ICGP Professional Competence System How to complete the cycle.

Competence Does the system measure competence? NO What does the system measure? What can be counted. Mostly Attendance not outcome. Except in case of Audit & some of the Internal content

Competence Measurement of competence is very complex The Dunning–Kruger effect is a cognitive bias in which "people reach erroneous conclusions and make unfortunate choices but their incompetence robs them of the metacognitive ability to realize it.” “ In the modern world the stupid are cocksure while the intelligent are full of doubt.” Medical Experience -Making the same mistakes with increasing confidence over an impressive number of years

What do GPs need to do Register Pay the fee You or someone in the practice must be computer savvy Consider putting some time away each week for the purpose of maintenance

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Audit

Its not rocket science Its not research Its about comparing to standards A sample can be used Implementing change Recounting

Medical Council Requirements component of PCS Actively engaged in audit Minimum - one audit exercise annually that relates directly to their practice Minimum one hour per month in audit activity recommended Audit should focus on the practice of the practitioner, not on processes

Distinguishing Audit from Research ® Research evaluates practice or compares alternative practices, with the purpose of contributing to a body of knowledge. It asks the question “What should we be doing?” It is peer reviewed, intends to publish the findings, can be generalised. ® Audit assumes that standards, guidelines or evidence exists, and asks, “Are we doing what we should be doing?” It is the comparison of current practice against previously agreed standards. Audit aims to influence activity at a local level Source Research Governance Framework - a users' guide NHS – Leeds

What is clinical audit? “a quality improvement process that seeks to improve the patient care and outcomes through systematic review of care against explicit criteria and the implementation of change…”. NICE. Principles for Best Practice in Clinical Audit. Oxford, Radcliffe Medical Press, 2002.

Audit improves practice.

Clinical audit can... Assess how closely local practice resembles recommended practice & Reinforce implementation of evidence-based practice Establish if you are actually doing what you think you are doing Provide assurance about the quality of care & Influence improvements to individual patient care Identify major risk, resource and service development implications

Identify Standard Measure activity Validate against standardMake appropriate changes

Audit steps Choose a topic Define your aims and objectives Choose guideline, Agree criteria and Set your standards Agree your method & Collect your data Analyse & Interpret data Determine what changes are needed Make the changes & Re-audit

Example – ACE inhibitors and renal failure. Guidelines: NICE Guidelines 2002 Criteria to be measured: The criteria selected was in terms of the recommended renal function checks-before starting ACE inhibitor, a week after initiation, on annual basis thereafter and on dose increase.

Example (continued) Standard(s) set: 100% or patients on ACE inhibitors should have renal function checks-before starting ACE inhibitor, a week after initiation, on annual basis thereafter and on dose increase.

Example (continued) Data Collection tool:Number of patients in the practice Number of patients on ACE inhibitors % who had baseline U&E % who had U&E checked one week later % who had U&E checked within following 6 months % who had U&E checked within following 12 months % who had annual U&E check % of type 2 diabetics who had annual U&E check while on ACE inhibitor

The Big Six Stroke and TIAs Acute Coronary Syndrome & Secondary Prevention Heart Failure Type 2 Diabetes Asthma COPD

In summary Ensure you are registered Keep the points ticking over Get familiar with the website Start an audit this month Use ICGP clinical guides Keep a record of all practice meetings.