Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2720_Библиотеки_им_академика_М_И_Перельмана
.pdf
24
https://t.me/med1917
24
CHAPTER What is general practice?
Organizations important
togeneralpractice
British Medical Association (BMA) Voluntary professional as-
sociation and independent trade union of doctors. >80% of UK doctors
are members. Also runs a publishing house producing books and journals
(including the BMJ); negotiates doctors’ pay/ terms of service; provides advice about matters related to work practice; provides educational and research facilities, accommodation, dining facilities, and nancial services. The
General Practitioners Committee (GPC) is a subgroup.
Further information F 020 7387 4499 M www.bma.org.uk
Care Quality Commission (CQC) Independent public body that:
• Assesses management, provision, and quality of health and social care in
England (including GP practices— E p. 52)
• Regulates the independent healthcare sector through registration,
annual inspection, monitoring complaints, and enforcement
• Publishes information about the state of health and social care
• Considers complaints about NHS organizations that the organizations
themselves have not resolved
• Coordinates reviews and assessments of health and social care and
carries out investigations of serious failures in the provision of care
Further information M www.cqc.org.uk
General Medical Council (GMC) Licenses doctors to practise
medicine in the UK. It investigates complaints against doctors, and has the
authority to revoke a doctor’s licence if appropriate. It also monitors standards of undergraduate, postgraduate, and continuing medical education and
provides information about good medical practice.
Further information M www.gmc.org.uk
General Practitioners Committee (GPC) BMA committee with
authority to deal with all matters aecting NHS GPs, representing all doctors in general practice whether or not they are a member of the BMA. The
committee is recognized as the sole negotiating body for general practice
by the DH.
Further information M www.bma.org.uk
Local Medical Committee (LMC) Committee of GPs representa-
tive of GPs in their area. All GPs (including locums and salaried doctors) are
represented by LMCs. Functions:
• Statutory Consultation regarding administration of primary care
contracts; involvement with disciplinary and professional conduct
committees; representation of GPs as a whole
• Non- statutory Advice on all matters concerning GPs; communication
between GPs; links with other bodies; helping individual GPs
National Association of Sessional GPs (NASGP) Acts as a voice
and resource for all NHS GPs who work independently of the traditional
‘GP principal’ model. This includes GP locums, retainers, salaried GPs, and
GP assistants.
Further information M www.nasgp.org.uk
https://t.me/med1917
ORGANIZATIONS IMPORTANT TOGENERALPRACTICE
National Institute for Health and Care Excellence (NICE)
Special Authority aiming to provide the NHS (patients, health professionals,
and the public) with authoritative guidance on ‘best practice’ and thus improve the quality/ consistency of health services. It evaluates health technologies and reviews management of specic conditions.
Further information M www.nice.org.uk
Patient Advice and Liaison Service (PALS) Provided by all
healthcare organizations running hospitals, GP, or community health
services. Equivalent service in Scotland is the Patient Advice and Support
Service (PASS). Aims to:
• Advise and support patients, their families, and carers
• Provide information on NHS services
• Listen to and record concerns, suggestions, or queries. PALS can liaise
directly with NHS sta and managers regarding patients' concerns
• Help sort out problems quickly
• Direct NHS users to sources of independent advice and support
Royal College of General Practitioners (RCGP) Founded to ‘en-
courage, foster and maintain high standards within general practice and to
act as the voice of GPs on issues concerned with education, training, research and standards’. Services include:
• Publishing— journals including British Journal of General Practice
• Education— online learning, courses, conferences
• Revalidation support
• Representation of GPs at national and international levels
• Support for specic groups, e.g. First5 (for GPs within 5y of their
Certicate of Completion of Training); AiT Committee for GPs in
training
Statutory responsibilities include:
• Developing and updating the GP training curriculum
• Setting and managing the UK licensing examination for general practice
• Managing certication and recertication
3 grades of membership:
• Members Are entitled to speak and vote at meetings, and to use the
designation MRCGP— E p.7
• Fellows Highest grade of membership; holders use the designation
FRCGP— application for Fellowship can be made by those who have
been Members for >5y
• Associates For doctors still in training. Associates can participate in
College activities but cannot vote or use the designation MRCGP
Further information M www.rcgp.org.uk
25
ALGRAWANY
26
https://t.me/med1917
26
CHAPTER What is general practice?
