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Notes of 2nd RCGP East Anglian Workshop
Bedford Lodge Hotel, Newmarket
Dec 9th 1998
Attendees
Arthur Hibble, Acting Regional Director of General Practice
David Kanka, Consultant in Public Health Medicine, Cambridge & Huntingdon
HA
Joe Neary, Royal College of General Practitioners
Peter Noke, Professional Development Manager, MSD pharmaceuticals
Jenny Schram, Non-Principal, Norfolk
Danielle Smith, Non-Principal, Cambridge
Veronica Stephenson, Non-Principal, Cambridge
Caroline Thornberry, Manager, Primary & Community Care, Suffolk HA
Andrew Wordsworth, Non-Principal, North West Anglia
Apologies were received from Roger Chapman, GPC, Alan Chapman, East Norfolk
Health Authority, Mike Knapton, Cambridge PGMEC, Christine McLeod, North West
Anglia HA and John Perry, Department of General Practice, Cambridge
Review of progress since
September workshop
National
The GMC is proposing to compile a Generalist Register. This is likely to
embody a requirement to demonstrate of continuing professional competence.
The RCGP view is that a 'once only' demonstration of professional standards
(the MRCGP exam) is no longer acceptable to validate college membership. It
proposes to investigate methods of demonstrating professional standards.
The needs of Non-Principals will feature in and influence these developments.
Deanery
Arthur Hibble and David Kanka have followed up the
possibility of securing funding for one postgraduate tutor session per week in
each Health Authority to support Non-Principal development.
Funding for a Deanery wide weekly session has been achieved
and Veronica Stephenson will take this up in the New Year.
Funding has been secured in Cambridge and Huntingdon to
appoint a Non-Principal Adviser for one session per week. The post will
initially expire in April '99. Following a scoping exercise, it should continue
during 99/2K.
Norfolk has identified £8K for Non-Principal education.
Values and
Principles
A discussion document produced by Dr Neary was reviewed, and
a list of values and principles for education and development of Non-Principals
was agreed.
This is reported in Appendix A.
Initiatives and
Projects
A list of possible proposals for GP Non-Principal
development was generated in small groups.
In a brief plenary, the ideas were pooled and 4 headings
were proposed for the projects identified.
Personal development
1. Co- tutoring and mentoring
2. Education/career workshops
Register
3. Establishment and maintenance of Registers of Non-Principals
4. Education information to be made available to all Non-Principals on the
Register
5. View Non-Principals 'in themselves' as a resource. Create a formal pool of
available Non-Principals
Employer/employee
responsibilities
6. Code of Good Practice for employers employing locums
7. Practice based locum packs, possibly using the NASGP pro-forma which could be
available via disc or web site.
8. Minimum information to be available in every practice (paper and
electronic).
9. PPDP’s to include the needs of Non-Principals
Spread of good practice.
Clinical governance
10. Develop a clinical governance strategy for Non-Principals
11. Support for Non-Principals who act as leaders. Skills development in
personal learning and the creation of portfolios
Miscellaneous
Projects
12. BNF Availability
13. PPDP’s - education facilitators: co-tutors
14. Education resource centre: to include IT etc.
15. Set up action learning sets
16. Consultation skills training
Encourage the dispossessed!! We recognised that there were
significant numbers of GP Non-Principals who were not motivated to seek out
personal development or to sign on a voluntary register
What has to happen
next
It was agreed that there are a range of initiatives underway
in the Anglia Deanery which will be well placed to take this work forward.
These include:
- Weekly session which has been established in the Department of Post
Graduate Medical Education
- Non-Principal Advisor session in Cambridge and Huntingdon
- Developing proposals in Norfolk.
Joe Neary will liaise with the RCGP and Richard Fieldhouse
of the NASGP to specify an appropriate code of practice for practices employing
GP Non-Principals. I have subsequently done so and found that the NASGP has
already developed this code which appears on their web-site. I have reprinted
this at Appendix B. JN.
We agreed to meet again in 6 months, details of the meeting
to be arranged by Veronica Stephenson. Joe Neary agreed to help with logistics.
Appendix A: Values &
Principles for GP Non-Principal Development
The following statements represent the collective views of a
group of non-principals and GP educators in the East Anglian Deanery.
They are set in the context of increasingly explicit
recognition of the importance of the contribution of GP Non-Principals in the
delivery of personal medical services in general practice.
Sensitive
to National Context
- "The New NHS": Clinical Governance, Primary Care Groups,
NICE
- "A First Class Service"
- GMC: List of Accredited Generalists
- RCGP: Accredited Professional Development, Membership by Assessment
- SCOPME report on Continuing Professional Development for GP Non-Principals
- CMO’s report on Continuing Professional Development for General
Practice
- Specialist Workforce Advisory Group (GP recruitment & retention)
Facilitative and Developmental
Person-Centred
- Built on the self-assessed development needs of each professional
- Opportunity for facilitated review of professional/career development
Wide
Variety of Methods
- Inclusive of local Non-Principal network meetings where appropriate
- Facilitate access nationally to relevant clinical and service information:
BNF, Bandolier, PGMEC programmes, library services, NHS net.
