Section One: Locally agreed details
Clause / Details / Evidence / Grade / CO/Q

Practice Objectives

Paragraph 2.1.1 The Contractor will use its best endeavours to achieve the objectives and targets set out in Schedule 2 of this Agreement. / This is a generic document and does not therefore give the details of each practices specific objectives.
Section Two: National Priorities
Clause / Details / Evidence / Grade / CO/Q
Delivery of National Services Frameworks and Local Delivery Plans
Paragraph 3.1.1. The Contractor will support the PCT in delivering the National Service Frameworks and Local Delivery Plan and the maintenance of the national public health targets. The Contractor will comply with associated local policies and will use its best endeavours to achieve objectives set by the PCT.

Mental Health Objectives

The NSF for mental health sets out seven standards covering health promotion, assessment, treatment and care for mental disorders ranging from common conditions such as anxiety and depression to very severe mental illnesses such as schizophrenia. Practices will have a role to play in showing how the NSF can be implemented in primary care, with standards two and three focusing on primary care in particular.

Standard Two

Patients contacting their primary heath care team with a common mental health problem should have their mental health needs identified and assessed; and be offered effective treatments, including referral to specialist services for further assessment, treatment and care if they require it. / CO 28. Are all Practitioners and Practice Nurses within the practice trained to recognise and assess common mental health problems? / All Practitioners and Practice Nurses within the practice are trained to recognise and assess common mental health problems / B / Q
CO 29. Does the practice have a prescribing protocol for mental health patients within the practice, which is compliant with the PCT’s Formulary? / A written protocol is available and there is evidence of compliance with the PCT’s formulary / A / Q
CO 30. Are the options of psychological therapies discussed with the patient? These may include;
  • Non-directive counselling
  • Cognitive-behavioural therapy
  • Problem-solving
  • Interpersonal therapy
  • Psychodynamic therapy
/ Options of psychological therapies are discussed with the patient. These may include;
  • Non-directive counselling
  • Cognitive-behavioural therapy
  • Problem-solving
  • Interpersonal therapy
  • Psychodynamic therapy
/ A / Q
CO 31. Are self-help and written materials about mental health problems available to patients and carers? / Self-help and written materials about mental health problems are available to both patients and carers? / B / Q
CO 32. Is the practice aware of the voluntary organisations and are they making use of them? / The practice are aware of the voluntary organisations and they are making use of them / B / Q
CO 33. Are patients who present with relevant mental health problems referred to the appropriate specialists? / How does the practice ensure that all patients who present with relevant mental health problems are referred to the appropriate specialists? / B / Q
Section Two: National Priorities
Clause / Details / Evidence / Grade / CO/Q
Mental Health Objectives

Standard three

Patients with a common mental health problem should be able to make 24 hour contact with the local services necessary to meet their needs, receive adequate care; and be able to use NHS Direct for first-level advice and referral on to specialist help lines or to local services. / CO 34. Does the practice have a clinical lead for Mental Health? / Name of clinical lead / A / Q
CO 35. Is there a facility to offer longer appointments to patients with Mental Health problems? / Are longer appointments offered to patients with Mental Health problems? If so, how is this done? / B / Q
CO 36. Are the OOH Services and NHS Direct advertised within the practice? / Both the OOH Services and NHS Direct are advertised within the practice / B / Q

Older People Objectives

GPs and primary care teams will need to work closely with PCTs and NHS Trusts to provide services and equality for older people.