Practice inothercountries
It is beyond the scope of this book to discuss dierent systems of healthcare
and practice regulations outside the UK; however, in most countries there
is a registration body (usually termed the ‘Medical Council’) which ensures
doctors are qualied and t to practise; an organization representing the
interests of the medical profession generally (often termed the ‘Medical
Association’); and, separate specialist bodies representing the interests of
family practitioners. Details can be obtained from the following websites:
International Directory of Medical Regulatory Authorities
Lists worldwide medical regulatory bodies and contact details. M www.
iamra.com
World Organization of Family Doctors (WONCA) Includes a list
of member organizations and contact details. M www.globalfamilydoctor.
com
European Union of General Practitioners/ Family Physicians
Gives overview of dierent healthcare systems in member states and contacts for member organizations. M www.uemo.eu
Medical Association of South East Asian Nations (MASEAN)
Contains contact details for medical associations in Brunei, Cambodia,
Indonesia, Laos, Malaysia, Myanmar (Burma), Philippines, Singapore,
Thailand, and Vietnam. M https:// masean.net/
Country- specicinformation
Australia
• Australian Medical Association M www.ama.com.au
• Australian Medical Council M www.amc.org.au
• Royal Australian College of General Practitioners M www.racgp.org.au
Canada
• Canadian Medical Association M www.cma.ca
• College of Family Physicians of Canada M www.cfpc.ca
• Medical Council of Canada M www.mcc.ca
China
• Chinese Medical Association M www.cma.org.cn
HongKong
• Hong Kong College of Family Physicians M www.hkcfp.org.hk
• Hong Kong Medical Association M www.hkma.org
• Medical Council of Hong Kong M www.mchk.org.hk
India
• Indian Medical Association M www.ima- india.org
• Medical Council of India M http:// mciindia.org
Ireland (Eire)
• Irish Medical Council M www.medicalcouncil.ie
• The Irish College of General Practitioners M www.icgp.ie
https://t.me/med1917
PRACTICE INOTHERCOUNTRIES
Japan
• Japan Medical Association M www.med.or.jp
• Japan Primary Care Association M www.primary- care.or.jp
NewZealand
• Medical Council of New Zealand M www.mcnz.org.nz
• New Zealand Medical Association M www.nzma.org.nz
• Royal New Zealand College of General Practitioners M www.rnzcgp.
org.nz
Pakistan
• Pakistan Medical and Dental Council M www.pmdc.org.pk
Singapore
• College of Family Physicians Singapore M www.cfps.org.sg
• Singapore Medical Association M www.sma.org.sg
• Singapore Medical Council M www.smc.gov.sg
SouthAfrica
• Health Professions Council of South Africa M www.hpcsa.co.za
• South African Academy of Family Physicians M www.saafp.org
• South African Medical Association M www.samedical.org
USA
• American Academy of Family Physicians M www.aafp.org
• American Board of Family Medicine M https:// www.theabfm.org
• American Medical Association (AMA) M www.ama- assn.org
• Educational Commission for Foreign Medical Graduates (ECFMG)
M www.ecfmg.org
• Federation of State Medical Boards M www.fsmb.org
27
ALGRAWANY
28
https://t.me/med1917
https://t.me/med1917
Chapter2
Practicemanagement
GPs as managers 30
Practice contracts and payments 32
Partnership agreements 34
Practice premises 36
Practice sta 38
Registration of patients 40
Out-of-hours services 42
Patient records 44
Condentiality 46
Consent 48
Complaints 50
Quality improvement 52
Audit and research 54
Outcomes in general practice 56
29
ALGRAWANY
30
https://t.me/med1917
30
CHAPTER2 Practicemanagement
GPs asmanagers
‘If you have time to do something wrong; you have time to do it right’
GPs in a practice, particularly if partners, may have dual roles as both clinicians and managers of businesses.