Related to
Local Working Context
- Facilitate access to clinically relevant information at locality and
practice levels; e.g. locum information packs
- Set in context of Practice Professional Development Plans where appropriate
- Sensitive to diverse circumstances of Non-Principals
- Health Action Zone planning to take account of the contribution and
development needs of Non-Principals
- Health Improvement Programmes to be aware of the contribution and needs of
Non-Principals
Pro-activity
- By non-principals
- By employing practices
- By PCG’s and Health Authorities
- By postgraduate tutors and Regional Director of General Practice
- Nationally by GPC, DoH and NHS Executive
Resource
Sensitive
- Identify, publicise and mobilise resources available for educational
activities (regional bursaries etc.)
- Flexible methods of education and development provision
- Plan events that are subsidised as far as possible
- Adjusted PGMEC fees for low-income doctors
Reflexive/Evaluative
- Explicit review of effectiveness of activities against specified objectives
- Redesign of activities of limited effectiveness
- Identify new and emerging educational needs to inform educational provision
- Development outcomes to inform Health Improvement Programmes
Appendix B: Code of Good
Practice
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National Association of
Non-Principals
Endorsed by the Council of
the Royal College of General Practitioners
The National Association of Non-Principals aims to foster
good relationships between all who work in general practice and in doing so
promote high standards of medical care. As an integral part of these aims the
NASGP has detailed its Code of Good Practice which includes endorsing the
General Medical Council’s guidance contained in ‘Good medical
practice’. Bearing this guidance, and our Code of Good Practice in mind,
it is hoped all in general practice can work towards meeting these aims.
The NASGP acknowledges that there are some established core
principles that it supports, namely that:
- Patients have a right to receive high standards of care from all doctors
- Doctors have a professional responsibility to maintain a high standard of
knowledge and skills
- Doctors have a responsibility to uphold standards of professional and
personal conduct
- Doctors are individually accountable for their actions
In addition the National Association of Non-Principals
believes that:
- Non-principals should be able to demonstrate, when asked to do so, their
legal eligibility to work, their current full registration with the GMC and
membership of a medical defence organisation
- Non-principals should be equally valued as general practitioner providers
of medical services
- Non-principals should be appropriately and promptly remunerated for all
aspects of the work they do
- Non-principals have a responsibility to aid practices in claiming due
income incurred through their work
- Practices and their staff have a responsibility to facilitate the delivery
of a high standard of care by:
- Being well organised, and by ensuring consulting rooms are appropriately
equipped and furnished
- Providing adequate up to date information, such as that contained in the
NASGP practice pack
- Supporting non-principals in their work, as they do principals
- Practices and non-principals have a responsibility to:
- Ensure they communicate clearly and effectively
- Ensure non-principals are able to use computer systems safely, effectively
and appropriately for that practice
- Doctors and practice staff should not make any patient doubt a
colleague’s professional ability by making unsustainable remarks about
them
- Non-principals’ flexibility and adaptability are key strengths which
should not be abused or exploited
- Practices and non-principals should formally agree terms of employment
- All parties must recognise their reciprocal responsibilities when booking
and cancelling work
- Appointment intervals of ten minutes are desirable to provide a high
standard of care
- Non-principals should be invited to attend practice meetings on clinical
issues and service provision · non-principals should, if required,
participate fully in the complaint system where recognition is made of any loss
of income incurred.
- There should be equal opportunities for access to and funding of continuous
medical education for all general practitioners
- GP tutors should be available to support all GPs and facilitate learner
centred personal education plans
Paragraphs 2 and 3 of the General Medical Council’s
guidance booklet, Good medical practice, (Duties of a doctor GMC, 1995) on Good
clinical care are particularly relevant to the way non-principals and
principals work together. They are reproduced here.
| You must take suitable and prompt action when
necessary. This must include:
- An adequate assessment of the patient’s condition, based on the
history and clinical signs including where necessary, an appropriate
examination
- Providing or arranging investigations or treatment where necessary
- Referring the patient to another practitioner, when indicated
In providing care you must:
- Recognise the limits of your professional competence
- Be willing to consult colleagues
- Be competent when making diagnoses and when giving or arranging treatment
- Keep clear, accurate and contemporaneous patient records which report the
relevant clinical findings, the decisions made, information given to patients
and any drugs or other treatment prescribed
- Keep colleagues well informed when sharing the care of patients
- Pay due regard to the efficacy and use of resources
- Prescribe only the treatment, drugs, or appliances that serve the
patients’ needs
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