BLUK012-FM 9/1/05 1:21 PM Page i pinnacle SUBHAKANT:BLUK012:Chapters:FM: Professional Development A GUIDE FOR PRIMARY CARE 2ndEdition BLUK012-FM 9/1/05 1:21 PM Page ii pinnacle SUBHAKANT:BLUK012:Chapters:FM: DISCLAIMER Every reasonable effort has been made to ensure that the factual information contained in this workbook was correct at the time of going to press. However, the workbook is intended as an outline guide only as information changes with the passing of time, and there is an inevitable time gap between the time of going to press and distribution of this book. The user of this workbook is expected to check points of detail as the editors and contributors cannot be liable for any errors or omissions, nor for any consequences of using it. Any expression or views contained in this workbook are the views of the editors or of contributors to specific chapters. BLUK012-FM 9/1/05 1:21 PM Page III pinnacle SUBHAKANT:BLUK012:Chapters:FM: Professional Development A GUIDE FOR PRIMARY CARE 2nd Edition EDITED BY Margareth Attwood MSc, DMS, MCIPD Medical Education Project Manager and Head of National Office for Summative Assessment, University of Winchester Anthony Curtis MSc (Dist) Cert Ed Head of Education and Training, Kennet and North Wilts PCTand Honorary Lecturer, De Montford University Dr John Pitts PhD, MSc (Med Ed), MRCGP, FRCGP Associate Director in Postgraduate GPEducation, Wessex Deanery and Honorary Research Fellow, University of Winchester, and Editor of Education for Primary Care Dr Robin While MBBS, FRCGP Severn & Wessex Deanery Lead Associate Director for Avon Gloucester and Wiltshire Strategic Health Authority/Workforce Development Confederation BLUK012-FM 9/1/05 1:21 PM Page IV pinnacle SUBHAKANT:BLUK012:Chapters:FM: ©by Blackwell Publishing Ltd Blackwell Publishing,Inc.,Main Street,Malden,Massachusetts -,USA Blackwell Publishing Ltd,Garsington Road,Oxford OXDQ,UK Blackwell Publishing Asia Pty Ltd,Swanston Street,Carlton,Victoria ,Australia The right ofthe Author to be identified as the Author ofthis Work has been asserted in accordance with the Copyright,Designs and Patents Act . 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BLUK012-FM 9/1/05 1:21 PM Page v pinnacle SUBHAKANT:BLUK012:Chapters:FM: Contents List of contributors............................................vii The use of portfolios in learning.......................48 Foreword..........................................................viii Reflective practice......................................49 Preface...............................................................ix Local delivery plans and health List of abbreviations..........................................xi needs assessment............................................52 1Creating a profile of your PART1: GETTING STARTED......................................1 practice population....................................54 How to use this workbook........................................3 2Key features of your practice The national perspective....................................4 population..................................................56 Background to the NHS......................................8 3Identification of top health problems in Useful websites for How to use this workbook....10 your practice..............................................58 The practice............................................................12 4Prioritising the list...................................62 The practice and links to other organisations...12 5Planning interventions............................64 Review of your current situation.................14 6Creating an action plan...........................68 National initiatives that have an impact on the 7New priorities...........................................71 practice.............................................................15 Developing the primary health care team..............73 nGMS................................................................15 Primary health care teams (PHCTs)...................73 Quality and Outcome Framework (QOF)............16 How to get the most from the PHCT?................73 Clinical Governance...........................................17 What are away days?........................................74 National Institute of Clinical Excellence............20 Why have away days?.......................................74 National Service Frameworks...........................20 What can be achieved?.....................................74 Funding.............................................................22 Away day programme.................................75 Maximising income...........................................22 Ground rules for away days..............................76 Useful websites for The practice.......................25 Running small groups.......................................76 The patient.............................................................26 Tips on running small groups............................77 What patients want..........................................26 Brainstorming...................................................77 The Patient Advice and Liaison Service (PALS) Practice