaborative. This means involving the whole practice team or running projects between at least two doctors. Audit involving at least two practices is even better. Remember, the results you achieve will be useful to other people too.

The process has to be simple and workable in order to be practicable. If audit is complex, it is defeating the object! The process simply involves –

• setting a standard

• measuring your practice against this

• setting a plan for improvement

measuring again, and continuing the cycle

Audit subjects can be about, or prompted by, subjects of interest,  CQC compliance, revalidation, seeking new learning, personal concerns with practice or outcomes of incidents.  The aim of Audit is to increase the standard of care in Clinical Practice, and the objectives of Audit are to measure performance against researched standards and make positive changes with measured improvement.  Practical projects suitable for revalidation involve anything from patient waiting times in practice to clinical effectiveness and prescribing habits.  This one aspect of Revalidation should not be onerous, it can be challenge and will be rewarding.

Contact the writer for more help if required.

Dr. John Shapter – QCS GP Expert Contributor

Topics: GPs


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