An Integrated Approach To Clinical Governance Within A PHCT

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An Integrated Approach To Clinical Governance
Within A PHCT

• Dr Iain Inglis
• Mrs Susan Fairlie
• Bewdley Medical Centre

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This Presentation

• Who and where we are
• Management and organization
• Specific examples of clinical governance
• Results

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The Setting

• Riverside town , 2 miles to the west of
  Kidderminster
• 13 700 patients
• Extended PHCT - GPs, PNs, DNs, DNs, CPNs,
  HVs
• Flattened management structure

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Bewdley
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Clinical Governance - What Is It?

• a framework through which NHS organisations are
  accountable for continuously improving the
  quality of their services and safeguarding high
  standards of care, by creating an environment in
  which excellence in clinical care will flourish
  Scully and Donaldson

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Initiators Of Change

• Medical audit of 1980s/90s
• Nursing process
• Patient's Charter
• Clinical governance
• Patient expectations
• The NHS Plan
• National Service Frameworks

Better care
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Management And Teamwork
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Management and Teamwork

• Time to develop ideas and trust in other members
  skills and professionalism
• Delegation to different team members
• Clear ideas of where the organisation is going
  begin with the end in mind
• Interdependence of team members both clinical and
  non-clinical skills
• Integral to the development of quality

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Management And Teamwork

• Regular meetings of whole team and
  uni-professional groups
• Brief action point minutes distributed by e-mail
• Regular updating of guidelines and policy
  documents on intranet
• Standing agenda item for core team meetings of
  significant event and risk management
• Group culture eager to embrace change

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Change
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Risk Management

• Structural processes to support risk management
• Empowerment of staff to help develop the working
  environment for themselves and patients

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Risk Management
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Medicines Management

• Regular PCT pharmacist led reviews of practice
  formulary
• Systematic approach to dealing with medicines
  withdrawals
• Drug budget which is overspent but is below
  national equivalent by 1
• Interactive decision support to guide clinicians
  in choosing formulary item

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Significant Event Audit

• Built on existing team members individual use of
  reflective practice
• Invitation to significant event meeting made to
  all members of PHCT both employed and attached
  including managers
• Regular time-tabled event
• Mixture of focus on individual events and themes
  where team members bring their experiences to the
  meeting e.g. deaths in the community, referrals
• We are looking at how this model will fit with
  controls assurance

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Training

• All employed and attached staff have annual
  appraisals
• Personal development plans are established for
  all members of the PHCT
• Appraisal for GPs has been accepted in principle
  and will be started before the New Year

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Standards

• Practice standards in the following areas
• Ischaemic heart disease
• 1º, 2º and 3º prevention
• Diabetes
• Mammography, hrt, and cervical smears
• Asthma
• Anticoagulant service
• Acute low back pain
• Appointment system
• Influenza vaccination

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Standards - Heart Failure
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Results

• Patients with IHD and BP lt 140/85 42
• Patients with IHD and cholesterol lt 5.0mmol/l -
  71
• Patients with IHD and a smoking history - 99
• Patients having had an MI on beta-blockers - 56
  and advised aspirin - 90
• Patients with chronic heart failure on ACE
  inhibitor - 73

• Asthmatics with PFR taken when seen 92
• Asthmatics with smoking history taken when seen
  91

• Diabetics with Hb1Ac in previous year - 81
• Diabetics and BP lt 140/85 - 41

• Patients aged gt65 years with influenza
  immunisation - 73

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Implentation of National Agenda

• NSF for CHD and mental health
• Commencing the pharmaceutical care elements of
  NSF elderly
• NICE guidance on PPIs, relenza, bupropion,
  pressure ulcer assessment
• Close to 48hr access

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Conclusions

• Teamwork is an important contribution to our
  success
• Positive attitude to change
• Greater team collaboration and cohesion, shared
  vision and leads to higher standards of care

Teamwork the key to success
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• www.bewdleymedicalcentre.force9.co.uk