Project Officer: Catherine Scardilli
Phone: 8752 4937

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Quick Reference Link
Practice Accreditation
4th Edition RACGP Standard
Accreditation Links and Resources
Practice Incentive Program
Practice Management Information

 

Program Overview

The Central Sydney GP Network (CSGPN) Practice Management Project provides support and information to GPs and practice staff through the following:

• Practice Visits
• On-site presentations to GPs and Practice Staff
• Helpdesk (telephone and email)
• Workshops
• Communication tools such as newsletters, fax-outs and emails.

Assistance is available to practices in the following areas:

• Accreditation: accreditation advice and assistance, collation of patient survey results, mock accreditation
• Practice Incentives Program (PIP) & Service Incentives Payments (SIP)
• Starting a new practice - assistance with all aspects of starting a practice
• Business Process Review: review current processes and provide recommendations and advice on the flow of procedures including procedure manuals
• Change Management and Human Resources
• Workshops for GPs and Practice Staff
• Risk Management and Occupational Health & Safety
• Privacy and Confidentiality including record retention guidelines
• Infection Control
• Other practice management enquiries as required

What is Accreditation?

Accreditation is the assessment of a general practice against the requirements outlined in the Standards of General Practice written and published by the Royal Australian College of General Practitioners (RACGP). The Standards of General Practice are considered the benchmark for Australian practices. The accreditation process is completed by either AGPAL or GPA Plus and covers the following areas:

• Practice Administration: appointment systems, triage processes, communication tools, interpreter services, after hours services, home visits, security, signage and health promotion
• Practice Management: human resources, training, occupational health and safety, quality improvement
• Consultation Room: facilities including design layout of the rooms and what to include in the doctor’s bag
• Management of Health Information: confidentiality, privacy, transfer of health information, retention and destruction of records, electronic information security and access, content of patient records
• Patient Management: practice costs, health promotion, continuity and co-ordination of care, recall systems, engaging other services, collaborating with patients
• Treatment Room: practice equipment, Schedule 8 medicines, vaccine potency, perishable materials, perishable materials, infection control
• Interviews: doctor interview, clinical staff (if applicable), staff interview
• Document Review: practice information sheet, policies and procedures; patient feedback surveys

What benefits do I get from being an Accredited practice?

• Guidance for best practice using benchmarks with other accredited practices
• Access to the Commonwealth’s financial incentives programs - Practice Incentives Program (PIP) and Service Incentives Program (SIP)
• RACGP QI & CPD points (Category 2)
• Increased recognition from insurance providers
• Reduced risks in service delivery
• Improved practice efficiency
• Improved patient outcomes

What does it involve?

Most practices prepare up to 8 months ahead of their accreditation date to gradually address the tasks needed. Practices must complete a Policy and Procedures manual, Patient Feedback survey and a formal Survey visit. Most requirements are already in place within practices however this process is a formal documentation and recognition of practices. For new registrations, the accreditation cycle lasts 12 months. The normal accreditation cycle lasts for 3 years. CSGPN is available to assist practices register and prepare for their accreditation.

New Changes in the 4th Edition Standards

From 1st of July until 31st of October 2011, any practice which registers for accreditation will be able to choose between the 3rd or 4th Edition RACGP Standards for General Practice for their practice assessment. Practices who are currently accredited and whose expiry dates fall between 1st of April 2012 and 31st of July 2012 will also have a choice of which edition they would like to be re-accredited against.The 4th Edition Standards will be used for all practices who register for accreditation from the 1st of November 2011 and whose current accreditation expires after the 1st of August 2012.

To help familiarise practices with the changes in the new edition of the Standards, the RACGP have produced a presentation and summary fact sheet which outlines the key changes between the 3rd and 4th editions.  The RACGP will also be running education sessions scheduled to resume in early September. Visit the RACGP Standards website for more information and timetables.

