RACGP Standards for general practices (5 th edition)

Transcription

1 Interpreting the RACGP Standards for General Practices 5 th Edition Presented by: Angela Mason Lynch SAVOY 1 10:30am 11:25am RACGP Standards for general practices (5 th edition) 1

2 Developing the Standards Who develops the Standards? RACGP Expert Committee Standards for General Practices Made up of: 9 GPs from both rural and urban practices A representative from the Australian Association of Practice Managers (AAPM) A representative from the Australian Practice Nurses Association (APNA) A consumer representative 2

3 Developing the 5 th edition Standards The 4 th edition Standards were released in October They required updating to reflect contemporary general practice. The RACGP started developing the 5 th edition Standards in February 2015 The process included: Feedback on 4 th edition Standards Assessment of evidence and comparable national and international primary care standards Development of drafts Multiple stakeholder consultation phases Three rounds of piloting and testing Changes between 4 th and 5 th edition Standards 3

4 Modular format Standards in Core Module Core Module Communication and patient participation Rights and needs of patients Practice governance and management Health promotion and preventive activities Clinical management of health issues Information management Content of patient health records Education and training of the practice team 4

5 Standards in QI Module Quality Improvement Module Quality improvement Clinical indicators Clinical risk management Standards in GP Module General Practice Module Access to care Comprehensive care Qualifications of our clinical team Reducing the risk of infection The medical practice Vaccine potency 5

6 Numbering of Criterion 5 th edition Standards Module C: Core Module Standard 1: Communication with patients Criterion C1.1 Practice information NB: each Module starts with Standard 1, therefore there is Criterion C1.1 AND QI1.1 AND GP1.1 don t get confused! Indicator A. Our practice manages telephone calls, telephone messages, and electronic messages from patients. You MUST You COULD Mandatory v Aspirational You Must You Could 6

7 Indicators in the 5 th edition The Indicators in the 5 th edition Standards are written to be: Outcome-focused meaning that the Indicator focuses on the outcome or the intent rather than the process. Patient-centred meaning that the Indicator focuses on what the patient receives rather than what the practice does. Practices can choose a number of different ways to show how they meet the intent of the Indicator. This provides practices with increased flexibility to develop systems and processes that reflect their preferred way of working. There are still some high-risk areas that remain prescriptive such as infection prevention and control. 7

8 Examples outcome focused Process-focused Indicator 4 th edition All members of our practice team have position descriptions and can describe their role in the practice. Our practice has a process for seeking and responding to feedback from patients and other people and our practice team can describe this process. Outcome focused Indicator 5 th edition All members of our practice team understand their role in the practice. (C3.2A) Our practice analyses, considers and responds to feedback. (QI1.2B) Example patient-focused Process-focused Indicator 4 th edition Practices are aware of the arrangements in place for their patients to access after-hours care. Our practice provides information to patients and carers about how we have responded to their input. Patient-focused Indicator 5 th edition Our patients can access after-hours care. (GP1.3B) Our practice informs patients, carers and other relevant parties about how we have responded to feedback and used feedback to improve quality. (QI1.2C) 8

9 Example - simplified Complex Indicator 4 th edition Our practice can demonstrate that referral letters are legible, contain at least three approved patient identifiers, state the purpose of the referral and where appropriate: are on appropriate practice stationery include relevant history, examination findings and current management include a list of known allergies, adverse drug reactions and current medicines the doctor making the referral is appropriately identified the healthcare setting from which the referral has been made is identified the healthcare setting to which the referral is being made is identified if known, the healthcare provider to whom the referral is being made is identified if the referral is transmitted electronically then it is done in a secure manner a copy of referral documents is retained in the patient health record. Simple Indicator 5 th edition Our practice s referral letters are legible and contain all required information. All information on what to include in referral letter has been moved to the explanatory notes Explanatory notes Explanatory notes for each Criterion have been re-structured and include three sections: Why this is important explains why the Indicators are important from a quality and safety perspective Meeting this Criterion provides more information and sets out ways that a practice may choose to demonstrate that it meets the Indicator and/or Criterion. Meeting each Indicator is a list containing some of the mandatory and optional ways to demonstrate how a practice meets the Indicator. 9

10 New Indicators in the 5 th edition The 5 th edition Standards covers all areas in the 4 th edition Some new Indicators cover areas in the 4 th edition that were mentioned in the explanatory notes, or in Criterion that previously had no Indicators. Some new Indicators cover gaps identified during the consultation phases or by International Society for Quality in Health Care (ISQua) who accredit our Standards. New Indicators in the 5 th edition CORE Core 1.4 C Our patients can access This was identified as a gap in the 4 th edition resources that are culturally Standards during the Initial Consultation Phase. appropriate, translated, and/or in plain English. Core 1.5 A Our patients are informed about This Criterion in the 4th edition did not have any out-of-pocket costs for healthcare Indicators associated with it. Indicators have now they receive at our practice. been created from the explanatory notes. Core 1.5 B Our patients are informed that there are potential out-of-pocket costs for referred services. This Criterion in the 4th edition did not have any Indicators associated with it. Indicators have now been created from the explanatory notes. 10