Standard One

Rooting out age discrimination: The practice will ensure that a patient’s age will not be used to assess their eligibility to available services / CO 8. Has the practice completed an audit and does it have a policy to ensure there is no discrimination against older people in primary care? / An annual audit has been completed and there is evidence of a practice based protocol being used within the practice. / A / Q

Standard Five

Stroke: The practice will take action to prevent strokes in high-risk patients and monitor patients who have had a stroke. / CO 15. The percentage of atrial-fibrillation patients aged 65 years and over on or assessed for anti-coagulants. / The percentage of atrial-fibrillation patients aged 65 years and over on or assessed for anti-coagulants. / A / Q
CO 9. Is there evidence of operational guideline/protocol for the identification and care of high-risk patients? / A practice based protocol is being used which includes action to prevent stroke in high risk patients and monitor patients who have had a stroke / A / Q

Standard Six

Falls: The practice should have a protocol to assess patients who may be at risk of falls. Each patient who as had a fall should be investigated and referred if appropriate / CO 16. Does the practice have a protocol for assessing and referring patients, who are at risk or who have fallen? To be done as part of the over 75 check. / A practice based protocol, which includes referral to the falls service is being used. Plus evidence of an action plan for patients who have been identified as high-risk. / A / Q

Standard Seven

Mental health in older people:
The practice should have a protocol, agreed by the PCT and local specialist services, to diagnose, treat and care for patients with depression and dementia. / CO 17. Does the practice have of a protocol to diagnose and manage care for patients with depression and dementia? / A depression and dementia protocol being used within the practice. / A / Q
Section Two: National Priorities
Clause / Details / Evidence / Grade / CO/Q

Older People Objectives

Standard Eight

Promoting an active healthy life in older people:
The practice should promote the health and well being of older people. Ensuring they have access to key health promotion services. /

CO 18. Is there evidence that where appropriate older people have access to mainstream health promotion and disease prevention programmes, including smoking cessation, blood pressure management etc

/ Evidence of services offered and up take rates / B / Q
CO 19. Is access provided to health promotion activities of specific benefit to older people including:
  • Programs to increase physical activity
  • Improved diet and nutrition
  • Management program for influenza
/ Evidence of promotion of services such as leap and exercise classes / B / Q

Cancer Services Objectives

GPs and Primary Health Care teams should achieve a cervical cytology uptake rate of over 80%of eligible patients or if below, efforts should be made to improve the rate year on year.
GPs and primary care teams will need to work closely with PCTs, and NHS Trusts to support hospital teams in meeting the two-week outpatient waiting time standard. If a GP decides that in line with cancer referral guidelines a patient with a suspected cancer needs to be seen urgently, the GP must reflect that urgency by making sure that the hospital receives the referral within 24 hours of making that decision by using the telephone, fax or electronic media and by ensuring that the referral is clearly annotated that the two week standard applies.

Preventative Care

Practices should ensure that all eligible women are included in the Breast Screening call and recall programme.
Practices undertaking smear tests should ensure that all smear takers are adequately trained
Practices should provide health and lifestyle information and literature on preventing cancer. / CO 22. Does the practice have a protocol for non-attendees within the screening programme operated by the Breast Screening department? / A written protocol is available and there is evidence of a structured call/recall system. / A / Q
CO 23. Is there evidence of the training undertaken by smear takers? / Evidence that all of the smear takers within the practice have undertaken update training and an audit / B / Q
CO 24. Is there information available to patients within the practice on smoking, diet, physical activity, alcohol, sexual health etc? / A full range of information is available for patients / B / Q
Section Two: National Priorities
Clause / Details / Evidence / Grade / CO/Q

Cancer services objectives

Palliative care

The practice should ensure that patients who require palliative care are able to access Community Palliative Care Services. / CO 25. Does the practice refer to Community Palliative Care Services any patients who wish to use this service? / The practice have a full knowledge of the services available and standard forms are used for referrals / B / Q
CO 26. Are self-help materials about cancer care and services available to patients? / A full range of information is available for patients / B / Q

