Shevington Surgery

Practice Development

up to topPrimary Care Development

In 1993 we undertook an team building away day as a primary health care team. As part of this we developed a joint mission statement and a set of agreed aims.

Mission statement of the primary health care team

The Shevington Surgery team aim to provide high quality care, advice, support and information to meet the health needs of this community. Our primary health care team meet on a monthly basis and have recently incorporated significant event audit into our leaning activities.

Aims of the primary health care team

  1. To practice optimum care.
  2. To provide seamless care for patients.
  3. Continue to develop the primary health care team and its individual members.
  4. To improve communications with management.
  5. To become a teaching team.

Our team meetings include:

Benefits resulting from working in the team:

  1. Liaison between disciplines.
  2. Updating knowledge of common issues.
  3. Updating knowledge of all specialist nurses.
  4. Agreeing protocols and coordinating advice.
  5. Meetings provide a forum for working with local voluntary agencies and lay members of the community.
  6. Nurse training students, GP registrars and SHOs and Medical students can experience working in the wider primary health care team.
  7. Individual members receive professional support from other members in the team.

up to topDeveloping the Practice Nurse Team

One of the key objectives we identified in 2000, was recognising that our nurses have an increasingly important role in helping the practice deliver the care required by the new National Strategic Frameworks.

Our two full-time practice nurses are refocusing their work to allow adequate time for screening all CHD and diabetes patients to ensure they are receiving the best advice on secondary prevention.

We have appointed a nursing assistant, and are exploring our needs for either a nurse practitioner or a staff nurse to complete the team.

Telephone triage training is currently being undertaken, following the Chester model.

Very soon our nursing team will talk to all patients requiring visits and urgent appointments, to help them access the most appropriate care and when they need it.

up to topPractice Based Education

We have used Investors in People to highlight the need to constantly reassess our educational needs as a practice. As a result we have undertaken a variety of educational activities. One of our longest standing group projects has been significant event auditing. We have also been involved in writing individual education plans and some of us have undertaken higher professional training as part of the educational process.

Resources for practice based education:

  1. Yourself and your practice.
  2. GP tutor.
  3. Local PCG clinical governance leads.
  4. Young principal groups.
  5. Higher professional training.
  6. Postgraduate centres and library.
  7. Regional advisors
  8. Postgraduate university departments
RCGP occasional training paper no 63. Portfolio Based Learning in General Practice. RCGP. London. Publications department, The Royal College of General Practitioners, 14, Princes Gate, Hyde Park, London, SW7 1PU. Tel: 0171 581 3232, Fax: 0171 225 3047, email: info@rcgp.org.uk.
Education for General Practice. Radcliffe Medical Press Ltd, 18, Marcham Road, Abingdon, Oxon, OX14 1AA. Tel: 01235 528820. Fax: 01235 528830, email: medical@radpress.win-net.net.

up to topSignificant Event Auditing

This is a useful and a practical way to examine issues within practice and determine practice learning needs.

What do you need to get started?

  1. Consensus: Everyone in the group needs to feel comfortable discussing events.
  2. External support: Your local GP tutor will advise you about PGEA accreditation and feedback forms.

What do you need to consider to have a successful meeting?

  1. Decide the participants: e.g. GPs, Registrar, SHO, medical students, Nurses, manager, staff, primary health care team.
  2. Decide who will chair the meetings: Will it be a rotating post or a fixed role? The chairman will be responsible for asking participants to submit events for discussion and for choosing which events are used. The chairman will direct the discussion and manage the time.
  3. Time, location and duration: protected time is preferable for a 1-2 hours on a monthly or bimonthly basis.
  4. Events: participants submit events to the chairman prior to the meeting. A meeting may manage to cover 1-2 events.
  5. Discussion: The event is first described by the participant who suggested the event. The event is then discussed by the group first for its positive and then for its negative aspects.
  6. Outcome: This is the most important part of the meeting. Congratulations a job well done, the need for further information and the need for definitive action e.g. a learning activity are all valid outcomes. Based on this an action plan is drawn up. At the start of the next meeting this action plan is reviewed.
  7. House keeping: Making sure PGEA forms are signed, minutes are written for the practice development plan/personal portfolio and the date and time of the next meeting are arranged.

Some example of successful outcomes from significant event auditing at Shevington Surgery.

up to topHigher Professional Training

Courses are now available through many universities. The following are examples of what might be expected based on the course run by the University of Manchester. This particular course was run as a monthly day release session from October to May with a three day session at the beginning and end of the year.

Outcomes from twelve months of higher professional training.

Rewards of higher professional training:

Difficulties of higher professional training:

up to topPersonal Education Plans

A learning plan should include:

The simplest way of getting started in determining your needs is to keep a diary.

A daily reflective diary:

  1. Todays best buzz.
  2. Todays worst low.
  3. Todays most significant event.
  4. A thought about my last patient.

We would recommend the RCGP occasional paper on portfolio learning as a guide to help you.

up to topPractice Development Plans

Most clinical governance groups will provide clear guidance on the structure and content of a plan.

Learning needs for a practice can be determined by activities such as significant event auditing and an action plan drawn up on how to address them. It is very important that all activities are documented and a review of the plan to assess its success is done. A practice plan can be a very good starting point for an individual personal education plan. If the practice as a whole has decided to tackle diabetes management it might be a good idea to do some learning of your own!