Practice manager Laurence Bernthal explains how his practice met the challenge of being nominated for assessment for a Charter Mark

Our practice was awarded a Charter Mark in 1998 and subsequently achieved Beacon status for sharing good practice in the primary care environment. Over the next 3 years we found that aiming for the Charter Mark standards provided a positive influence, bringing significant patient and organisational benefits to the practice.

In 2001, greatly encouraged by being nominated by more than 1000 patients, we decided to apply once again for assessment for a Charter Mark by demonstrating our commitment to patient care. The rigorous assessment process would provide a challenge to the practice to measure itself against 10 criteria that are used to benchmark excellence in public service.

The Charter Mark criteria required the practice to:

  • Set standards
  • Be open and provide full information
  • Consult and involve
  • Encourage access and the promotion of choice
  • Treat all fairly
  • Put things right when they go wrong
  • Use resources effectively
  • Innovate and improve
  • Work with other providers
  • Provide user satisfaction.

Setting standards

In clinical matters we aim to set ourselves achievable standards against which we can realistically measure our performance (see Box 1, below).

Box 1: Setting Charter mark standards
Headline standard Standard Measure Actions
Waiting times To keep to appointment times See 90% of patients within 20 minutes of their appointment time Audit against computerised appointment system
Repeat prescription requests To provide repeat prescriptions Issue repeat prescriptions within 2 working days of request Regular audit
Flu vaccination To meet national standard 60% of over 65-year-olds should be vaccinated against flu

Measure performance (75% achieved)

Innovations

To improve the patient experience, the practice has introduced several innovations. For example, new services such as minor surgery, physiotherapy, dermatology clinics and a phlebotomy service mean that patientsÍ visits to hospital have been reduced (see Box 2, below).

Box 2: Innovations introduced by the practice
Objective Innovation Improvement Benefits
To reduce patient hospital visits Introducing more in-house patient services Minor surgery and dermatology clinics; physiotherapy and phlebotomy services Enhanced patient care
To improve overall health of patients Introducing health improvement programmes Exercise on prescription
Slimming by referral
Improved patient health
Weight reduction
To be proactive in managing chronic medical conditions Introducing specific equipment Spirometer introduced
ECG monitor introduced
Improved patient care
To protect the health of patients travelling overseas Providing tailored advice for patients Personalised vaccination requirements produced by computerised system
Surgery designated a yellow fever vaccination centre
Increased number of vaccinations
To improve repeat prescription service Using IT to improve communication Patients can request repeat prescriptions through practice web site and by fax Efficient processing of repeat prescriptions
To improve processing of pathology results Using IT to improve communication Electronic transfer of results from pathology laboratories Results are received sooner
Paperwork is reduced

Access and choice

The practice encourages access and promotes choice in a variety of ways. Appointment times for GPs, practice nurses and specialist services are managed by a computerised appointment system, which allows patients to choose times suitable for them.

Other ways in which we have ensured patient access and choice include:

  • Having four male doctors and two female doctors
  • Two surgery locations - the main and the branch surgeries
  • Surgeries do not close for lunch
  • Disabled access at both sites, with lift facilities at the main surgery
  • Good toilet facilities, including toilets for the disabled
  • A visual call system at the main surgery to reinforce the tannoy call system
  • Arrangements for local pharmacists to collect prescriptions
  • All day Saturday flu vaccination clinics. Patients typically wait no more than 5 minutes and a maximum of 10 minutes.

Treating all fairly

The Charter Mark criterion to treat all fairly reinforces one of the basic principles of the practice - not to discriminate against any group of patients.

The practice has sought to encourage everyone to make use of our services in the following ways:

  • Health visitors offer ïdrop-inÍ baby clinics so that parents with childcare problems can drop in for advice without having to book an appointment
  • Providing baby hearing tests
  • Providing baby changing facilities
  • Offering an annual over-75 health check
  • Clinic times are arranged so that appointments are available outside normal working hours for those who require it
  • Nurse triage for home visit requests and minor illness clinics
  • Introducing a patientsÍ participation group to act as a link between patients and the practice.
  • All members of practice staff are encouraged to ïdo our best to say ñyes,îÍ and to ïfind ways to say ñyesîÍ.

Putting things right

The practice has adopted a positive attitude to putting things right. Feedback and patient complaints are considered learning opportunities rather than threats.

Our complaints procedure ensures that complainants receive a formal reply within 10 working days and if this is not possible, perhaps because investigations are taking longer, the patient is advised of the situation.

Members of the practice staff are prepared to learn by taking action to avoid the problem occurring again. A learning culture seeks to understand the ongoing difficulties of general practice and to communicate shared experiences that may generate positive change. To achieve this several groups meet regularly:

  • The practice and community nurses meet each week with one of the partners to discuss the service they give patients.
  • The practice receptionists meet every 8 weeks to discuss the service they provide to patients.
  • A working group consisting of one partner, the practice manager, senior receptionists, one practice nurse, a member of the administration team and a community nurse, discuss the efficient operation of the practice. This is a proactive group that identifies areas where change can improve the experiences of many of the stakeholders.
  • A significant event meeting enables significant clinical, patient service and administrative events to be discussed without apportioning blame, so that lessons can be learnt and changes put into practice.
  • A regular meeting, generally monthly or more frequently if needed, of all the partners and the practice manager to discuss issues central to the efficiency and effectiveness of the practice.

Working with other providers

The practice works closely with the Greater Derby PCT, cooperating with initiatives that seek to achieve improvement in patient care. Other links exist between the practice and the local consultant dermatologist, the Citizens Advice Bureau, and the University of Nottingham School of General Practice.

Teamwork, innovation, a proactive approach to improving the patient experience and the application of business principles including strategic planning, financial management and budgetary control and human resource and asset management are the foundations for the ongoing efforts of the practice.

The Charter Mark criteria and the aspiration of all staff at the practice to establish a culture of best practice has provided patients with a model of good patient service, and resulted in the award of the Charter Mark to the practice for a second time.

Guidelines in Practice, February 2003, Volume 6(2)
© 2003 MGP Ltd
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