Waiting Time Targets

Practices should ensure that they follow cancer referral guidelines. If a GP decides that a patient has a suspected cancer and needs to be seen urgently, the GP must reflect that urgency by:
  • Following the cancer rapid access referral protocols
  • Ensuring the hospital receives the referral within 24 hrs of making the decision by telephone, fax or electronic media
  • Ensuring the referral is clearly annotated that the 2 week standard applies
/ CO 27. Does the practice have a protocol to ensure that the rapid access service receives the referral within 24 hours (one working day if the 24 hour period encompasses a weekend)? Do the letters/forms used clearly indicate that the 2 week standard applies? / A written protocol is in place and forms with the 2 week standard clearly indicated are being used. / A / Q

Coronary Heart Disease Objectives

Identify all people with established cardiovascular disease. Offer comprehensive advice and appropriate treatment.
Identify all people as significant risk of cardiovascular disease, who have developed symptoms. Offer appropriate advice and treatment to reduce their risks. / CO 1. Does the practice have a clinical lead for CHD? / Name of nominated lead / A / Q
CO 6. Does the practice have an operational guideline/protocol for the provision of systematic care for its patients with coronary heart disease? / A practice based protocol being used within the practice / A / Q
CO 7. Does the practice have an operational guideline/protocol for the care of high-risk patients? / A practice based protocol is being used within the practice / A / Q
CO 2. The percentage of patients with coronary heart disease whose notes have a record of their diet in the previous 15 months. / The percentage of patients with coronary heart disease whose notes have a record of their diet in the previous 15 months. / A / Q
CO 3. The percentage of patients with coronary heart disease whose notes have a record of their exercise in the previous 15 months. / The percentage of patients with coronary heart disease whose notes have a record of their exercise in the previous 15 months. / A / Q
Section Two: National Priorities
Clause / Details / Evidence / Grade / CO/Q

Coronary Heart Disease Objectives

/

CO 4. The percentage of patients with coronary heart disease whose notes have a record of their BMI in the previous 15 months.

/

The percentage of patients with coronary heart disease whose notes have a record of their BMI in the previous 15 months.

/ A / Q
CO 5. The percentage of patients with coronary heart disease who are currently treated with or have been assessed for statins. / The percentage of patients with coronary heart disease who are currently treated with or have been assessed for statins. / A / Q

Diabetes Objectives

Improve the care and management of patients with Diabetes, meeting the requirements of the National Standard Framework for Diabetes.
Ensuring that current services are maintained in readiness for the NSF in Diabetes / CO 13. Does the practice have a clinical lead for Diabetes? / Name of nominated lead / A / Q
CO 14. Does the practice have an operational guideline/protocol for the provision of systematic care for its patients with Diabetes? / A practice based protocol being used within the practice / A / Q
Asthma objectives
Improve the care and management of patients with Asthma / CO 37. Does the practice have a clinical lead for Asthma within the practice? / Name of clinical lead / A / Q
CO 38. Does the practice have an operational guideline/protocol for the provision of systematic care for its patients with Asthma? / A practice based protocol is being used within the practice / A / Q
Hypertension objectives
Improve the care and management of patients with Hypertension / CO 10. Does the practice have a clinical lead for Hypertension? / Name of nominated lead / A / Q
CO 11. Does the practice have an operational guideline/protocol for the provision of systematic care for its patients with hypertension? / A practice based protocol being used within the practice / A / Q
CO 12. The percentage of patients with hypertension who have received a risk assessment within the last 3 years. / The percentage of patients with hypertension who have received a risk assessment within the last 3 years. / A / Q
Section Two: National Priorities
Clause / Details / Evidence / Grade / CO/Q

