Wolverhampton City Primary Care Trust

Excellence in

Primary Health Care

A development framework designed to help practices comply with Standards for Better Health and Statutory and Contract Monitoring to ensure compliance with nGMS contract

CONTENTS

Subject / Domain Number / Page
Introduction / 2
Establishment Profile / 4
Safety / 1 / 6
Clinical and Cost Effectiveness / 2 / 10
Governance / 3 / 11
Patient Focus / 4 / 15
Accessible and Responsive Care / 5 / 17
Care Environment and Amenities / 6 / 18
Public Health / 7 / 22
Appendix One: Annex B, nGMS Contract / 24
Appendix Two: Standards for Better Health Quick Reference / 25

INTRODUCTION

The document ‘Standards for Better Health’ produced by the Department of Health aims to move the health care system from one that is driven by targets to one in which standards are the means to deliver continuous improvement in quality.

As a consequence of this change in direction and emphasis, a number of PCTs throughout the country, including Wolverhampton, are currently exploring ways of supporting the introduction of quality and performance standards to general practices.

THE FRAMEWORK

This Framework was originally produced by the LMC and PCT in Liverpool and has been modified for use in Wolverhampton by practices, PCTs and the LMCs. The Framework has been developed taking full account of the statutory requirements of the new GMS Contract, the GMC’s Good Medical Practice and the new national standards which are mandatory for all health care organisations including GP practices. The structure of the Framework is based on the requirements of ‘Standards for Better Health’ QOF and Contract monitoring and the different sections reflect each of the standards as follows:-

1Safety

2Clinical and Cost Effectiveness

3Governance

4Patient Focus

5Accessible and Responsive Care

6Care Environment and Amenities

7Public Health

Links to other Frameworks

Indicators that are purely related to Standards for Better Health are aspirational and without links to Contractual & Statutory Regulations or QOF and are indicated as such. Other key indicators arehighlighted in the ‘links’ column of each domain for PCT cross-referencing purposes. Although these indicators are not related directly to Contractual and Statutory Requirements, they will provide Practices with a reference tool for further reading and evidence sourcing across the whole standards framework.

The following documents are appended for ease of reference:

Appendix One Annex B, nGMS Contract: Contractual & Statutory Regulations

Appendix Two Summary of the Standards for Better Health Core and Developmental Standards

KEY:SfBH= Standards for Better Health

C & SR= Contractual and statutory requirements (Annex B nGMS Contract)

QOF= Quality and Outcomes Framework indicators (nGMS Contract)

SUPPORT TO PRACTICES

The framework is intended to support practices to put in place ‘a system of clinical governance which enables quality assurance of its services and promotes quality improvement and enhanced patient safety’.

QOF is a quality system which provides practices with financial rewards for providing high quality care in a number of clinical, organisational and patient experience domains. Clinical Governance is however much broader and this Framework encourages practices to put in place systems and processes that enable the delivery of outcomes and at the same time ensure compliance with the new contractual and statutory requirements of the new GMS arrangements.

KEY BENEFITS

FOR PRACTICES

The Framework is developmental and allows practices and PCTs to performance manage the new contractual arrangements in a more supportive environment. It is acknowledged that practices may not have all components in place but this document identifies areas to be tackled.

PCTs will be able to identify and prioritise the additional resources, facilitation and educational support required in a consistent way to enable practices to implement Development Plans agreed as part of the document.

Standards receive a straight yes or no answer on the basis of supporting evidence. Any serious concerns that arise about performance will be dealt with through performance management procedures that are in line with professional standards and new contract regulations.

FOR PCTS

All practices will be encouraged to agree Developmental Plans that enable them to achieve and improve standards as outlined in the document.

It enables medical practice contracts to be performance managed in line with DoH requirements.

Provides the ability to evidence to the Healthcare Commission the progress being made towards achieving the developmental standards referred to in ‘Standards for Better Health’.

FOR LMCS

Demonstrates a continuing commitment to work constructively with PCTs in supporting practices to provide a range of high quality, accessible service for patients.