Denition Management is the process of designing and maintaining an
environment in which individuals, working together, eciently accomplish
selected aims. The manager coordinates individual eort towards the group
goal. To do this, he/ she needs:
• Technical skill— knowledge specic to the business of the organization
• Human skill— ability to work with people
• Conceptual skill— ability to see the ‘big picture’
• Design skill— ability to solve problems
There are 5 managerialfunctions
• Planning Involves selecting missions and objectives and the actions to
achieve them— requires decision- making
• Organizing Dening roles— ensuring all tasks necessary to accomplish
goals are assigned to those people who can do them best
• Stang Ensuring all positions in the organizational structure are lled
with people able to full those roles
• Leading Inuencing people so that they will contribute to organization
and group goals
• Controlling Measuring and correcting individual and organizational
performance to ensure events conform to plans
Team work Key features which contribute to successful teamwork are:
• Communication Information sharing, feedback, and grievance airing
• Clear team rules Especially with regard to responsibility and
accountability. Make sure these are understood by everyone
• Sympathetic leadership Any team needs a coordinator to direct its
eorts. Aweak leader may allow the team to drift; an autocratic leader
may be too directive and diminish the status of other team members,
and thus the eectiveness of the team
• Clear decision- making processes Especially if dierences of opinion
• Pooling knowledge, experience, skills, resources, and responsibility for
outcome
• Specialization of function Team members must understand and respect
the role and importance of other team members
• Delegation Work of the team is split between its members. Each
member leaves the others to carry out functions delegated to them
• Group support Team members share and are committed to a common,
agreed purpose or goal which directs their actions
Practice meetings Essential to ensure necessary decisions are made;
review policies and agree standards of care; review the nancial position
of the practice; educate and inform practice members; aid communication;
and maintain/ improve morale of practice members.
Quality improvement E p. 52
W. Edwards Deming
https://t.me/med1917
GP ASMANAGERS
Risk management Primary care is about risk and uncertainty, but
sometimes unnecessary risks cause needless harm. Risk management
means taking steps to minimize risk. All the major defence organizations
run risk management programmes for their members. There are 4 stages:
1. Identify the risk— through analysis of complaints; comments from GPs,
other practice sta, or patients; signicant event review (E p. 54); or
using defence organization data to identify common pitfalls
2. Assess frequency and severity of the risk
3. Take steps to reduce or eliminate the risk
4. Check the risk has been eliminated
Categories ofrisk relevant togeneralpractice
• Clinical care, e.g. prescribing errors
• Non- clinical risks to patient safety, e.g. security and re hazards
• Risks to the health of the workforce, e.g. hepatitis B, HIV
• Organizational risks, e.g. failure to safeguard condential information
and unlicensed use of computer software
• Financial risks, e.g. employment of a new sta member
Key safety issues forprimarycare
• Diagnosis 28% of reported errors
• Prescribing 1 in 5 prescriptions contains a prescribing error; 1 in 550
prescriptions contains a serious error; 9% of hospital admissions are due
to potentially avoidable problems with prescribed drugs; 4% of drugs
are incorrectly dispensed each year
• Communication Poor communication is a major cause of complaints;
28% of patients have discrepancies between the drugs prescribed at
hospital discharge and those they receive in the community
• Organizational change Better teamwork, communication, and
leadership d adverse incidents
In each case, consider:
• Organizational and management factors Financial resources/
constraints; practice policies; organization
• Work environment factors Stang levels; skill mix; work load;
equipment
• Team factors Team structure; communication; supervision
• Individual (sta) factors Knowledge and skills; competence; physical and
mental health
• Task factors Availability and use of protocols/ guidelines; availability and
accuracy of test results
• Patient factors Condition (complexity and seriousness); language and
communication; personality and social factors
Change management The NHS is in constant ux and medicine
doesn’t stand still. Change is something that all practices have to deal with.
However, change is inherently unsettling. Change management involves
clear communication of the reasons for change, careful planning to ensure
that everyone in the organization knows what to do, and clear leadership to
maintain direction and deal with any problems that arise.
31
ALGRAWANY
32
https://t.me/med1917
32
CHAPTER2 Practicemanagement
Practice contracts andpayments
A number of dierent contracts are now available for primary care providers within the NHS. Contracting arrangements are changing rapidly and
new models of care provision requiring new contractual arrangements with
the NHS are likely to emerge over coming years.
General Medical Services (GMS) Contract Nationally negotiated
contract between 60% of GP practices and the NHS.