Human Resources Management

Paragraph 3.2.1. The Contractor shall comply with all current national statutory employment requirements and related NHS policy.
Human Resources Objectives
Modern Human Resource Management practices are required to plan effectively at a local level and to ensure that they can recruit and retain a workforce that has the capacity, skills, diversity and flexibility to meet the demands of the service.
Practices should ensure that all staff have a contract that conforms to Health & Safety legislation, including working hours, equal opportunities, transfer regulations and any new legislation introduced during the term of the practice.
From 1 October 2004, part of the Employment Act 2002 will come into force making it a legal requirement for all organisations to have disciplinary and grievance procedures in place.
Practices should operate recruitment and selection processes that are open and transparent. This should include:
  • An objective selection procedures for short listing, the interview process and the interview panel
  • Appropriate training in recruitment and selection processes.
  • A monitoring process to ensure compliance
/ CO 77. Do all members of practice staff have contracts of employment that conform to Health and Safety Legislation? / A copy of the contract of employment for the most recently employed member of staff. / A / Q
CO 78. Does the practice have disciplinary, appeals and grievance procedures? / Evidence that the practices procedures are comply with the Employment Act 2002. / A / Q
CO 79. Does the practice operate an open and transparent recruitment and selection process, which includes short listing and the interview process? / There is a written procedure complete with monitoring process and evidence of the training undertaken by recruitment and selection officer / A / Q
Section Two: National Priorities
Clause / Details / Evidence / Grade / CO/Q

Improving Working Lives

The Practice will demonstrate they are working towards the following, taken from the Improving Working Lives standard – NHS HR Management Framework:
  • Accepting joint responsibility with staff to develop a range of working arrangements that balance the needs of patients, staff and services
  • Understanding all staff have a vital role in contributing towards patient care and meeting service needs
  • Providing personal & professional development & training opportunities that are equally accessible and open to all staff irrespective of working patterns
  • Ensuring clinical staff have access to professional supervision & support
  • Establishing policies and practices that enable staff to manage a healthy balance between work and outside commitments
  • Actively investing in improving diversity and tackling discrimination and harassment
  • Establishing proper partnerships with staff and their representative organisations, by involving them in decisions as an integral part of effective service delivery.
/ CO 80. Has the practice developed any working arrangements, which have helped to balance the needs of the staff, patients and services? If so, did the practice staff have joint responsibility? / There is evidence of change working arrangements and staff taking joint roles and responsibilities / B / Q
CO 81. Do all staff feel that their role in contributing towards patient care is understood?
(A variety of staff should be asked this question) / All staff members believe that their role in contributing towards patient care in understood / B / Q
CO 82. Is there evidence that training and development opportunities are available to all staff irrespective of work patterns? / All members of staff have a Personal Development Plan and has a training schedule for staff needs been produced / B / Q
CO 83. Does each member of the clinical staff have a mentor/clinical supervisor? / All of the Clinical staff has a clinical supervisor or mentor / B / Q
CO 84. Is there any evidence of flexible working policies, which balances work and outside commitments? / There is a practice specific flexible working polices that is being used within the practice / B / Q

Significant Event Monitoring

Paragraph 3.3.1. The Contractor will report all adverse health care events in line with national policy guidance and clinical governance arrangements.
The Practice will identify a person within the practice to co-ordinate the reporting of events. / CO 70. Has the practice identified a designated person with the practice who reports on significant events? / Name of nominated person / A / Q
Section Two: National Priorities
Clause / Details / Evidence / Grade / CO/Q

Risk Management

Paragraph 3.4.1. The Contractor will introduce appropriate mechanisms for the management of risk, which are in accordance with the local policies and procedures of the PCT. The Contractor will comply with these mechanisms at all times and will provide to the PCT controls assurance of its compliance with all applicable statutory regulations.
  • All practices should have a risk management policy.
  • All practices should have a health & safety policy folder specific to their practice.
  • All staff should receive regular training in fire, manual handling, risk identification and have had incident reporting
/ CO 85. Is there evidence of a risk management policy? / There is a policy in place with evidence of action / A / Q
CO 86. Does the practice have a Health and Safety Policy folder specific to their practice? / There is an up to date Policy folder in place, which is easily accessible to all staff / A / Q
CO 65. Have all of the practice staff received regular fire, manual handling and risk identification training? / All staff are trained in all areas / B / Q
Section Three: Minimum PMS Requirements
Clause / Details / Evidence / Grade / CO/Q

Premises