The new contract’s practice management indicators are based largely on good working practices so maximum points should be achievable, says Dr Nigel Watson


   

Practice management is one of the five areas covered by the organisational indicators of the new GMS contract.1 This area consists of 10 indicators together worth 20 quality points, which should be achievable by all practices (see Table 1, below).

Table 1: Practice management indicators
Indicator Points

Management 1
Individual healthcare professionals have access to information on local procedures relating to child protection

1

Management 2
There are clearly defined arrangements for backing up computer data, back-up verification, safe storage of back-up tapes and authorisation for loading programmes where a computer is used

1.5

Management 3
The hepatitis B status of all doctors and relevant practice employed staff is recorded and immunisation recommended if required in accordance with national guidance

0.5

Management 4
The arrangements for instrument sterilisation comply with national guidelines as applicable to primary care

1

Management 5
The practice offers a range of appointment times to patients which as a minimum should include morning and afternoon appointments five mornings and four afternoons per week, except where agreed with the PCO

3

Management 6
Person specifications and job descriptions are produced for all advertised vacancies

2
Management 7
The practice has systems in place to ensure regular and appropriate inspection, calibration, maintenance and replacement of equipment including:
  • A defined responsible person
  • Clear recording
  • Systematic pre-planned schedules
  • Reporting of faults
3

Management 8
The practice has a policy to ensure the prevention of fraud and has defined levels of financial responsibility and accountability for staff undertaking financial transactions (accounts, payroll, drawings, payment of invoices, signing cheques, petty cash, pensions and superannuation etc.)

1

Management 9
The practice has a protocol for identifying carers and a mechanism for the referral of carers for social services assessment

3

Management 10
There is a written procedure manual that includes staff employment policies including equal opportunities, bullying and harassment and sickness absence (including illegal drugs, alcohol and stress), to which staff have access

4

Once the initial work is complete, the rewards can be achieved each year. In 2004-5 this area will be worth £1500 for the practice with an average list size, rising to £2400 in 2005-6.

Tackling the practice management indicators

Child protection procedures – indicator 1

Every PCO will have access to a child protection expert, and the practice should first make contact with him or her. Similarly, every area will have local child protection procedures and you should obtain a copy – an electronic version will facilitate access by all the practice staff.

It would be useful to arrange a meeting between the primary healthcare team and the local child protection experts to discuss these procedures. The practice can then decide if it wishes to develop them further. It is also worth considering covering this topic in staff training.

At an assessment visit the practice may be asked to demonstrate how they can access the procedures, and a team member may be asked what action they would take if they suspected that a child was being abused.

Backing up data – indicator 2

It is vital to back up clinical data stored on computer regularly. The practice must have a written policy for who is responsible for backing up data, how it is done and how often it is done.

It would be good practice to back up the data daily Monday to Friday and to store the tape off site on Friday. It is wise to keep this weekly back-up tape for 4-6 weeks, and to keep a monthly back-up tape for 6 months. You should also keep a log of these events. The back-up tapes should be replaced at regular intervals.

The daily tapes should be stored in a fire-proof safe in the surgery, and weekly and monthly back-up tapes stored off site, paying due regard to confidentiality.

The practice should have a policy for who is authorised to load new software programmes.

At an assessment visit the practice may be asked to demonstrate the arrangements for loading software programmes and back up procedures.

Hepatitis B status – indicator 3

All healthcare workers who perform ‘exposure prone procedures’ should be immunised against hepatitis B. Those whose hepatitis B status is unknown should be tested before carrying out exposure prone procedures.

The practice must have a record of all those who are at risk, including doctors as well as all employed staff, and their hepatitis B status. Do not forget to include locums especially those who are long term who may carry out exposure prone procedures.

GPs are obliged, under the Health and Safety Act, to ensure that all staff receive appropriate training and are familiar with the procedures for working safely.

Useful guidance produced by UK health departments on hepatitis B risk and immunisation is available at www.doh.gov.uk/pub/docs/doh/chcguidl.pdf.

Instrument sterilisation – indicator 4

Each practice must have a policy for instrument sterilisation. However, many practices are confused about which type of sterilisation process is acceptable. The debate surrounding BSE questions the efficacy of even the most expensive sterilisers found in general practice. Some practices now use disposable instruments and speculums for minor surgery and vaginal examination.