Payment topractices comprises thefollowingcomponents
• The Global Sum +
• Enhanced Services payments +
• Payment for premises +
• IT payments +
• Quality payments +
• Dispensing payments (if applicable)
The Global Sum Major part of the money paid to practices. It is paid
monthly and intended to cover practice running costs. As well as sta costs,
it includes provision for delivery of:
• Essential services Services that all practices must undertake
including:chronic disease management; general palliative care; and
day- to- day medical care of the practice population (health promotion,
management of minor and self- limiting illness, and referral to other
services as appropriate)
• Additional services Services that the practice will usually undertake.
Includes:certain minor surgery procedures (curettage, cautery,
cryocautery of warts/ verrucae and other skin lesions); child
health surveillance (excluding neonatal checks); cervical screening;
contraceptive services (excluding coils and implants); maternity care
(excluding intrapartum care); and vaccinations and immunizations.
Opting out results in a d Global Sum
• Out- of- hours care If not opted out— E p. 42
Enhanced services May be agreed locally or nationally and are paid for in
addition to the Global Sum. Examples include:more advanced minor sur-
gery (e.g. joint injections, incisions/ excisions); intrapartum care; inuenza
vaccination; targets for childhood immunizations; anticoagulation monitoring and minor injury services.
Payment forpremises and information technology GP premises are funded in
many dierent ways. The GP Contract has provision to reimburse practices
that rent their premises the cost of the rent, or pay practices that own their
premises for the use of those premises. The PCO also reimburses all the
IT costs of the practice.
Quality payments Related to performance against Quality and Outcomes
Framework (QOF) targets.
Dispensing Any practice in an area classied as rural may apply to dispense
to patients living >1 mile from the local pharmacy, as long as this would not
render the pharmacy’s business unviable. Aseries of fees are paid for providing this service in a similar way to that in which community pharmacists
are funded and in addition to the GMS Global Sum.
https://t.me/med1917
PRACTICE CONTRACTS ANDPAYMENTS
Other provider contracts Examples of other contractual arrange-
ments for primary care provision currently used by the NHS include:
• Personal Medical Services (PMS) (40% of practices) Alternative contract
for traditional GP practices. Locally agreed, and locally managed. The
GMS contract has a strong inuence on the content/ scope of PMS
Contracts but some elements of the GMS Contract may be omitted
and/ or additional elements may be required
• Primary Care Led Medical Services (PCLMS) Services delivered directly
by employees of the PCO (e.g. Clinical Commissioning Group or Local
Health Board)
• Alternative Provider of Medical Services (APMS) Services provided by
any suitable individual, company or organization
Quality and Outcomes Framework (QOF) Quality incentive
scheme. Data is extracted directly from practice systems. Quality indicators
are reviewed and updated annually and cover both clinical and non- clinical
aspects of patient care. All achievement against quality indicators converts to
points, and each point achieved converts to a monetary value for the practice.
Exception reporting Prevents practices being penalized when unable to meet
targets due to factors beyond their control, e.g. patients fail to attend for review or medication is contraindicated. It applies to indicators where level of
achievement is determined by % of patients reaching the designated level.
Practices report number of exceptions for each indicator set and individual
indicator. It is important to ensure the reason why a patient has been ‘excepted’ is identiable in the clinical record.
Carr- Hill Allocation Formula Geographical and social factors re-
sult in diering workload for GPs. The Carr- Hill Formula allocates Global
Sum and quality payments to practices on the basis of the practice population, weighted for factors that inuence relative needs and costs in order
to reect the dierences in workload these factors generate. The factors
included are:
• Age and sex Older people and children <5y require most GP care
• Nursing and residential home residents
• List turnover Areas with high list turnovers often have higher workload
• Additional needs Many deprived areas have higher rates of morbidity
and mortality resulting in higher GP workload
• Sta market forces Reects geographical variation in sta costs that
practices incur across the UK
• Rurality Rural practices have i practice costs. An additional adjustment
is made for a few small practices in Scotland to allow for economies
of scale (small practices incur disproportionately high costs as many
expenses— particularly relating to premises— must be met regardless of
practice size)
Further information
BMA The GMS Contract. M www.bma.org.uk
NHS Employers M www.nhsemployers.org
33
ALGRAWANY
Соседние файлы в папке Библиотека им академика М.И. Перельмана