SCOTanalysis......................................79 and your practice..............................................27 Developing learning profiles for Gaining patient feedback.................................28 PHCTs...............................................................80 Using complaints to improve practice...............30 The Learning Styles Helper’s Guide..................80 New NHS complaint procedure (2004)..............31 Activists............................................................80 Useful websites for The patient........................34 Reflectors..........................................................81 The primary health care team................................37 Theorists...........................................................81 The GP’s perspective – counting the ‘beans’....37 Pragmatists.......................................................81 The practice nurses’perspective......................40 Reflecting on learning Useful websites for The primary style questionnaire....................................82 health care team..............................................43 Skill mix of the primary health care team..............83 What is skill mix?..............................................83 PART2: WHERE DO WE START...............................45 Individual skills assessment (clinical)........84 The practice professional development plan.........47 Individual skills assessment (non-clinical The practice professional development team members)..........................................86 plan (PPDP).......................................................47 Team skills assessment.............................88 The personal development plan (PDP)..............47 Useful websites for Skill mix of the primary What are the best ways to learn?......................48 health care team...............................................92 v BLUK012-FM 9/1/05 1:21 PM Page vi pinnacle SUBHAKANT:BLUK012:Chapters:FM: C O N T E N T S Appraisal................................................................93 Blind spots......................................................150 GPNHS appraisal.............................................93 Phased evaluation plan (PEP).........................150 PHCTs appraisal................................................97 Phased Evaluation Programme – Question The heinz medical practice: formal record Bank (PEP-QB)..................................................151 of staff appraisal.......................................100 Communication skills .....................................151 360 degrees feedback.....................................103 Medical ethics.................................................153 Useful websites for Appraisal.........................106 Resuscitation..................................................154 Audit and research................................................107 Conflict in the consultation – data Research and development (R & D) in primary entry vs caring.................................................155 care.................................................................107 Stress and you................................................158 Using evidence in the management of common Daily stress log at work.............................160 diseases..........................................................108 Delegation skills checklist........................162 Using evidence in the management of Looking after yourself.....................................162 common diseases......................................111 Managing performance distractors Practice audit..................................................113 self-evaluation..........................................164 Significant-event auditing (SEA)......................114 The work of general practice– Recording a significant event....................117 questionnaire...........................................166 Personal sea..............................................118 Useful websites for Methods of identifying Heinz medical practice – recording a educational needs...........................................173 significant event........................................119 Meeting educational and Minutes of significant event audit developmental needs...........................................174 meeting – heinz medical practice..............121 Learning style.................................................174 Referral data...................................................122 Learning skills – getting the most out of your Prescribing analysis and cost learning...........................................................174 (PACT) prescribing...........................................124 Reflection........................................................175 The practice prescribing costs for the last Your learning need..........................................175 quarter......................................................126 Your learning goal...........................................176 Performance indicators – thinking beyond the What is available to you..................................176 numbers..........................................................128 