Establishment Profile

Main Site / Other Sites / List Size
Name / Computer System / Emis
Address
Address
City
Post Code
Direct Line
Fax Number
E-Mail Address
Employers Liability Insurance / Tower Gate MIA / Not available Come back to see it
Whole Time Equivalent GP's based on 9 Sessions, all others 35.5 hours per week / WTE / Registrations GMC Number / Registration MDU/MPS number / Performers List / Other Accreditation / Annual Appraisal / CRB Check / Hepatitis B status from QOF
GPs / Yes / Not confirmed
GPs
GPs
GPs
GPs
GPs
Regular Locum
Registrations pin Number / Registration MDU/MPS number -Month & Year / Annual Appraisal / CRB Check / Hepatitis B status from QOF
Nurses / No
Nurses
Nurses
Nurses
NVQ Qualifications / Registration MDU/MPS number -Month & Year / CRB Check / Hepatitis B status from QOF
Health Care Assistants
Health Care Assistants
Health Care Assistants
Attached Pharmacists / RPSGB
Prescribing Status
Health visitor
Midwife
Registration
Practice Manager / 20 / No / Yes
Practice Manager / Yes
Administration Staff / 4 / No
Reception Staff / 20 / Yes
30 / Yes
18 / Yes
23
28

DOMAIN ONE – SAFETY

Ref / Contracting
requirements / Standards for Better Health Indicator / Statutory Obligations / Evidence in Practice / Practice Checklist Yes/No
Delete as appropriate / Evidence/PCT Support / PCT Compliance Checklist Yes/No / Comments / Links
1 / See links / SfBH C1,
C8 C14 / Significant event/audit reporting / There is an effective policy and pathway for identification and reporting of significant events / Yes
No / Folder of reported events and agreed actions. / Yes / Policy and event log / QOF Ed 7
Ed 10
Staff are trained and regularly participate in SEA systems / Yes
No / Notes of practice meetings. / No / No staff have been trained the GP and the PM have agreed the policy not formal implementation or training done ACTION REQUIRED 8th September 2008
2 / C & SR20 / SfBH C1, C8, D1 / Patient Protection
Individual healthcare professionals should be able to demonstrate that they comply with the national child protection guidance, and should provide at least one critical event analysis regarding concerns about a child’s welfare if appropriate. Standards for better general practice / Prompt action is taken on patient safety notices, alerts and communications / Yes
No / Policy attached / Yes / Policy for alerts seen / QOF Mgt 1
Staff are trained and regularly participate in SEA systems / Yes
No / Examples / No / No training ACTION REQUIRED 8th September 2008
The practice has a written risk assessment procedure / Yes
No / Procedure / No / No Policy ACTION REQUIRED 8th September 2008
Staff participate in Risk Management Training / Yes / Who/When / No / No formal training ACTION REQUIRED 8th September 2008
There is an effective child and vulnerable adult protection procedure / Yes
No / SET procedure available in practice / Yes / The PCT file is available, the staff know where it is kept
Staff are trained in child protection and patient protection procedures / Yes
No / Details / No / No training ACTION REQUIRED 8th September 2008
Contact details of PCT child protection advisors and social services are accessible to all / Yes
No / Notice / Yes / Part of child protection file
3 / C & SR 7 / SfBH C1, C4, C10, C20, C21 / Infection Control
The premises, equipment and arrangements for infection control and decontamination meet the minimum national standards / There is an effective infection control policy and system which pays due regard to risk assessment and is environmentally friendly / Yes
No / Policy attached / No / No Policy discussion with the Pm and Nurse infection control needs to be reviewed ACTION REQUIRED 8th September 2008 / QOF M+
gt 1
Staff follow NICE Clinical Guidelines – Infection Control – prevention of healthcare associated infection in primary and community care / Yes
No / Examples / No / Discussion with the nurse could not provide any evidence that NICE was included in the day to day infection control management. No Policy review The PCT have carried out two general infection control inspection in the last 12 months they reached 56% ACTION REQUIRED 6th September 2008
Are single use disposable instruments used? If not are there clear up to date procedures for the cleaning, disinfection, inspection, packaging, disposal, sterilisation, transporting and storing of reusable medical equipment and devices / Yes
