Q One of the requirements of the DoH's Raising Standards for Patients: New Partnerships in Out-of-Hours Care document that we shall need to comply with is that patient calls are recorded (Standard 6). Many GPs (I am one) cover their own on-call. What equipment can we use to record the calls at home? What can one use if the calls are received on the mobile phone, at home, in the car, on the road, or at another patient's home?
A The report Raising Standards for Patients: New Partnerships in Out-of-Hours Care was produced in 2000, and commissioned by John Denham, Health Minister. The report was subtitled 'An independent review of GP out-of-hours services in England'.
The committee, chaired by Dr David Carson, took advice from a number of sources, including GPs, GP co-operatives and commercial deputising services.
The report contained 22 recommendations. Recommendation 6 states: 'All providers of out-of-hours services should put in place appropriate systems for call abandonment, time taken to answer the call, call recording and the recording of all clinical consultations.'
Remember that these are recommendations, and have not yet been negotiated or agreed by the General Practitioners Committee of the BMA. As all GPs will be aware, the GPC is currently negotiating a new GMS contract, and out of hours will be part of these negotiations.
The author of the recommendations envisaged that commercial deputising services and cooperatives either already have, or will be required to have, the technology to deliver recommendation 6.
The original report states that practices like your own, who provide their own out-of-hours service, would be able to comply with recommendation 6 by using NHS Direct as the first point of contact.
Individual practices would not be able to afford such equipment.
It seems unlikely that NHS Direct will be able to deliver the first point of call contact for all out of hours within their current capacity. This would appear to be many years off and would require significant extra investment.
My advice is to make good records of all consultations with patients whether they be face to face or via a telephone. This record may be in written format, or in electronic format in the patient's electronic health record.
Do not make an audio recording of a consultation without informing the patient first; if you do, you will be breaking the law.
Q Where can I find good patient information leaflets on the internet?
A The four websites listed below are good sources of patient information:
This site is produced by Doctor Online. It contains a very comprehensive list of high quality patient information leaflets, plus much more. The quality of the diagrams on some of the leaflets, e.g. otitis media, are excellent.
Whatever your view on PRODIGY overall, most GPs agree that the PRODIGY patient information leaflets are excellent.
This is a useful site that patients can access. It also contains some very good audiovisual clips.
This site provides a gateway to many very good sites that contain patient information leaflets.
Q Our primary care trust (PCT) is encouraging all practices to take part in the PRIMIS programme. Our clinical governance lead has stated that part of his role will be to examine the extracted data and ensure that GPs are not committing any wrongdoing by looking at individual patient records. Is this OK?
A The PRIMIS1 programme will assist in improving data quality in many practices. There needs to be commitment from the practice, and many PCTs have found funding to assist practices in moving down this route.
PRIMIS is not intended to be used to monitor individual GP's performance. If you suspect that this is being done you should report it to your LMC.
Any data extracted from a clinical system can only be shared with a third party if it is anonymised, i.e. there are no patient-identifiable data. The only exception to this is if each individual patient gives explicit, written consent. To supply identifiable data without explicit consent breaches the Data Protection Act and also GMC guidelines.
I suggest you point this out to the clinical governance lead and express surprise that he/she was unaware of these facts. Then stop providing data until this has been rectified.
- Watson N. PRIMIS will ensure effective use of practice computers. Guidelines in Practice July 2001; 4(7): 76-8.