Conclusion......................................................176 Useful websites for Audit and research...........130 Mentoring.......................................................177 The practice professional Self-directed learning groups.........................178 development plan (PPDP).....................................131 Keeping up to date..........................................178 Components of the plan..................................131 Higher professional education (HPE)..............179 Practice professional development Career pathways.............................................180 plan – the heinz medical practice..............132 GPs with special interest (GPSIs)....................182 Teaching PCOs................................................182 PART3: PERSONALDEVELOPMENTPLAN.............135 GPretainer and flexible career schemes.........183 Framework for personal GPtrainer........................................................185 development plans (PDP).....................................137 For the more adventurous . . . Getting started................................................137 career breaks..................................................185 Past educational profile............................138 Useful websites for Meeting educational Learning highlights...................................140 and developmental needs...............................186 The self-audit and personal SCOTanalysis.....142 Personal development plan..................................187 Methods of identifying educational needs...........144 Appendix 1: Confidentiality declaration................191 Sticky moments..............................................144 Appendix 2: Websites...........................................192 Discovery page – sticky moments.............146 References and further reading............................199 Identification of educational needs..........148 Index....................................................................201 vi BLUK012-FM 9/1/05 1:21 PM Page vii pinnacle SUBHAKANT:BLUK012:Chapters:FM: List of contributors Ms Sue Bacon Dr Di Jelly Clinical Governance Support Manager,Kennet and GP,North Shields North Wilts PCT Dr David Jenner Dr Peter Baskett GP and NHS Alliance nGMS contract lead,Exeter Consultant Anaesthetist,Frenchay Hospital,Bristol, Ms Julie Lennon Editor ofResuscitation Education and Training Manager,Kennet and North Mr Arthur Belbin Wilts PCT Director Strategic Planning,West Wiltshire PCT Dr Colin Lennon Mr Brian Canfer GP,Melksham Practice Manager/GP trainer,West Midlands/East Wales Dr Murray Lough Professor Ruth Chambers Assistant Director (Audit),West ofScotland Deanery Professor ofPrimary Care,Centre ofHealth Policy and Practice,Staffordshire University Dr Nick Lyons Associate Director Postgraduate General Practice Dr Paul Colbrook Education,Severn and Wessex Deanery Medico Legal Adviser,Medical Defence Union Dr Liz Mearns Professor Colin Coles Research GP and Clinical Governance Lead, Medical Educationalist,University ofWinchester Swindon PCT Dr John Elliman Ms Sue Nutbrown GP and GP Trainer,Swindon Chair,RCN Practice Nurses Association Ms Pam Gates Freelance Primary Care Trainer and Facilitator; Ms Joyce Robins LayMember ofWessex Deanery,Bath Director,Patient Concern Dr Steve Rowlands Ms Ros Grant Research GP and Associate GP Tutor,Trowbridge Head ofMedicines Management,Banes PCT Dr Michael Greco Dr Peter Tate Hon Senior Research Fellow in Health Services GP,Corfe Castle Research,North Devon RDSU Dr Richard Wharton Dr Phil Hammond GP and GP Tutor,Bath GP returner,writer and broadcaster,Bristol Dr Vicky Woods Dr Anne Hastie Senior Lecturer,Pan Bath and Swindon Research and Deputy Dean ofPostgraduate GP Education,London Development Unit,University ofBath Deanery Dr John Howard Ms Naomi Jefferies Associate Director ofPostgraduate General Practice Chartered Occupational Psychologist,Bath Education,Mersey Deanery vii BLUK012-FM 9/1/05 1:21 PM Page viii pinnacle SUBHAKANT:BLUK012:Chapters:FM: Foreword The Royal College ofGeneral Practitioners (RCGP) has led the way in driv- ing up standards in general practice over the last 50 years by setting stan- dards and promoting the education and training of general practitioners (GPs).We are now in a new world where the ‘name ofthe game’for health care professionals is accountability for professional practice and standards to patients,peers,the National Health Service (NHS) and regulators.The land- scape has changed totally with the introduction ofNHS systems ofquality such as clinical governance and appraisals.Nationally we have a system of standard setting through the National Institute for Health and Clinical Excellence (NICE),the national service frameworks and the new GP con- tract,with its emphasis on an evidence-based quality and outcomes frame- work. Getting all this right–and the stakes are high–requires primary health care professionals to have an understanding of policy and techniques for professional development.I know as a practicing GP just how hard it can be to keep up to date in a generalist discipline and showing progress.Just how do you achieve good glycaemic control in a patient with type 2 diabetes faced with a bewildering