Quality

Publication of Practice Assessment and Quality of Care [Occasional Paper 39]

Three year project started to develop education applications of medical audit in England, funded by the Department of Health. Dr Oliver Samuel appointed audit adviser.

Publication of "Towards a curriculum for general practice training" by Oliver Samuel [College audit adviser]

Clinical Audit programme started

Medical Audit Working group

Quality Network established with four main areas of interest

The Scope of Primary Care - recognising changing boundaries and providing support for new roles, such as purchasing.

• Clinical Care - developing guidelines for care of clinical conditions and the development of theoretical basis for such work
• Support Mechanism - developing practical management and the application of information technology to primary care
• Quality Assurance - assisting primary health care to adapt the methods of quality assurance to their own needs, via project based audit and quality assurance programmes.

Multidisciplinary Audit Working Group. This interim group lasted a year and was Chaired by Donald Irvine and included representatives from the Royal College of Nursing, Health Visitors Association and Association of Health Centre and Practice Administrators.

Forum on Assessment established as a joint initiative of the Examination Board and the Education Division - it reviewed formative and summative assessment in vocational training and issues relating to individual recertification and practice reaccredidation.

Clinical Guidelines Working party

Scottish Council Working party report on Reassessment and Reaccreditation

Counting on Quality by Dr Oliver Samuel [audit adviser], Dr |Paul Sackin and Dr Bonnie Sibbald published

Conference on Recertification and Reaccreditation.

George Shirriffs appointed RCGP Recertification Fellow

Practice Accreditation Working Party founded [in 1999 renamed Practice Team Development]

Management Programme Development Working Party considered "Managing for Quality programmes and courses" and set up RCGP Management Resource Unit at Newcastle University

Medical Audit Group renamed Quality Improvement Group

Quality and Audit in General Practice- Meaning and Definitions published

Conference on Clinical Guideline implementation held at RSM

RCGP Audit Unit- based at Hull University - with a core funding of £100, 000 from the Department of Health it had two main foci construction and dissemination of national clinical guidelines, which could be used by practices employing multidisciplinary audit as their main method of internal quality assurance and development of the managing for quality programme for practice teams.

RCGP/GMSC National Consultative Conference for MAAG Chairmen "Defining a future for Clinical Audit in General Practice"

• To discuss the development of clinical audit in primary care within the new health authorities
• To consider draft guidelines for health authorities about clinical and research matters
• To obtain views about local developments in the organisation of clinical audit
• To gain a consensus view of what guidance should be provided by the DOH

Significant Event Auditing Occasional Paper 70 - report of a study of the feasibility of case-based auditing in primary medical care. Placed emphasis on qualitative review, on the whole person and on people working together in the practice setting.

Publication of "Audit in Practice - the 24 Packages from the Working in Tamar Programme"

Quality Team Practice Award launched nationwide. The award was set up in 1995 under the guidance of the Quality Practice Award Working Party and was piloted in the North East Scotland Faculty of the RCGP in 1996 with the help of a grant from the Primary Care Development Fund. It ran from North East Scotland until 2007 when administration moved to London.

Measuring Quality In General Practice [Occasional Paper 75]

Assessment Network established under chairmanship of David Haslam

Quality in General Practice written by Mike Pringle as a CEC paper published [blue and white series]

Continuing Professional Development Conference"The Way Ahead" - this led to a tender being sent out for designing a system of APD [Accredited Professional Development]

 Implementing Clinical Governance in Primary Care conference

Council issued a statement on quality in general practice: 

• recognised the need for patients to be confident of the quality of their general practitioner's care
• reaffirmed that continuing membership of the College indicates commitment to encouraging and fostering high standards of general medical practice for patients
• applauded the unanimous decision of the College's Annual General Meeting to add Membership by Assessment of Performance to the College's quality markers
• supported the General Medical Council's decision that all general practitioners must demonstrate on a regular basis that they are keeping themselves up to date and remain fit to practise
• decided that, for those in active clinical practice, membership of the College will be linked increasingly to the explicit demonstration of satisfactory standards of care for patients
• decided to continue its work towards establishing a comprehensive national framework which would allow all general practitioners to demonstrate the quality of their care for patients

Practice Accreditation moved to new Assessment Network

Dr Susan Love first  member of the College through MAP [Membership by Assessment of Performance]. This scheme founded in 1999 allowed experienced GPs who could show evidence of good quality practice to become members of the College through an assessment of their performance rather than by sitting the College’s membership examination. MAP consisted of three separate elements which had to be passed in turn: video assessment or simulated surgery ; a portfolio of written evidence and a practice visit.

