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All things Pharma

Life after PGEA

Planning your meetings in the new GMS world

Paul Midgley of Healthcare Partnership looks at the combined effects of the new practice-based GMS and PMS contracts, GP appraisal, revalidation and the greater use of skill mix on what type of educational meeting will meet the needs of the Pharma representative’s customers now PGEA has ended.

Background – the move from PGEA to PDP

The Postgraduate Education Allowance (PGEA) for GPs, introduced back in 1990 with the first GMS contract, failed to deliver consistent, high-quality continuing medical education leading to improved delivery of patient care. The spread between the best and the worst of the 10 000 practices in the United Kingdom is still wide. In a matter of minutes one can travel from paperless practices with integrated teams which have developed skill mix with triage, nurse practitioners heading a nursing team, healthcare assistants, and other in house enhanced services, to those where the prescribing is suspect and the consultations perfunctory, performed with the sole aids of prescription pads, sick notes, unchecked equipment and barely any use of IT. The new contracts aim to remedy this. How?

Goodbye PGEA, hello CPD

PGEA was scrapped on April 1st 2004 with the advent of the new GMS contract. CPD, in the guise of Personal (PDP) and Practice (PPDP) development plans, aims to bridge the gap between time spent learning and the practical application of what has been learnt. This move to CPD is a direct result of the former Chief Medical Officer Sir Kenneth Calman’s ‘Review of Continuing Professional Development in General Practice’ (1998) publication. This review added a surge of energy to the “corporate” rather than the “independent practitioner” vision of primary care that has now culminated in the new practice-based GMS and PMS contracts. Calman’s review was a response to the criticism that the postgraduate education allowance has been based on an educational model which is “didactic, uni-professional and top-down,” rarely involved the whole practice team, and showed little evidence of any “convincing benefits to patient care.” Calman’s doctrine became enshrined in the NHS Plan in 2000 – signalling a move away from PGEA to a system of PDPs as the way to manage doctors’ education and professional development, and PPDP to manage the organisational development of the practice unit.

PDP/PPDP – the new way of documenting Continuing Professional Development Personal and practice development plans are a hybrid approach which combine documented personal learning within an organisational development framework. Successful training and development interventions contain features that predispose to, enable, and reinforce changes that deliver information, rehearse behaviours, and provide reminders and feedback. Effective strategies also use contextual and motivational influences. You need look no further than the very effective systems employed within the Pharmaceutical Industry for training and developing employees to judge the relative efficacy of these methods. Personal and practice development plans call for the construction of learning portfolios for all the practice team (doctors, nurses, managerial and admin staff) which take account of the development needs of the practice or department as well as the individuals in it. The plans therefore combine a systems approach to change management, with self-directed learning holding the key to harness motivation and maximise the impact of time spent learning. PDP/PPDP represents a gradual shift away from individual to organisational performance as a proxy measure for quality. The involvement of patient feedback (encouraged by the Quality and Outcomes framework) will strengthen the process, ensure local responsiveness, and guard against the loss of personal care.

What elements are driving CPD in primary care under nGMS?

Quality and Outcomes Framework The new GMS contract encourages practices to seek patient involvement by incentivising the running of annual Patient Satisfaction Surveys, and getting patients involved in reviewing the results alongside the practice, by providing 70 points on the ‘Quality and Outcomes framework’. Practices will need help establishing ‘Patient Participation Groups’. There are a further 29 points for attending to a range of training issues, including PDPs for all nursing staff, appraisals for all staff, and regular Critical Event audit. All staff are also encouraged to regularly update basic life-support skills.

Practice Management Competency Framework Annex C to the new GMS contract is a framework for managing a practice effectively. It identifies 85 management tasks that every practice should perform, and grades each into definitions of administrative, managerial and strategic levels of activity. These tasks fall within 9 key areas of Practice operation and development, Risk management, Partnership issues, Patient and community services, finance, human resources, premises and equipment, IT and population care. Increasingly, practice managers will encourage the senior team members to benchmark themselves against each of these standards and put together a strategic development plan for the practice management team. Good facilitation of these sessions is essential and will be sought by practice teams. Practice manager groups are already holding training days on this topic – HCP run these too.

GP Appraisal, PDP and Revalidation Now appraisals for GPs have commenced (all GPs should have been appraised at least once by April 2004), the link between PDP, annual appraisal and ultimately revalidation (starting April 2005) becomes apparent (see diagram, and www.gmc.org.uk). The GP appraisal process results in a Personal Development Plan being agreed between appraiser and appraisee, so all GPs should now have a PDP. Many GPs have a learning objective around developing their IT skills, as these are central to doing well on the Quality Framework in the new contract, and practices are being encouraged to move away from paper-based records, in preparation for a patient hand-held record by 2010.

Appraisal and PDP – supporting GPs through Revalidation

Practice Professional Development Plans and the GMS Quality Framework A number of primary care focused ‘Think Tanks’ have advocated team-based development initiatives for a number of years, for example, the RCGP’s ‘Quality Team Development’ and the Kings Fund’s ‘Commitment to Quality’ audit. Many PMS practices have part of their contract incentive payments based around high quality organisational standards including producing an annual PPDP. So, what is the benefit of all this planning? Practices who construct development plans (PPDPs) have found significant benefits. Teamwork is improved as the plans (when constructed via a whole-team approach) represent a consensus view about how best to deliver the organisation’s priorities. Perhaps nurses should become responsible for immunisation procedures? Should warfarin and lithium monitoring services be available? Does the appointment system provide reasonable access? How easy is it to communicate with the practice by phone? As part of the PPDP process involved an audit of practice activities, HCP now uses the Quality and Outcomes Framework as a benchmarking tool as part of our PPDP workshop. This has the added benefit of identifying how to maximise QOF points and practice income. PPDPs become tools for measuring the achievement of priorities a form of stepwise practice reaccreditation. By linking the personal/professional development of individual practitioners to an organisational development strategy that recognises variable starting positions, professional and practice development plans could be the most effective lever for change in primary care yet devised (Note – they apply equally to doctors in secondary care). Next month: Who is driving PPDP and PDP and what are the difficulties and opportunities?

If you would like further information on the work of The Healthcare Partnership, and on the range of topical talks and skills development workshops we run for NHS professionals via our team of expert facilitators, then please call us on  0870 2413506  0870 2413506 or e-mail to enquiries@healthcarepartnership.com. Find out how we can help improve your access to key customers by providing PDP and PPDP development workshops, and support for their ongoing professional development through our extensive range of educational programmes specifically designed for the NHS.
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