Providing information for patients should enable GPs to claim maximum points, but first check that your systems comply with the indicators, says Dr Matthew Lockyer
The aspirations of the new GP contract’s quality indicator system are rooted in good practice, and this is true of both clinical and organisational indicators.
The nonclinical areas offer points for systems that will already exist in many practices. In order not to miss out on easily available points, practices must check that their systems can be verified by PCO assessors and are fully compliant with the contract. Non-clinical indicators are worth a maximum of 500 points.
Information for patients
Information for patients, a subsection of the organisational indicators, offers a maximum of 8 points (Box 1, below), which most practices should be able to achieve.
|Box 1: Information for patients|
|Information 1||The practice has a system to allow patients to contact the out-of-hours service by making no more than two telephone calls||0.5|
|Information 2||If an answering system is used out of hours, the message is clear and the contact number is given at least twice||0.5|
|Information 3||The practice has arrangements for patients to speak to GPs and nurses on the telephone during the working day||1|
|Information 4||If a patient is removed from a practice’s list, the practice provides an explanation of the reasons in writing to the patient and information on how to find a new practice, unless it is perceived such an action would result in a violent response by the patient||1|
|Information 5||The practice supports smokers in stopping by a strategy, which includes providing literature and offering appropriate therapy||2|
|Information 6||Information is available to patients on the roles of the GP, community midwife, health visitor and hospital clinics in the provision of ante-natal and post-natal care||0.5|
|Information 7||Patients are able to access a receptionist via telephone and face to face in the practice, for at least 45 hours over 5 days, Monday to Friday except where agreed with the PCO||1.5|
|Information 8||The practice has a system to allow patients to contact the out-of-hours service by making no more than one telephone call||1|
Access to out-of-hours care – Information 1, 2, 8
Three of the indicators relate to systems for patients to gain access to out-of-hours care. Standards for ease of access out-of-hours were specified in reports for England and Wales and for Scotland, and the indicators are based on them.1,2
Information 1, worth half a point, requires that a patient can contact the out-of-hours services by making no more than two phone calls. It applies to those practices that still use a telephone answering machine to advise patients about access to out-of-hours care.
Information 2, for a further half-point, demands that any answering machine message is clear and the relevant contact number given at least twice.
It is sensible to ensure that members of staff have a written protocol for checking that the answering machine is activated when the surgery is closed. A specimen message should be left with the machine in case it is accidentally erased.
Information 8, worth one point, rewards practices that use a call transfer system where a single call to the practice is re-routed to the out-of-hours answering service.These systems are widely available and economical. In the event of a system failure, staff should have the contact details of someone who will rectify the fault.
All call systems will be verified by a trial call made by the PCO assessors before any visit to the practice.
Many practices will be able to claim the points with their existing systems. Some very rural practices may still be using a telephone answering machine giving the doctor’s home number, which may necessitate a third call if he or she is not immediately available. These are probably special cases and may be argued as such.
The rest of us need to ensure that our systems are robust and that the practice staff understand them.
Increasingly, practices are using an automated call filter system to take calls when the surgery is open, and I suspect that future quality markers may assess these systems for ease of use.
Information 3 specifies that the practice has arrangements for patients to speak to GPs and nurses on the telephone during the working day. This is worth one point. It does not distinguish between the many ways in which a practice may use the telephone as an aid to consultation. Most practices have a message book to allow clinical staff to pick up messages at the end of surgeries and return calls. Some paper-free practices can use a computerised messaging service to perform the same function. Some practices have dedicated time for telephone consultations and triage.
Whatever the arrangement, it should be clear in the practice leaflet and other sources of patient information. Staff should know how the system works so that they may confidently advise patients.
Information 4 refers to the removal of patients from the practice list. It is worth one point. The practice should have a written policy for removal, which includes a written statement for the patient about the grounds for removal and advice on finding a new practice. If it is thought that such an action might provoke a violent response from the patient, the practice is exempted from the requirement.
A complaint from the patient should not be used as the sole justification for removing him or her from the practice list.
These recommendations are supported by the GMC and the RCGP.3,4 It is worth noting that the Health Service Ombudsman has already upheld several complaints against practices that failed to follow these precepts.
Ours is a rural practice and does not have some of the problems faced by urban practices. Except in cases of violence or threatened violence, our practice has a policy of issuing a written warning backed up with a face to face meeting before asking any patient to leave the list. Since we introduced this policy several years ago we have only had to remove one or two patients from the list.
Information 5, worth one point, specifies that the practice should have a coherent policy to support smokers in stopping smoking, through providing information and offering appropriate therapy.4
The strategy itself can be taken from national or local guidelines. The UK has a good record of using evidence for smoking cessation guidelines.5 Many practices are supported in this by the PCO.
Our PCT has a nurse specialist who runs clinics for complex smoking cessation problems and also supports practice nurses who run practice-based clinics.
Prescribing data analysis is the proposed strategy for verifying claims, although many practices audit their quit rates and have full evidence of their activity.
Information 6 requires information about the roles of the members of the extended primary healthcare team involved with ante-natal and postnatal care to be readily available.
The practice leaflet should contain information about the services provided and the reception team should be able to supply more details or leaflets on demand. If possible, this information should name the professionals on the local team. It is wise to update information regularly as team members change and antenatal care protocols are reviewed.
Finally, Information 7, worth one and a half points, specifies that a receptionist should be available by telephone or face to face for at least 45 hours over 5 days, Monday to Friday. Exceptions, for example for branch surgeries or practices in very rural areas, may be agreed with the PCO. For the rest of us it means being open for our patients for 9 hours every weekday.
Many surgeries close their doors for an hour at lunch-time but have a receptionist manning the phone. However, even without this set up most surgeries will probably fulfil the indicator’s requirements. In our area, most surgeries work from 8 am to 6.30 or 7 pm.
Details of hours of availability are already submitted to the PCO, so this is one point most of us will get just for turning up to work!
The information for patients section of the organisational indicators should give many practices some easy points, but it is sensible to read the indicators carefully and make sure your existing systems comply before claiming them.
- Department of Health.Raising the Standards for Patients: New Partnerships in Out-of-Hours Care. London: DoH, 2000.
- The Scottish Office. GP Out of Hours Services: Working Group Report October 1998. Edinburgh:The Scottish Office, 1998.
- General Medical Council. Good Medical Practice. London: GMC, 2001.
- Royal College of General Practitioners. Removal of Patients from GP’s Lists: Guidance for College Members. London: RCGP, 1997. www.rcgp.org.uk/corporate/position/removal/index.asp
- Peto R, Darby S, Deo H, Silcocks P,Whitley E, Doll R. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. Br Med J 2000; 321: 323-9.
- Silagy CA, Stead LF, Lancaster T. Use of systematic reviews in clinical practice guidelines: case study of smoking cessation. Br Med J 2001: 323; 833-6.