We operate from a purpose built surgery built in 2008 providing large clinical rooms which are compliant with the standards set by The Disability Discrimination Act (DDA) and GP Training.  Each GP trainee has their own room which is big enough for video recording and ‘sit and swap’ surgeries’.  We have a well-equipped library (providing online access, books and a quiet space for study).  We have a separate conference room (providing access to projector, online access and again a quiet space for study. This space is often used by a group of GP trainees practicing for their CSA.  There is a small common room downstairs and a large common room upstairs providing a space not only for tea and coffee but also ‘bump zones’ to aid networking with others.

Get your PM to do both . 

1. Statement of QOF achievement.
2. Summary of the CQC inspection.

In Yorkshire & the Humber, it is mandatory you use the template provided.

Attach a short written reflection relating to your practice QOF and CQC achievements. Clinical and organisational factors should be discussed here, and trends/patterns or specific areas for change or improvement within your practice as a training practice should be highlighted in what you write any areas of concern highlighted by QOF and CQC processes should be included.

CLINICAL
Trends and Patterns

• See our latest QoF achievements here:  http://qof.hscic.gov.uk/search/index.asp  ; type in BD10 into the search box and select Ashcroft Surgery, Bradford.
• There has been yearly increases in requests for appointments and work diverted from secondary care.  The practice has the same list size but the workload has increased dramatically since last re-approval.  Despite this, QoF, DES and LES targets have all been delivered well.  This has been through collaborative team work which encourages GP trainees to actively participate.
• From the current set of paperwork, we have achieved 518 points from a maximum of 545.
• Specific areas for change or improvement within your practice as a training practice
• The main clinical area we need to improve on is diabetic care (mainly foot checks and retinopathy screening).  We scored 64 from a total available pot of 86 points.  We have a new diabetic lead within the practice.  No doubt this area will improve over the coming year.

All our protocols and policies are available here: www.ashcroftsurgery.co.uk/protocols

Any areas of concern highlighted by QOF or CQC

• None highlighted in QoF. 
• CQC – discussed improving our diabetic care and uptake of chlamydia testing in teenagers.

ORGANISATIONAL

Trends and Patterns

a)    Records and information

• The practice has up to date clinical summaries for over 80% of the patients.
• The practice has a system for summarising new patient records within 8w of registration.
• The practice has a system for acting on information received about patients.
• The practice has a robust system for transferring information to other doctors/organisations (e.g. OOH)

b)    Information for patients

• The practice supports patients with appropriate health literature (stopping smoking for example) from a variety of sources (physical/electronic leaflets and online material). 

c)    Education and training

• All practice members receive annual training in Basic Life Support, Info. Governance & Fire Safety.
• All doctors maintain a record of up to date Child and Adult Safeguarding training.
• All GPs and nurses participate in peer appraisal.
• The practice maintains a register of who is up to date and who is not.
• The practice has a system for handling patient complaints and sharing learning points from discussions.
• The practice has a system for reviewing Significant Events and highlighting points for learning and change.   In addition, the practice regularly reviews deaths, patients on the terminal care register, child and adult protection cases. 

d)    Practice Management

• The practice has clear and accessible pathways for Adult and Child protection.
• The practice offers a range of appointments to patients – online, in person, telephone, face-to-face, video consultations and e-consultations.
• The practice has a system to ensure regular inspection, calibration & maintenance of medical equipment.
• The practice has policies which include a staff manual, employment policies, equal opportunities, bullying & harassment and sickness absence – to which staff have access.

e)    Medicines Management

• The practice possesses equipment and in-date drugs appropriate to emergency care in general practice.   In addition, there is a system in place for checking the expiry dates of emergency drugs on an annual basis.
• The number of hours from requesting a prescription to availability for collection is 48 hours.
• The practice meets a prescribing advisor at least annually to review and improve prescribing.
• The practice has a medication review process for patients who are on repeats (which is recorded in the medical notes).

Specific areas for change or improvement within your practice as a training practice

• We re-profiled our nursing team last year, to increase HCA time and nursing skills.  We created a new admin role specifically for the nurses to help with nursing admin work which is on the increase. 
• Looking to increase the skill mix and develop our doctor team with introduction of an employed in-house pharmacist, and Advanced Nurse Practitioner.   

Any areas of concern highlighted by QOF or CQC

• None highlighted by QoF.
• CQC – none

Attach a list of the meetings that run regularly in the practice (for example, in a typical 3-month period). Within this please highlight those meetings which trainees are free and encouraged to attend.

The practice holds a number of meetings and GP trainees are expected and encouraged to attend.  These are….

• Doctor weekly meeting: discussing various hot topics, messages from various organisations (eg CCG updates) and practice issues – in attendance are Doctors, Nurses, GP trainees, Practice Manager and Assistant PM – others by invitation.
• Protected Learning Time: every Thursday afternoon – Doctors, GP trainees, Nurses, and admin as required
  • • Significant Event Meetings : 1 per month.  All practice members attend including GP trainees.  
    • Palliative and End of Life care meetings: 1 per month.  All clinical staff along with District Nursing Team.
    • Children at risk & update meetings: 1 per month: All clinical staff along with Health Visitors.
    • Mortality review meetings: 1 per month.   All clinical staff.
    • Prescribing review meetings: 2 per year on average.  All clinical staff with in house pharmacist.
• Ashcroft Nursing Home Weekly Ward Round: a nominated GP goes.   GP trainee occasionally invited to join to learn.
• CCG/CCF meeting: 1 per month – GP & PM – GP trainee invited if they show interest.
• Committee of Reps meetings: 1 per quarter – GP & PM – GP trainee invited if they show interest.