[MAP finished 2006 and was replaced by iMap]

Practice Team Accreditation Programme renamed Quality Team Development [QTD]

Practical Guidance on the Implementation of Clinical Governance in Primary Care in Scotland - statement by RCGP Scottish Council, Scottish General Practitioners Committee; Directors of Postgraduate GP Education; Scottish Practice Nurses Association; The Association of Managers in General Practice (Scotland); University Departments of General Practice; The National Board for Scotland and The Scottish Association of NHS Trust Medical Directors

Joint statement with GPC, JCGTGP, COGPED Revalidation for Clinical General Practice

The St Paul RCGP Quality Unit – to be funded The St Paul International Insurance Company until 2002 developed quality markers, advised on issues such as clinical governance and reviewed learning needs. Dr Tim Wilson appointed director January 2000.

Publication of Revalidation for Clinical General Practice and Good Medical Practice for General Practitioners

APD: Revalidation Through Education Conference [Accredited Professional Development]

Primary Care Research Team Assessment (PCRTA) –schedule and written guidance for candidates 1st edition

National Collaborating Centre - Primary Care  [NCC-PC] joint project with NICE [National Institute of Clinical Excellence] to develop clinical guidelines and audit for the NHS

College position statement [blue and white booklet] "Quality Indicators in General Practice"

This looked at the pros and cons of introducing such indicators. It states that quality indicators will allow comparisons to be made between practices. These comparisons can stimulate and motivate change. They will also be used to ensure accountability and identify unacceptable performance. However, it goes on to state that they may be difficult to interpret – for example, apparent differences in care may relate more to random variation, case-mix, or case severity, rather than real differences in the quality of care. They would also be expensive and time consuming to produce; the cost-benefit ratio of measuring quality of care is largely unknown.

Good Medical Practice for General Practitioners GPC/RCGP

First NCC-PC guidelines “Audit of the management of Post –MI patients in primary Care” by Richard Baker and piloted through RCGP Wales

Publication of  A Toolkit for Trainer Appraisal and Developmentby G A Rutt, M J Dodd [Occasional Paper 85]

Publication of revalidation folder for GP's working in Scotland

Launch of newsletter on patient safety aimed at primary care staff  entitled "In Safer Hands" a joint publication of the Quality Unit and the National Patient Safety Agency. This runs until c.2005

"Quality standards for GP Appraisal" a report for the RCGP Quality Unit by National Association of Primary Care Educations (NAPCE) Nick Lyons

A Practical Guide to Appraisal and Assessment in Primary Care conference

Quality Unit [see 1999] renamed "Innovation Unit" . The remit of the unit was to:

• Offer advice and support for those implementing clinical governance and create linkages between practising GPs, GP educators and researchers in developing, testing and refining systems of clinical governance.
• Map quality markers that are appropriate to general practice, reflect quality of care and be reliable. 
• Develop a framework through which individuals and organisations can review learning needs and risks and plan to address them. 
• Forge links with national organisations such as NICE, Strategic Health Authorities and Primary Care Organisations.

“Quality Assuring Patient Pathways in Practice Based Commissioning (PBC)” [Stephen Cox Innovation Unit] Patient Pathway Toolkit  (launched by Dr Stephen Cox and Dr Mayur Lakhani on the 11th May, 2006 during the NHS Confederation Conference - Practice Based Commissioning: Achieving Universal Coverage. )

Practice Accreditation Working Party chaired by Philip Evans

To review the national policy context around practice accreditation in England and the relationship of College practice quality practice markers in England to the QOF and other requirements, including any recommendations in the Chief Medical Officer’s report.

To identify the principles underpinning the future use of College quality practice markers in England.

To make recommendations about any development needed, piloting of scheme(s), and the support necessary for Practice Accreditation (England). 

To make recommendations for future consultation with and dissemination to the Faculties and Membership

iMap pilot started with 127 candidates (72 producing portfolios). "Interim Membership  by Assessment of Performace" replacing MAP. The aim was to assess a portfolio based scheme, which separated the individual from the practice, and provided a membership route for  registered GPs, in the context of the introduction of nMRCGP

Quality and Outcomes Framework (QOF) for patients groups and professional body leaflet by Helen Lester (National Primary Care Research and Development Centre/RCGP/University of Birmingham)

Doctors, nurses and call handlers will be able to assess their ability to identify emergencies, the quality of their advice and speed of response using a new clinical audit toolkit to help improve the standard of out-of-hours services. The arrangements are set out in a document published for the NHS by Health Minister Andy Burnham and the Royal College of General Practitioners.

...

Dr Jill Edwards appointed as Medical Director of Quality Management and Training Standards.  She will be responsible for developing RCGP quality standards for training, overseeing the College’s role in quality management of training at a national and local level and supporting the RCGP role in the certification of GPs.