New Criterion- 1.5.2 Clinical Handover- Our practice has an effective clinical handover system that ensures safe and continuing healthcare delivery for patients
Clinical handover has been defined by the AMA as ‘the transfer of professional responsbility and accountability for some or all aspects of a patient’s or group of patient’s care to another person or professional group on a temporary or permanent basis’. Practices must be able to demonstrate that an effective clinical handover system is in place to deal with situations of clinician illness, annual leave or patient referral to other health services. This procedure should be supported by a documented policy to ensure that it is standardised across all clinicians within the practice and so all practice support staff are aware of it. Attention should be paid to patient health summaries and referral letters as these will assist in the safe handover of patients to other clinicians both internally and externally. Useful resources to assist practices include the ACSQHC OSSIE Guide to Clinical Handover or the AMA’s Safe handover: Safe patients guide.

New Criterion- 3.1.3 Clinical Governance- Our practice has clear lines of accountability and responsibility for encouraging improvement in safety and quality of clinical care.
The RACGP define clinical governance as ‘the framework through which clinicians and health service managers are jointly accountable for patient safety and quality care. This criterion is made up of two flagged indicators:

• Our practice has leaders who have designated responsbility for safety and quality improvement systems
• Our practice shares information about quality improvement and patient safety within the practice team

The Australian Commission on Safety and Quality in Health Care proposes that an effective clinical governance model should include recognisably high standards of care, transparent responsbility and accountability for maintaining those standards, and a constant dynamic of quality improvement. Practices must nominate clinical leaders in areas of quality improvement and patient safety who are responsbile for the implementation and monitoring of safety and quality systems. It may be beneficial for practices to consider other activities currently undertaken by the practice or other criterion within the Standards, as many activities may intersect. For example, regular practice meetings and the use of clinical audits, can satisfy more than one criterion and lend itself to elements of a clinical governance system.

New Criterion- 3.1.4- Patient Identification- Our patients are correctly identified at each encounter with our practice team.
Incorrect patient identification can result in medication errors, diagnostic test errors or failure to receive appropriate medical treatment. Studies have shown that using three identifiers decreases the risk of incorrect identification from 1 in 3 to 1 in 3500. The RACGP has introduced one new flagged indicator to meet this criterion: Our practice has a patient identification process using three approved patient identifiers and the practice team can describe how it is applied. The approved identifiers include:

• Patient name, including given and surname/family name
• Date of birth
• Gender (self identified by the patient)
• Address
• Patient record number (where one exists)

When asking patient’s for identifying information, it is important that practice staff not volunteer the information for confirmation as errors may occur and that patient’s state their own information. All staff in the practice must be aware of the process for identifying patients and patients should be identified on occasions when attending the practice, over the telephone or when documents are requested/collected. Three approved identifiers must also be used when preparing referral letters.

New Criterion 5.3.1- Safe and Quality Use of Medicines- Our clinical team prescribes, dispenses and administers appropriate medicines safely to informed patients.
The 4th Edition Standards expands on medicine safety outside the previous focus on Schedule 8 medications. The medicines safety framework consists of 4 flagged indicators:

• Our clinical team can demonstrate how patients are informed about the purpose, importance, benefits and risks of their medicines and how patients are made aware of their own responsbility to comply with the recommended treatment plan
• Our clinical team can demonstrate how we access current information on medicines and review our prescribing patterns in accordance with best available evidence
• Our clinical team can demonstrate how we ensure patients and other health providers to whom we refer receive an accurate and current medicines list
• Our clinical team can demonstrate how we ensure that medicines are acquired, stored, administered, supplied and disposed of in accordance with manufacturers’ directions and jurisdictional requirements

Clinical team members must be able to demonstrate how patients are informed about their medications, how staff access current prescribing information and the medicines management within the practice. Patient medical records and consultation notes are of crucial importance in satisfying this criterion as well as the availability and use of promotional patient information. Clinical desktop systems and prescribing software allow for consumer information to be produced and, in some cases, self-recorded within the patient file. The Therapeutic Goods Administration Safety website has medicine safety information for both consumers and health professionals which may be used.

New Flagged Indicator- 1.7.1B Where our practice has an active hybrid medica record system, for each consultation/interaction, our practice can demonstrate that there is a record made in each system indicating where the clinical notes are recorded
Hybrid record systems pose a significant risk to patient management particularly in situations where patients are unable to see their regular GP. Where hyrbid record systems exist, practices need to ensure that all information is accessible when needed and it is recommended that practices work toward creating wholly electronic systems.

