Clinical Governance and Appraisal

Here follows a highly personal view of each.

What are they?

Clinical Governance (CG) There are hundreds of definitions, all very PC, mainly unintelligible and all totally unhelpful. For me it means simply quality assurance. As such it has two main components – weeding out dodgy docs, and making sure that the rest of us are delivering the best possible quality of care to our patients.

Appraisal There is to be an annual meeting of every GP in the UK with a trained colleague. Each appraisal is supposed to have 2 aims: Firstly, to help us identify our learning needs, and become even better at our jobs, Secondly to make sure that we are not incompetent or raving psychopaths.

CG

There is a lot written about this in the medical press. Much is totally unintelligible and further the majority is applied to hospital medicine. Clinical governance has been the “in” buzz words for the last couple of years, and there has been substantial government pressure for it to be embraced in primary care. Just as most hospitals now have “departments of clinical governance”, so most PCTs have appointed a CG-supremo, and a number of underlings to sort out their GPs. Joy, joy, joy….

Each practice is supposed to have a nominated CG partner who goes to endless meetings, and then fired by enthusiasm sets up a CG program in the practice.

Cutting through much of the bullshit however, there is a kernel of good stuff in much of this. All of us went into medicine wanting to a good job for patients. CG does offer us a range of tools/ideas for doing this. I think the key is that to be effective we as GPs have to both sign up to the idea and have the time and enthusiasm to do it properly.

The following are general resources you might like to look at (just click on them if you are on-line):

1. For the government line on the subject (brief): http://www.doh.gov.uk/pricare/clingov.htm

2. An overview of the subject of the subject for primary care trusts (quite good this one)

3. A review of what it means to practices of what it means to practices (by Mike Pringle – something of personal hero, although my senior partner thinks he is a smug git)

I will leave you to peruse these. You can download them as PDF’s if you like from the same site.

Please think about the following questions:

What methods can we use as GPs to ensure that we are providing good quality care to our patients?
How much of this information should be shared with other practices, or our employers (the PCT).
Following from this, my PCT wants us to put the minutes of all our significant event meetings on to a public website. What are your thoughts about this?
If you became a CG supremo, how would you know if you had a dodgy doc on your books?
What could/would you do about it?
How would you have picked up Harold Shipman’s dire deeds?

Appraisal

All of you should have been appraised. If by some fluke not, you will be during this year by your trainer and indeed by one of the course organisers. You will have your own views on whether it is helpful or not. Personally I think it is, as long as it is done properly. Each of us is to have a 2 hour appraisal, based on our PDP. Most doctors (but not all) have been funded some time to prepare for and be appraised.

I have put in a single piece of reading here, from the Department of Health website.

It is actually quite helpful: http://www.doh.gov.uk/pricare/gpappraisal.htm There are 2 links (both sadly only in pdf format, one a summary, and for the keenies a 57 page detailed exposition. I know which one I would look at first.

The implementation of all this however has been woeful. Everyone is supposed to have been appraised by April 2003. This seems unlikely. Most PCTs (with whom the words “couldn’t”, “piss-up” and “brewery” spring often to mind) haven’t yet done a single one. One reason for this has been the resource implications (for both doctor, practice and PCT) which have been poorly addressed.

Please think about the following questions:

What areas would be useful to cover in an appraisal with a principal
What areas would be useful to cover in an appraisal with a non-principal (for they are not immune!)
How honest would you be at an appraisal if you know that the appraiser is also checking that you are not incompetent, and needing to be reported to the GMC. How might this affect the process?
Knowing (3) how as an appraiser would you structure the session.
Speculate on how Harold would have performed had appraisals been in place 10 years ago.

Preparation for group work

Please reflect on the italicised questions, and discuss them with your trainer and the other doctors in the practice. Find out what your practice is doing about CG and appraisal, and be prepared to discuss during the afternoon.

Written by: Bill Irish

Last update: 29 August 2007