Learning to recognise what good practice looks like: how general practice trainees develop evaluative judgement

The ePortfolio—love it or loathe it—is an integral part of the workplace-based assessment, it is now a fact of life for general practice trainees. It is also preparation for the appraisal system for qualified GPs, which is heavily reliant upon portfolios of evidence and the creation of personal development plans (or PDPs). Such reliance is only likely to increase with the proposed new revalidation system, which is currently expected to be introduced in 2010–11. Given this context, it is wise for GP trainees to learn how to use these tools to best effect, not only to provide robust evidence of good practice but also to aid personal development. This article aims to describe the way in which PDPs and portfolios can be best employed during your years as a trainee, equipping you with useful skills for a career in general practice. Although the use of tools such as significant event analysis, audit and the consultation observation tool (COT) and case-based discussion, assessments are all important reflective components of the ePortfolio, they will not be discussed in depth in this article.

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Self-awareness and professionalism

InnovAiT Education and inspiration for general practice ◽

10.1177/1755738017710962 ◽

2017 ◽

Vol 10 (8) ◽

pp. 452-457 ◽

Cited By ~ 2

Author(s):

Andrew Papanikitas

Keyword(s):

General Practice ◽

Good Practice ◽

Self Awareness ◽

Professional Self

Professionalism is a key component of good general practice, and self-awareness is a key component of professionalism. Being self-aware means understanding your own fitness to practice as a GP. It is a critical skill for ePortfolio reflections and appraisals, as it is a critical skill for good practice. In this article I will offer an approach to professional self-awareness through a set of four questions: What are my goals? What are my beliefs? What are my values? and What is my condition?

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Tensions and opportunities in social prescribing. developing a framework to facilitate its implementation and evaluation in primary care: a realist review

BJGP Open ◽

10.3399/bjgpo.2021.0017 ◽

2021 ◽

pp. BJGPO.2021.0017

Author(s):

Sara Calderón-Larrañaga ◽

Yasmin Milner ◽

Megan Clinch ◽

Trisha Greenhalgh ◽

Sarah Finer

Keyword(s):

Primary Care ◽

General Practice ◽

Best Practice ◽

Grey Literature ◽

Good Practice ◽

Realist Review ◽

Individual Characteristics ◽

Quantitative Evidence ◽

Social Prescribing ◽

Community Sector

BackgroundSocial prescribing (SP) involves linking patients in primary care with services provided by the voluntary and community sector. Despite growing interest within NHS primary care, it remains unclear how and under what circumstances SP might contribute to good practice.AimTo define ‘good’ practice in SP by identifying context-specific enablers and tensions. To contribute to the development of an evidence-based framework for theorizing and evaluating SP within primary care.Design and settingRealist review of secondary data from primary care-based SP schemes.MethodWe searched for qualitative and quantitative evidence from academic articles and grey literature following the Realist and Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES). We characterised common SP practices in three settings (general practice, link workers and community sector) using archetypes which ranged from best to worst practice.ResultsA total of 140 studies were included for analysis. We characterised common SP practices in three settings (general practice, link workers and community sector) using archetypes which ranged from best to worst practice. We identified resources influencing the type and potential impact of SP practices and outlined four dimensions in which opportunities for good practice arise: 1) individual characteristics (stakeholder’s buy-in, vocation, knowledge); 2) interpersonal relations (trustful, bidirectional, informed, supportive, transparent and convenient interactions within and across sectors); 3) organisational contingencies (the availability of a predisposed practice culture, leadership, training opportunities, supervision, information governance, resource adequacy and continuity and accessibility of care within organisations); and 4) policy structures (bottom-up and coherent policymaking, stable funding and suitable monitoring strategies). Findings where synthesised in a multi-level, dynamic and usable SP Framework.ConclusionOur realist review and resulting framework revealed that SP is not inherently advantageous. Specific individual, interpersonal, organisational and policy resources are needed to ensure SP best practice in primary care.

