Johnny LyonMaris

1
Practice visiting in UK Deaneries

• Johnny Lyon-Maris
• Glynis Buckle
• Mohan Kumar
• John Pitts

2
Currently what is known

• PMETB in process of developing Quality Assurance
  Framework1.
• To date all deaneries have developed their own
  standards.
• Little research Use of QOF on the visit2
• Visits valued
  but too much paperwork3
• 1. The PMETB Quality assurance framework
  Consultation document 2007
• 2. Swanwick et al., 2007 Education for primary
  care
• 3. Pitts et al., 2007 Education for primary
  care

3
Survey of deaneries Aug-Oct 2007

• Time scales for approval visits.
• Supporting paperwork.
• Visiting teams.
• Use of video teaching.
• QOF.

4
Common Features

• All deaneries visit.
• Initial trainer appointment 1-2 years.
• Three year re-approval (many looking to 5 year
  periods).
• Structured re-approval forms completed
  beforehand.
• Visit led by senior medical educator.
• Reapproval report sent to trainers.

5
Ranges for majority activities
6
Composition of visiting team

• Visit lead senior medical educator in 100 1
• Breakdown
• 12/20 same patch
• 2/20 random allocation
• 6/20 remote2

• AD, senior trainer or director
• Forces and NI not applicable

7
Composition of visiting team

• CO in 11/22.

8
Composition of visiting team

• Trainer in 16/22 1.
• In only 10/22 is it considered mandatory for
  trainer to be part of team.

1. expenses nil to 225 (5 deaneries pay the
trainer)
9
Composition of visiting team

• GPR in 4/22.

10
Composition of visiting team

• Practice manager in 11/22 1.

1. expenses nil to 140 (6 deaneries pay the PM)
11
Composition of visiting team

• Practice nurse in 2/22.

12
Composition of visiting team

• Lay member in 6/22 1.

1. in these representation from 5-25 of visits
13
Recommendations

• Time between trainer practice approval visits
• 1-2 years as is current practice throughout the
  United Kingdom. The reapproval visit period
  currently 3 years, is being prolonged to a 5 year
  period in some Deaneries. This extended
  reapproval period be evaluated and compared to
  current practice.

14
Recommendations

• Pre-visit supporting information
• A study be undertaken looking at the approval and
  reapproval application forms from all UK
  Deaneries to highlight similarities and
  differences so that these forms can be
  standardised for future use. The forms should
  however contain a section for local variance.

15
Recommendations

• Visiting teams
• Lead continue to be senior medical educators but
  that the teams consist of the key stakeholders,
  namely GP Trainers and GP Registrars with the
  addition of lay visitors in a pre-determined
  percentage of practice visits.

16
Recommendations

• Re/approval report
• The re/approval report is made universally
  available to the trainers being inspected.

17
Recommendations

• Training practice visit processes
• All patches within each Deanery standardise their
  visiting processes as occurs in a large number of
  the Deaneries, as without standardisation within
  the Deaneries national standardisation cannot
  occur.

18
Recommendations

• Videotaped teaching
• Trainer skills in teaching continue to be
  assessed, currently most commonly using
  videotaped teaching which is entirely acceptable,
  but if this is done that the videotape be
  reviewed in the presence of the trainer for
  developmental feedback reasons.

19
Recommendations

• QOF
• QOF scores be used in part or whole in a
  reapproval visit to prevent duplication of data.