No / Procedure / Yes / Procedure discussed with the nurse . No policy
single use confirmed
Staff are trained on the use and decontamination of equipment / Yes
No / Who/When / No / No formal training ACTION REQUIRED 6th September 2008
4 / SfBHC1,4,21 / Equipment / There is equipment monitoring and maintenance schedules according to manufacturers instructions / Yes
No / Schedules written procedure / No / NX service all in house equipment: unable to find the schedule for the practice equipment ACTION REQUIRED 6th September 2008 / QOFMgt 7
5 / C & SR 4
C & SR5
C & SR 19
C & SR24
C & SR25
C & SR23 / SfBH C2, C3, C4, C5, D1 16 / Medicines
The practices adhere to the requirements of the Medicines Management Act for storage, prescribing, dispensing, recording and disposal of drugs including controlled drugs.
Batch numbers are recorded for all vaccines administered.
Vaccines are stored in accordance with the manufacturer’s instructions
For vaccines and immunisations, fridges in which vaccines are stored have a maximum thermometer daily readings take place on working days
For vaccines and immunisations, staff involved in administering vaccines are trained in the recognition of anaphylaxis and able to administer appropriate first-line treatment when it occurs
For vaccines and immunisations, consent to immunisation, or contraindications if they exist, are recorded in the records. / There is Practice Medicines policy which consists of the following: / Yes
No / Policy attached / No / Medicines management policy is not complete or robust enoughACTION REQUIRED 6th September 2008 / QOF Meds 2, Recs 8, Ed1+5, Med 2Recs 8
A written up to date controlled drugs policy for the management of controlled drugs in practices that keep controlled drugs / Yes
No / Policy attached / No / Not included in the policy ACTION REQUIRED 6th September 2008
A written guideline for the safe and secure handling of medicines in practice in line with the Medicines Management Act of 1968 / Yes
No / Written guidelines attached / No / Not included in the policy ACTION REQUIRED 6th September 2008
A written procedure for managing the drugs kept in the Doctor’s bag and the upkeep of the bag / Yes
No / Procedure attached / The GP does not have a bag,
A written policy on prescription security in the practice / Yes
No / Policy attached / Yes / Policy seen
A written policy for the handling administration and storage of vaccines / Yes
No / Policy attached / No / No PolicyACTION REQUIRED 6th September 2008
Vaccines – document following information:
Vaccine name
Dose given
Site administered
Batch number
Expiry date / Yes
No / Evidence seen in patient record / No / On the set of notes reviewed the position on the two the site administered was not recorded whtrn the nurse was asked her reply was some times I do sometime I don’t record. ACTION REQUIRED 6th September 2008
Appropriate practice staff attend CPR and anaphylaxis training / Yes
No / List of attendees with dates attended / No / List for non clinical ok to 2009 GP and Nurse ran out in November 2007 training due next month
There is a up to date practice anaphylaxis shock kit / Yes
No / Seen in the practice / Yes / Seen and kept in the nurses room
Written consent and contraindications are recorded in the Personal Child Health Records and in practice patient records / Yes
No / Policy attached / No / No PolicyACTION REQUIRED 6th September 2008
A comprehensive written practice policy on repeat prescribing / Yes
No / Policy attached / Yes / Policy seen
Ref / Contracting
requirements / Standards for Better Health Indicator / Statutory Obligations / Evidence in Practice / Practice Checklist Yes/No
Delete as appropriate / Evidence/PCT Support / PCT Compliance Checklist Yes/No / Comments / Links
6 / C & SR9 / SfBH C2,6,10,11 / Medical Protection
All professionals working in the practice are covered by appropriate indemnity insurance / Professional staff hold adequate insurance against liability arising from negligent performance of clinical services / Yes
No / Renewal dates / No / When the nurse was askedif she had adequate insurance cover she said I did not know I had to have it she was referred to RCN for confirmation her cover ACTION REQUIRED 6th September 2008