11 New Indicators in the 5 th edition - CORE Core 2.1 E Core 3.1 A Core 3.1 B Our clinical team considers ethical dilemmas. Our practice plans and sets goals aimed at improving our services. Our practice evaluates its progress towards achieving its goals. This was identified as a gap in the 4 th edition Standards during the Initial Consultation Phase. Included in response to feedback from the International Society for Quality in Health Care (ISQua) - who assess the Standards against their accreditation requirements who identified this as a gap in the previous edition. Included in response to feedback from the International Society for Quality in Health Care (ISQua) who identified this as a gap in the 4 th edition Standards. Core 3.1 C Our practice has a business risk management system that identifies, monitors, and mitigates risks in the practice. Included in response to feedback from the International Society for Quality in Health Care (ISQua) who identified this as a gap in the 4 th edition Standards. New Indicators in the 5 th edition - CORE Core 4.1 A Our patients receive appropriately tailored information about health promotion, illness prevention, and preventive care. This Criterion in the 4th edition did not have any Indicators associated with it. Indicators have now been created from the explanatory notes. Core 5.2 A Our clinical team can exercise autonomy, to the full scope of their practice, skills and knowledge, when making decisions that affect clinical care. This Criterion in the 4th edition did not have any Indicators associated with it. Indicators have now been created from the explanatory notes. Core 6.4 F Our practice has a policy about the use of . This was identified as a gap in the 4 th edition Standards during the Initial Consultation Phase. Core 6.4 G Our practice has a policy about the use of social media. This was identified as a gap in the 4 th edition Standards during the Initial Consultation Phase. 11

12 New Indicators in the 5 th edition - QI QI 1.1 C Our practice seeks feedback from the team about our quality improvement systems and the performance of these systems. This Criterion in the 4th edition did not have any Indicators associated with it. Indicators have now been created from the explanatory notes. This Indicator has been included in response to that identified gap in the 4th edition Standards. QI 1.3 B Our practice uses relevant patient and practice data to improve clinical practice (eg chronic disease management, preventive health). This Criterion in the 4th edition did not have any Indicators associated with it. Indicators have now been created from the explanatory notes. This Indicator has been included in response to that identified gap in the 4th edition Standards. QI 3.2 A Our practice follows an open disclosure process based on the Australian open disclosure framework. This was identified as a gap in the 4 th edition Standards during the Initial Consultation Phase. New Indicators in the 5 th edition - GP GP 2.2 D Our practice initiates and manages patient reminders. This Criterion in the 4th edition did not have any Indicators associated with it. Indicators have now been created from the explanatory notes. This Indicator has been included in response to that identified gap in the 4th edition Standards. GP 2.2 E High-risk (seriously abnormal and lifethreatening) results identified outside normal opening hours are managed by our practice. This Criterion in the 4th edition did not have any Indicators associated with it. Indicators have now been created from the explanatory notes. This Indicator has been included in response to that identified gap in the 4th edition Standards. 12

13 New Indicators in the 5 th edition - GP GP GP 3.1 C Our clinical team is trained to Included in response to feedback from the International use the practice s equipment Society for Quality in Health Care (ISQua) who that they need to properly identified this as a gap in the previous edition. perform their role. 3.1 D Our clinical team is aware of This was identified as a gap in the 4 th edition Standards the potential risks associated during the Initial Consultation Phase. with equipment use. GP 4.1 F Our practice records the sterilisation load number from the sterile barrier system in the patient s medical record when sterile items have been used, and records the patient s name against those load numbers in a sterilisation log or list. GP 5.2 E Our practice has a defibrillator. This was identified as a gap in the 4 th edition Standards during the Initial Consultation Phase. A number of stakeholders suggested that defibrillators be included in this edition of the Standards during the Initial Consultation Phase. This new Indicator is not mandatory. Patient Feedback 13

14 Patient Feedback Seeking patient feedback is an opportunity to meaningfully engage with your patients. There are opportunities for the practice to implement quality improvements based on that feedback. The focus should be on that outcome quality improvement rather than the process of collecting feedback. Patient Feedback In the 5 th edition patient feedback collection will be more flexible: practices can create a method of collecting patient feedback that suits their needs. The RACGP Toolkit and commercial tools approved by the RACGP are available for practices to use. The approval process for other practice specific methods will be streamlined and timeframes for approval of practice specific methods shortened. 14

15 Patient feedback guide The revised Patient feedback guide provides support to practices. Practices will have flexibility to create their own method of collecting patient feedback. Toolkit for developing practicespecific questionnaires The Toolkit has been developed as a supplement to the Patient feedback guide to: provide information and resources to assist practices in developing their own patient experience questionnaire for the purpose of meeting the Standards for general practices (4 th and 5 th editions) provide a framework and a range of templates to assist the development of a practice-specific questionnaire. 15

16 Resources included in the Toolkit Sample questions practices can use to build their questionnaire Guidance on developing additional questions A blank template practices can use to build their questionnaire A guide for practice staff on patient selection and data management A pre-testing guide that will assist practices in piloting any questions developed for the questionnaire An excel spreadsheet for data entry and reporting that will assist in determining areas that require quality improvement activities. Each resource needs to be adapted to ensure it is relevant for your practice. Resource Guide The Resource Guide: has been developed to be a supplementary resource to accompany the 5 th edition Standards. includes additional resources and links to support practices in meeting the Criterion and Indicators. It will be updated regularly with any new resources that become available. 16

17 Next steps Between October 2017 October 2018, practices can choose whether to seek accreditation under use 5 th edition for accreditation after October All practices will need to gain accreditation against 5 th edition Standards from 1 November Information is available at or Via at standards@racgp.org.au 17