GP Trainees are also released to….

• 2 in-house tutorials per week each lasting 1.5h.
• weekly Wednesday 1.5h tutorial focused on clinical topics, devised by the scheme.  
• Half Day Release every Tuesday pm.

• Attach details of 2 such meetings held in the past 3 months.  Declare that minutes of meetings are dated, with names and roles of those attending.
• Regular meetings should be clearly structured with agendas, objectives, clear descriptions of topic, list attendees etc.

Our practice identifies areas worth analysing via audit through

• Significant Events (practice and personal)
• Prescribing Review meetings in liaison with our in-house pharmacist
• Items on QoF that we are underachieving
• Through items on Local and Direct Enhanced Services
• When we (as a practice) feel or know there is a clinical area that we may be neglecting
• From clinical ideas as a result of attending courses like GP Update

• Be specific about where debriefs happen.  
• Highlight tutorials and other educational (e.g HDR) activities. 
• State how trainee gets OOH/UUC experience. 
• Who supervises when Trainer is away?  
• Does trainer timetable include 1h per week for educational preparation time (e.g. for tutorial preparation, ePortfolio reading etc.)? 
• In Yorkshire & the Humber, you must use the timetable proforma they give you and not your own.  

Ask PM to write a brief account about how this timetable might alter depending on the particular needs and level of each trainee (i.e. appropriate adjustment of appointment length, GP trainee involvement with telephone triage, home visits, insurance and other paperwork, tasks etc.).

We recognise that all trainees are different and that they learning and develop in varying ways.    Therefore, we modify GP training at this practice in the following ways to help construct a smoother progression and development for the trainee.

The Sessions

• The number of sessions in the GP trainee’s timetable is dependent on whether they are full-time or part-time.
•  If they are part-time, we try to ensure as much overlap as possible between the trainer and the trainee (at least 50%).   Attendance at the Scheme’s HDR is scheduled in. 
• We then make fine adjustments to the timetable if there are particular trainee needs.   The trainer approves these finer adjustments.
  • • For example, surgeries might start later or finish earlier if there are child care issues.
    • If a trainee is struggling or has acute social/home issues, we may temporarily put in some appointment blocks to make surgeries feel less pressured.
    • If the trainee needs to be away on certain days (e.g. academic GP trainee), we will provide for that.
    • If the trainee is nearing their AKT exam, some of the tutorials may be put in with other GPs to increase knowledge levels.
    • If the trainee is nearing their CSA exam, some tutorials are changed to CSA mock practice with the Trainer, with more “sit and swap” surgeries.

Appointment Length

• GP ST1’s usually start on half-hour appointments and we gradually work them down to 15 minute appoints.
• GP ST3’s usually start on 20 min appointments and we gradually work them down to 10 minute appointments.
• How quick this happens depends on the trainee and is done only after liaising with the GP trainer and the trainee.

Increasing Clinical Exposure:

• In order to get GP trainees trained up to real world General Practice, we involve them in the following (but only when the time is right)
  • • Home visits
    • Various Reports
    • Death Certification
    • Clinical Tasks
    • Projects to help us reach targets

• In Yorkshire & the Humber, there is no proforma for this.
• Ask your PM to give you the last time table they used. 
• The induction timetable should cover at least 2w.
• It should show things like tutorials, sitting in with various staff, tour of premises, etc.  

• Doctors Bag – equipment and drugs (click for Ashcroft Surgery’s protocol) 

There are minimum requirements that some Deaneries/HEE GP schools stipulate that should be included in your Induction Pack.    Here are the minimum requirements…

• Introduction to the work of all members of primary health care team.
• Trainee knowing and understanding the ways in which they can also communicate with members of the practice team including admin staff/managers, and clinicians, Doctors, nurses, HCAs and other attached clinical staff such as counsellors, midwives, health visitors etc.
• Trainee understanding how they can contact you, their GP trainer for help/advice throughout the day.
• Trainee is shown how to use equipment and facilities.
  • Audiovisual equipment for recording and reviewing of consultations for WPBA.  Discussion about their personal responsibility for protecting media which holds patient information including camcorders, etc.   Keep under lock and key when not in use.  Never leave recording equipment alone in an empty room. 
  • Basic training in how to navigate the practice computer system and also any practice intranet / desktop / library facilities.
• Child and Adult protection protocols/policies.   Must be a discussion re: recognising protection issues and the multidisciplinary aspects of putting protection into place.
• Trainees own personal safety issues – i.e. panic alarms, room layout, keeping doors locked etc.
• Trainee understanding how to raise concerns during the placement.
• Information about how to access counselling or occupational health advice.
• Details of how trainee applies for study and annual leave.