DOMAIN 2 – CLINICAL AND COST EFFECTIVENESS

DOMAIN 3 - GOVERNANCE

Ref / Contracting
requirements / Standards for Better Health Indicator / Statutory Obligations / Evidence in Practice / Practice Checklist Yes/No
Delete as appropriate / Evidence/PCT Support / PCT Compliance Checklist Yes/No / Comments / Links
9 / C & SR21 / SfBH C8, C9, C10, C11, C12, C13 & C14
D2 / Clinical Governance
All practices have in place systems of clinical governance which enable quality assurance of its services and promote quality improvement and enhanced patient safety.
The underpinning structures within a practice, which will assure embedding of clinical governance through a nominated clinical governance lead. / The practice has a named Clinical Governance Lead who will co-ordinate Clinical Governance activities / Yes
No / Who? / Yes / Dr .....
Regular multidisciplinary meetings are held to discuss all Clinical Governance Issues / Yes
No / Minutes / No / No MeetingsACTION REQUIRED 6th September 2008
The practice has identified at least one example of best practice to the PCT this year / Yes
No / Example / No / Nothing identified
10 / C & SR16
C &
SR 17 / SfBH C2, C7, C12, C17
D2 / Employment, Induction and Training
The practice complies with current legislation on employment rights and discrimination.
All staff have written terms and conditions of employment conforming to or exceeding statutory minimum. / There is a practice induction and training programme for new staff / Yes
No / Programme / Yes / Policy seen / QOFEd 4Mgt 10
CRB checks are undertaken for all staff according to current regulations / Yes
No / Summary / No / Will do them for all new staff starting from now
Employees are provided with information, which conforms to Section 1 of the Employment Rights Act 1996 / Yes
No / Sample / No / They were not given any employment information single page contract no detail ACTION REQUIRED 6th September 2008
Staff have a written job description, contract of employment including disciplinary procedure / Yes
No / Sample / No / The Job Descriptions seen at the visit were not job descriptions just a few bullet points contract of employment not robust ACTION REQUIRED 6th September 2008
The practice has a complaints procedure for cases of discrimination, harassment and victimisation / Yes
No / Procedure attached / No / The policy is not robust enough it does not include the NHS complaints process, it does not outline what the process for patient to complain were the PM said she thought it was for the staff onlyACTION REQUIRED 6th September 2008
Staff supervision arrangements comply with relevant professional standards and guidelines / Yes
No / Explanation / No / No evidence ACTION REQUIRED 6th September 2008
11 / C & SR 8 / SfBHC11D2 / Professional Registration
The practice ensures that all healthcare professionals who are employed by the practice are currently registered with the relevant professional body on the appropriate part(s) of its Register(s) and that any employed general practitioner is a member of a recognised medical defence organisation and registered on a primary care performers list (or equivalent). / The practice ensures that the appropriate checks with statutory bodies are made before applicants take up post and during their appointment
Professional Standards: GMC, RCGP, BMA
Nursing and Midwifery Council
Health Professional Council / Yes
No / Registration renewal dates / No / ……….. is responsible for booking locum she was not on site for the visits confirmation of process required ACTION REQUIRED 6th September 2008
12 / C & SR10 / SfBHC12, C13D2 / CPD
All doctors have an annual appraisal / GPs participate in the national GP process (co-ordinated by the PCT according to GMC guidance)
Professional Standards:
GMC Revalidation Process
- Licence to practice and Revalidation folder of evidence / Yes
No / Dates of latest / Yes / Dr ..... confirmed his next appraisal was due in December 2008 / QOF Ed 8 & 9
13 / SfBHC12, C13D2 / Professional Development
(QOF – Nurses) / CPD for all personnel in line with the local and national policy requirements / Yes
No / Learning plan / Yes / Dr ..... confirmed he had a PDP not available / QOFEd 8
The practice ensures staff attend appropriate training courses as part of Personal Development Plans / Yes
No / Examples / No / There is no training offered to the staff the P.M and another member of staff confirmed this ACTION REQUIRED 6th September 2008
Staff have access to skills update training courses / Yes
No / Examples / No / No evidence ACTION REQUIRED 6th September 2008
14 / C & SR 14 / SfBHC13D2 / Clinical Performance
If the team uses a computer, it is registered under, and conforms to the provisions of the Data Protection Act. / There is a system for the identification and remedy of poor monitoring effectiveness
Appraisal
Confidential reporting systems
Performance monitoring
Professional Standards:
GMC – Good Medical Practice – Conduct or performance of colleagues
GMC – fitness to practice procedures / Yes
No / Description / No / The appraisal process is purley for QOF, The contract of employment is on one A4 sheet and is not detailed enough or include any performance issues or monitoring
PM, Nurse, & …….O/SACTION REQUIRED 6th September 2008
15 / SfBHC5, C10, C11, C12, C13, C14D2 / Ethics / The practice has a system to identify staff who are not abiding by their published codes of professional practice.
Professional Standards:
GMC – Good Medical Practice
-Observance of professional ethical obligations / Yes
No / No / ………….. is responsible for booking locum she was not on site for the visits confirmation of process required practice enurse has not had her appraisal ACTION REQUIRED 6th September 2008

DOMAIN 4 – PATIENT FOCUS