Case study 3 - North East Primary Care Services Agency

This page is aimed at employers, responsible officers and organisations.

Introduction

The North East Primary Care Services Agency provides health services on behalf of the Primary Care Trusts in the North East Strategic Health Authority area. Formed on 1st December 2010, it acts on behalf of 12 PCTs in the region, covering an area of approximately 5,000 miles² and serving a patient population of 2.7 million.

One of the Agency’s central roles is to organise professional performance processes like appraisals and revalidation into a single, standardised system. Two Medical Directors and four Responsible Officers oversee the implementation of the new standardised system throughout the region. In total the Agency is responsible for the revalidation of 2,500 doctors.

Challenges

Despite many of the doctors being used to engaging in appraisals, there were a number of challenges that the North East Primary Care Services Agency faced when rolling out the system to such a large number of doctors. Dr Hilton Dixon, a Responsible Officer at the Agency since 2011, explained:

“A key challenge is balancing out the workload associated with organising the appraisals for 2,500 GPs. There is a lot of administration involved, such as setting up appraisal dates and ensuring all documentation is collated, so we need a process in place that was not going to be a huge administrative burden.”

In addition, because of the varying levels of experience and differing specialisms among doctors who volunteered to be appraisers, ensuring consistency across the appraisal process was difficult. For appraisals to be as effective as possible, the Agency was aware that it would need to guarantee Personal Development Plans were completed after each appraisal, with evidence based and measurable outcomes, to allow the annual progress to be clearly assessed.

Supporting locum doctors with appraisal and revalidation was also a challenge for the Agency. Because of the nature of their practice, locums often find it difficult to collect patient and colleague feedback and to carry out clinical audits as they don’t have a fixed practice base, or access to long-term patient management data that is needed to complete the audits.

The Agency was also aware that some doctors were concerned about the use of colleague feedback and the potential for this to cause issues amongst colleagues, particularly in small practices. Although as Di Jelley, Lead Appraiser in the North East explained, “poor feedback among peers is rare.”

Action

To help reduce the impact on administration resources, the Agency now carries out doctors appraisals during their birthday month, rather than at a fixed time in the year. Dr Hilton Dixon commented: “Organisations should level load the work to enable the process to run smoothly throughout the year rather than create peaks and troughs.”

An electronic booking system, that enables doctors to directly book their appraisal dates, has also been rolled out across the North East. This has significantly reduced the administrative burden and management costs associated with revalidation.

Furthermore, the Agency is currently constructing an online dashboard to enable Responsible Officers to oversee and monitor the number of appraisals taking place. It allows them to send appraisal reminders to doctors and, where necessary, flag any doctors with known performance related concerns who may require further review.

Whilst the online booking system and the dashboard represent an efficient move away from a people heavy system to a modern IT-based one, telephone and face-to-face communication is still an integral element of support for doctors that is provided by appraisers.

In order to ensure consistent quality of appraisals throughout the area, the Agency, in collaboration with the Northern Deanery, organises an annual regional conference that focuses on appraisal best practice, plus regular update training sessions for all appraisers. The conference includes sessions on how to effectively support appraisees in writing an appropriate Professional Development Plan, with attainable objectives that can be used as an effective record for their next appraisal.

The North East has a strong GP tutor network, jointly funded by NE PCSA and the Northern Deanery. One of the core roles of GP tutors is to ensure the quality of appraisals. This is done through local appraiser support groups run by tutors 3-4 times a year, plus an annual review of the quality of each appraiser's work against agreed standards, including appraisee feedback where this is available.

Doctors going through appraisals are also supported by the GP tutor network. For instance, GPs can contact GP tutors if they are concerned about colleague feedback they have received and wish to discuss the feedback with an educationalist before their appraisal.

For locum doctors, the Agency recommends joining the North East Employed and Locum GPs group (NELG), which has played a key role in providing sessional GPs in the North East with up-to-date information and support on revalidation. Simple yet effective measures include email alerts to members about educational events, new North East PCSA polocy documents, and the website has also been a vital tool to communicate the latest information and guidance from the GMC. The NELG also supports its members to join self-directed learning groups which meet once a month for professional development. This is proving to be very popular, with anecdotal evidence suggesting that 75% of the region’s sessional GPs are currently affiliated to one of these groups.

The Agency also recommends that if locum doctors are finding it difficult to provide the clinical audit information required as supporting information for their appraisals, they should discuss this with their appraiser and consider alternative documentation that may be easier to collate, using recommendations in the Royal College of General Practitioners ' Guide to Revalidation.'

Results and benefits

According to Dr Hilton Dixon, in 2011, 98% of GPs in the North East engaged with the standardised appraisal process, and the small number who didn’t have subsequently been contacted. Throughout the process, there has been regular communication with doctors via appraisers, GP tutors, online information and email correspondence, resulting in clarity around the requirements of revalidation.

“Preparing doctors for revalidation has been a relatively smooth process at the Agency,” said Di Jelley. “Appraisal for revalidation is no tougher than the appraisal system we have been running for the past few years, so doctors in the North East are used to collecting this information – the only thing that is new is patient and colleague feedback.” She continued, “Revalidation will help doctors to keep up-to-date with best clinical practice, whilst also encouraging them to reflect on ways in which they can improve their practice. We are never going to be perfect, but capturing things like significant events, learning from others and from patients will ultimately improve the quality of care.”

Key findings

• IT systems can reduce workload - The online booking system helps to significantly reduce the administrative workload associated with revalidation and the online dashboard makes it easier for Responsible Officers to monitor performance across the board at a glance.
• Training and support for appraisers is vital - Appraisers must be properly trained and have an avenue of communication between themselves and Responsible Officers so they too feel supported, as well as the GPs.
• Ensure Personal Development Plans contain evidence based objectives - Appraisers need to clearly communicate with doctors and ensure that a Personal Development Plan is written after every appraisal, containing measureable objectives. GP tutors can offer support with training appraisers on the importance of evidence-based PDPs and it can be helpful to offer education sessions for GPs to help them write their PDPs.