The health department in each home country will issue guidance on instrument sterilisation when it has been agreed with the General Practitioners Committee of the BMA.

Appointments – indicator 5

The practice must state in its leaflet what type of appointments it offers and the times when they are offered. This will be verified at practice assessment visits.

Practices wishing to offer fewer than five morning and four afternoon sessions per week must agree their times with the PCO. This is likely to apply only to single-handed practices and even then only if a convincing case, which includes adequate cover, can be made.

In some areas of the country practices close on one afternoon each week or month to allow GPs, nurses, practice managers and staff to undergo training. These events may be in-house or PCO-wide.The out of hours service covers practices for these afternoons.

Person specifications and job descriptions – indicator 6

Under this indicator, practices will be asked to produce the person specification and job description for the last person employed after 1 April 2003.

Many practices already produce job descriptions and person specifications for staff vacancies. These are useful when considering what practices want a particular post to achieve and what sort of person would best fulfil that role. They may also help to protect the practice from breaching the Sex Discrimination Act, the Equal Pay Act, the Disability Discrimination Act and the Race Relations Act.

Useful guidance on recruiting without discrimination can be found on the following websites: www.eoc.org.uk (The Equal Opportunities Commission); www.acas.org.uk (Advisory, Conciliation and Arbitration Service; ACAS); www.disability.gov.uk (for information on the Disability Discrimination Act); www.cre.gov.uk (The Commission for Racial Equality).

Equipment – indicator 7

The practice must have a named person responsible for health and safety matters. A schedule of regular and appropriate inspection, calibration, maintenance and replacement of all equipment should be available, and a log of inspection and maintenance must be available for verification.

These requirements should form part of the statutory risk assessment undertaken by practices to fulfil the obligations under the Health and Safety at Work Regulations 1999.

Finance – indicator 8

This is an area that may seem irrelevant to practices – that is, until a case is reported in which a practice is defrauded of a considerable sum of money.

A policy for fraud prevention protects not only the practice but also its staff. Such a policy could cover the following areas:

  • A specified partner, with the practice manager, is responsible for the business and financial affairs – in larger practices this may be more than one partner.
  • Bank accounts can only be operated with a minimum of two signatures, one of which must be a partner’s.
  • No one should sign a cheque that has not been fully completed.
  • The payee and the authorising signatory should not be the same individual.
  • The practice should not put undue reliance on one member of staff for financial and business control.
  • Staff are never paid in cash for work undertaken.
  • There is written evidence for any money removed from petty cash.
  • All income and expenditure is recorded and reconciled with bank statements.
  • Purchases up to an agreed value can be made only with the approval of a partner. Any purchase above the agreed level should have wider agreement.
  • All transfers between accounts must be authorised and recorded.
  • All cheques when signed should have an invoice attached.
  • The practice should ensure if at all possible that the same individual does not place an order, authorise the invoice and sign the cheque.

Carers – indicator 9

The practice should create a procedure for how carers are identified, and also a protocol for referring carers to social services for assessment and recording those carers with specific needs.

At the assessment visit, some members of the primary healthcare team will be asked to describe the action they would take if they identify a carer who might benefit from assessment by social services.

Staff employment policies – indicator 10

It is good employment practice to have procedures recorded in a manual available to staff, so that both the practice and its staff are clear about what steps should be taken if a problem arises.

Policies should be consistent with current legislation and a review date should be indicated. The practice manual may be inspected during the practice assessment visit.

The work involved in ensuring the practice gains maximum points in this section will have the additional benefit of making the practice a better employer. The work could be shared across a number of practices – as it is already in areas that have an active practice managers’ group.

Useful guidance on establishing the procedures is available from The Equal Opportunities Commission and ACAS (see above for website addresses). The BMA website (www.bma.org.uk) contains advice on managing absence.

References

  1. Investing in General Practice:The New General Medical Services Contract, Supporting documentation, 2003. www.bma.org.uk

Guidelines in Practice, February 2004, Volume 7(2)
© 2004 MGP Ltd
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