New Flagged Indicator- 5.1.1G The practice must have one or more height-adjustable beds
The RACGP has released a fact sheet on Height-Adjustable Beds outlining the rationale for the change and factors for consideration by practices. To assist practices with the cost of purchasing a new height-adjustable bed, your practice may be eligible for a rebate from Workcover NSW. Visit the Workcover NSW Safety Solutions Rebate page for more information.

New Flagged Indicator- 2.1.2C At least once every 3 years, the practice actively seeks feedback about patient experiences by using a validated patient experience questionnaire approved by the RACGP or their own uniquely developed method
The RACGP has acted on research evidence which suggests that the most meaningful changes to a practice can occur from collecting and using patient experience feedback. Tha RACGP have recently published a detailed guide Learning from our Patients which describes the methods practice can use to gather patient feedback along with their advantages and disadvantages. The RACGP has approved the following survey tools:

• Patient Accreditation Improvement Survey- developed by Client-Focused Evaluation Programs. Two versions have been approved for use, a whole-of-practice survey and practitioner-specific feedback. Download the CFEP information sheet for more information about fees and processes.
• PSI v4 of a Patient Satisfaction Instrument- developed by Ultrafeedback. For more information, download the PSI Flyer.

Human Resource System- Designated Responsibility amongst the ‘Practice Team’
The 4th Edition Standards has introduced the term ‘Practice Team’ to reflect the changing dynamics of medical practices and recognises the multi-disciplinary roles amongst practice staff, acknowledging to both clinical and non-clinical staff. Practice must now designate a team member responsbility in the following areas:

• Cleaning
• Complaints Management
• Infection Control
• Information technology
• Quality Improvement
• Risk Management Systems
• Sterilisation
• Vaccine Management

Under the 4th Edition Standards, position descriptions are now mandatory for all staff and if a team member has a deligated responsbility in the above areas, it must be documented as part of this document. It is expected that all other members of the practice team can identify the designated leaders in each area and that a process is implemented to monitor team member performance against their position descriptions. The CSGPN Practice Recruitment Guide may be able to assist you with the require documentation and implementing an effective performance management system.

Accreditation Links and Resources

• RACGP 3rd Edition Standards 2007
• RACGP 4th Edition Standards 2010
• CSGPN 4th Edition Manual Template NEW!!
• CSGPN Transitioning to the 4th Edition Standards Fact Sheet NEW!!
• CSGPN Demonstrating Compliance in the 4th Edition Suggestion Sheet NEW!!
• CSGPN 4th Edition Mock Interview Questions- Clinical Team Member NEW!!
• CSGPN 4th Edition Mock Interview Questions- Practice Team Member NEW!!
• CSGPN 4th Edition Standards Practice Checklist NEW!!
• AGPAL Registration Information Guide
• GPA Plus Registration Information Guide
• CSGPN Accreditation Guide Book- 3rd Edition
• CSGPN Mock Accreditation Interview Questions for the GP
• CSGPN Mock Accreditation Interview Questions for the Practice Manager
• CSGPN Mock Accreditation Interview Questions for the Practice Nurse
• CSGPN Mock Accreditation Interview Questions for the Receptionist
• GPA Plus 1-5 Rating Feedback Collation Template
• GPA Plus Yes/No Feedback Collation Template
• GPA Plus Patient Feedback Analysis Report Template
• Practice Information Sheet 3rd Edition Checklist
• Practice Information Sheet 3rd Edition Template
• Practice Facilities 3rd Edition Checklist
• Doctor’s Bag Checklist Template
• Infection Control Precautions Poster
• Spills Kit Contents- 3rd Edition
• Spills Kit Location Signage
• Privacy Notice for Patients
• RACGP Approved NSW CPR Providers
• CSGPN List of Height-Adjustable Bed Suppliers

How can CSGPN Practice Support help practices with Accreditation?

Full assistance is provided by CSGPN to plan for the accreditation visit including the provision of resources, checklists, collating patient survey results, mock interviews and training with staff, and conducting a mock accreditation visit.