choice ofdrugs in the context ofthe patient’s ideas, concerns and expectations? However,it can be done if GP learning of pri- mary care teams is supported properly. GPs are now in charge of their own learning –since the demise of the postgraduate education allowance in 2003.For many this is a frightening thought:How to plan systematic learning and improvement in the context of a personal and practice professional development plan? It is clear that help is needed for most GPs including ‘high achievers’with a process that provides a degree ofchallenge and stimulation. GPs want to raise the quality bar even further.As a GP appraiser,I know that the importance and impact ofa high-quality learning experience can- not be underestimated.These are however far and few in between! A degree of challenge and sometimes prescription is needed to ensure that GPs remain up to date and fit to practice. I am convinced that professional development is a process whose poten- tial has not been fully realised and as Chairman ofthe RCGP,I want to mod- ernise the process.I have no doubt that this book will be a valuable contri- bution to that modernisation process. We need to take professional development up a notch and to another level–from a superficial process to something deeper and embedded in professional cultures and NHS quality systems. And so I welcome this book–it is one of the best texts I have read on professional development.I particularly like the emphasis on using tools, audits and forms to inform the professional development planning process. This is a thoughtful book,well researched,up to date and most importantly set in the context ofprofessional development for primary health care pro- fessionals in the new and modern NHS. viii BLUK012-FM 9/1/05 1:21 PM Page ix pinnacle SUBHAKANT:BLUK012:Chapters:FM: Preface Once again the National Health Service (NHS) is changing and along with it comes changes in professional development and the introduction ofNHS appraisal and revalidation for general practitioners (GPs).These changes may often bring increased demands but offer new opportunities for personal and professional development, ultimately improving patient care. Many may find the prospect of revalidation, the process by which GPs will evidence their fitness to practice, as threatening. The way in which revalidation will occur has been debated for several years and the way ahead is still unclear in the months following Dame Janet Smith’s Shipman Enquiry. It seems likely, however, that revalidation and GP appraisal will continue with similar evidence being used to inform both processes. This workbook will act as a resource to help individuals in their preparation for these changes. This workbook will help to provide an educational framework which enables you to plan and structure your continuing professional develop- ment and improve quality in general practice.It also provides a frame- work to meet the requirements of the primary care organisation and clinical governance.It is not an exhaustive list ofwhat can and cannot be achieved,but rather a framework into which you can dovetail your own ideas.In addition,useful website addresses at the end of chapters indi- cate where further information can be obtained. We must thank all those who have helped to compile this workbook. We are grateful particularly to those who contributed chapters and responded to the draft version and did the proofreading. The Editors are grateful to the following for the contribution they made to the First edition of this workbook,which has formed much of the foundation to this volume–Dr Peter Agar; Dr Tim Ballard; Dr Charles Campion-Smith;Mrs Mary Connor;Dr Chris Goldie;ProfJanet Grant;MrsKate Harris;ProfJacky Hayden;ProfRoger Higgs;Dr Claire Kendrick;Dr Roger Kneebone;Mrs Lesley Millard;ProfMike Pringle;Dr Neil Scheurmier; Dr Paul Smith; Prof Tim Van Zwanenberg; Ms Sarah Walker. We particularly appreciate the administrative help received from Seana Lamb-Hughes and Rupert Attwood in the compilation of this workbook. We have been very fortunate in editing this book and to have been offered much advice from Ms Claire Bonnett from Blackwell Publishing. Thanks are also due to Ms Seema Koul,at Techbooks for her invaluable support. ix BLUK012-FM 9/1/05 1:21 PM Page x pinnacle SUBHAKANT:BLUK012:Chapters:FM: Finally,we are grateful to Kennet and North Wilts PCT,University of Winchester and Astra Zeneca for supporting this production,which we hope will be a valuable and practical guide for all those working in pri- mary care. Margareth Attwood MSc, DMS, MCIPD Medical Education Project Manager and Head of National Office for Summative Assessment, University of Winchester Anthony Curtis MSc (Dist) Cert Ed Head of Education and Training, Kennet and North Wilts PCTand Honorary Lecturer, De Montford University Dr John Pitts PhD, MSc (Med Ed), MRCGP, FRCGP Associate Director in Postgraduate GPEducation, Wessex Deanery and Honorary Research Fellow, University of Winchester, and Editor of Education for Primary Care Dr Robin While MBBS, FRCGP Severn & Wessex Deanery Lead Associate Director for Avon Gloucester and Wiltshire Strategic Health Authority/Workforce Development Confederation x