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An evaluation of the clinical microsystems approach in general practice quality improvement

Primary Health Care Research & Development ◽

10.1017/s1463423620000158 ◽

2020 ◽

Vol 21 ◽

Author(s):

Vanessa Abrahamson ◽

Sabrena Jaswal ◽

Patricia M. Wilson

Keyword(s):

General Practice ◽

Quality Improvement ◽

Diffusion Of Innovation ◽

Good Practice ◽

Added Value ◽

Normalisation Process Theory ◽

Future Research ◽

Sampling Frame ◽

Clinical Microsystems ◽

South East England

Abstract Background: Changes to the general practice (GP) contract in England (April 2019) introduced a new quality improvement (QI) domain. The clinical microsystems programme is an approach to QI with limited evidence in primary care. Aim: To explore experiences of GP staff participating in a clinical microsystems programme. Design and setting: GPs within one clinical commissioning group (CCG) in South East England. Normalisation process theory informed qualitative approach. Method: Review of all CCG clinical microsystems projects using pre-existing data. The Diffusion of Innovation Cycle was used to inform the sampling frame and GPs were invited to participate in interviews or focus groups. Ten practices participated; 11 coaches and 16 staff were interviewed. Results: The majority of projects were process-driven activities related to administrative systems. Projects directly related to health outputs were fewer and related to externally imposed targets. Four key elements facilitated practices to engage: feeling in control; receiving enhanced service payment; having a senior staff member championing the approach; and good practice–coach relationship. There appeared to be three key benefits in addition to project-specific ones: improved working relationships between CCG and practice; more cohesive practice team; and time to reflect. Conclusion: Small projects with clear parameters were more successful than larger ones or those spanning organisations. However, there was little evidence suggesting the key benefits were unique attributes of the microsystems approach and sustainability was problematic. Future research should focus on cross-organisational approaches to QI and identify what, if any, added value the approach provides.

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A review of required monitoring and management of physical health parameters in patients being treated with clozapine

BJPsych Open ◽

10.1192/bjo.2021.326 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S111-S111

Author(s):

Louisa Ward ◽

Charlotte Marriott ◽

Giles Glass ◽

Mariam Negm ◽

Hannah Porter

Keyword(s):

General Practice ◽

Data Collection ◽

Physical Health ◽

Current Practice ◽

Good Practice ◽

Junior Doctors ◽

Staff Members ◽

Shared Data ◽

Routine Monitoring ◽

Data Source

AimsTo review available standards for physical health monitoring in people taking clozapine To audit current practice against standards To identify changes in practice and facilitate a re-audit to assess impact of any changesMethodStandard: CG178 Psychosis and Schizophrenia in Adults: Prevention and Management – NICE, February 2014Target:100%Exceptions: NoneSample: The original audit included all 58 patients from the Worcester clozapine clinic, as per October 2018. The re-audit reviewed a random sample of all patients attending the clozapine clinics in Worcester, Kidderminster and Redditch, as part of Worcestershire Health and Care NHS Trust, as per October 2019. A total of 66 patients were selected.Data Source: Carenotes and ICEResultAreas of good practice:Monitoring of HbA1c and FBC remains goodThere has been an improvement in monitoring alcohol use, substance misuse and side effectsAreas requiring improvement:There continues to be limited recording of respiratory rateThere has been a decline in recording temperature, BMI and concomitant therapiesPotential reasoning for missing data includes:Staff not knowing the monitoring requirements, which is more likely to be an issue when staff members running the clinics change frequentlyMonitoring being completed but not documentedPatients’ refusal of monitoringData being recorded in alternative locations including general practice, without communication between servicesPatients moving between teams or having inpatient stays may disrupt monitoring regimeConclusionLIMITATIONSThis audit assumes all patients involved to be on a stable dose of clozapine with routine monitoringSome patients may have been transferred between teams or inpatients during the period of data collectionThere is no scope to record when patients refuse monitoringWe may not have access to all notes such as those from general practice for data collectionRECOMMENDATIONSInduction programme for junior doctors to include education on clozapine monitoringTraining for staff involved in clozapine clinics to ensure better understanding of monitoring requirementsProcurement of ECG machines for each site and relevant training for nursing and medical staffCollaboration with GPs for shared dataRe-audit in 1 year

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