Practice Incentive Program

The Practice Incentive Program (PIP) provides financial incentives to general practices aimed to encourage improvements in quality of care, access and outcomes of all patients. Practices must either be accredited or become accredited within 12 months to be eligible for the PIP. The PIP is administered by Medicare Australia on behalf of the Department of Health and Ageing. There are 13 individual incentives which make up the PIP each with their own payment structures. Payments are made to both the practice and the individual practitioner, and are generally calculated based on practice size.

For more information about the PIP and the individual incentives, visit Medicare Australia: Practice Incentive Program website.

The New Practice Nurse Incentive Program

Medicare Australia and the Commonwealth Government released in early June the guidelines for the new Practice Nurse Incentive Program (PNIP). The PNIP is designed to streamline current financial payments made to practices through the PIP Nurse Incentive and MBS nurse items into one single payment. Under these new arrangements, eligible practices will be supported with payments of up to $12,500 per annum for an Enrolled nurse or Aboriginal Health Worker and up to $25,000 for a Registered nurse. Payments are calculate based on practice SWPE and contracted hours of the employed nurse or Aboriginal health worker.

The program also offers a one-off $5,000 incentive payment to eligible non-accredited practices to become accredited. Applications for the program open 1st of October 2011. For more information on the PNIP, click on the program guidelines below. To calculate how much your practice may be eligible for, use the Ready Reckoner link below.

PIP Links and Resources

• PIP and GPII Application Form
• PIP Incentive Guidelines
• PIP Quarterly News November 2011
• Asthma SIP Quick Guide
• Cervical Screening SIP Quick Guide
• Diabetes SIP Quick Guide
• CSGPN PIP Income Estimator
• New Practice Nurse Incentive Program Guidelines
• Practice Nurse Incentive Program Ready Reckoner

 

Practice Management

Practice management is a growing area of need for Australian general practices and is now being recognised by professional bodies as a key element in the delivery of high quality healthcare services. The RACGP in it’s review and development of the new 4th Edition Standards for General Practice, has acknowledged the evolution in the general practice environment and the growth of the general practice team by acknowledging the contribution they can make in areas of risk management and service coordination. In the RACGP’s Draft Definition of General Practice published in March 2011, there is further acknowledgement of the need for coordination and teamwork in delivering high quality patient care including compliance with national standards and guidelines, in the general practice setting. Practice management encompasses a number of issues which affect the day-to-day running of a practice including human resources, information technology and information management, facility and equipment maintenance, accreditation and compliance, administration and finance.

Practice Management Training Providers

• The Australian Association of Practice Managers (AAPM) is a non-profit, national organisation which exists to provide professional support, advocacy and education to Practice Managers to assist them with the performance of their practice.
• UNE Partnerships is the education and training company of the University of New England and in association with the AAPM, have developed a number of professional qualifications for Practice Managers.
• Indigo Medical and Dental Consulting are a nationally Registered Training Organisation (RTO) who have several courses available in Healthcare Business Administration, Medical Reception, Dental Assisting and Practice Management. I
• Medical Administration Training is a natioanlly Registered Training Organisation (RTO) who has been delivering medical administration courses since 2004.
• Some courses are available for completion as Traineeships in conjunction with some RTO’s so employees can learn whilst ‘on-the-job’. The NSW State Government supports the employment of Trainees and there may be financial incentives available for employers to establish Traineeships. Download the NSW State Government Guide to Apprenticeships and Traineeships in NSW for more information or contact CSGPN for a list of Australian Apprenticeship Centres in your area.

How CSGPN supports Practice Managers

CSGPN helps support the education and professional development of Practice Managers with monthly practice staff events with a range of topics to address practice management issues. Visit our CPD Page to access presentations from previous events. 

We strongly encourage Practice Managers to provide feedback and comments on what topics or information should be featured both at events and on our website. Use the feedback tool on the website to send us your comments.

CSGPN also offers Practice Managers, Practice Nurses and Aboriginal Health Workers, working in practices within the CSGPN area to apply for full Ordinary membership. If you are interested in a Member, please visit the Membership page for more information or to download an application form.