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At the heart of general practice since 1960

Complacency on revalidation damages us all

Your computer system still has a great deal more to offer ­ Dr John Couch shows how to bring functionality into the 21st century

The new contract has prompted us to make better use of our computer systems. But there is still much room for improvement, particularly with the quality and outcomes framework.

Most practices still only use a small proportion of their computer's capability. We are in the middle of a rising curve of computerisation with national linking the next major step.

At a local level there is no doubt that your system has a great deal more to offer at a clinical and business level. Have a careful look at the following areas to bring functionality into the 21st century.

Records

Patients' computer records have never been more important. For a variety of reasons it is now less common for patients to always see the same GP. This reduction in continuity makes clear records even more important. Q&O has also focused on comprehensive data gathering and accurate Read coding.

Summaries must be kept tidy and up to date. You may have worked hard getting patient summaries on to your system but they can quickly become disorganised and out

of date. You will be surprised how quickly diagnoses achieve multiple entries or minor problems recorded as significant.

Have a protocol for entering new relevant data and a system for checking, tidying and linking summaries regularly.

Make sure you are now linking all new and reinstated prescription items to a diagnosis. Your system will allow you to do this easily. There are Q&O points for this and clinically it also helps greatly for audit and when patients see different GPs.

Encourage use of templates wherever possible for accuracy, protection and uniformity. They must be designed to be Read code accurate (ie Q&O codes), user friendly and, vitally, kept up to date.

Use macros and keyboard shortcuts for speed. Most systems have both of these functions but how many in your practice actually use them? They can save considerable time.

For instance, one of my macros allows me to enter the consultation and prescribe for standard conjunctivitis with one keystroke.

Keep entries objective not subjective. Patients have a right to see their data.

Check that locums enter consultations clearly. Ensure before they start that they can use your system. We all have horror stories about poor (or non-existent) locum records. Locums should not be allowed to work for you unless they can meet this basic requirement.

Finally, once your data is accurate, create standard hospital letters which electronically extract data such as past history, current medication and allergies. All you then need to do is dictate the presenting problem and your system does the rest. This saves you and your secretary time as well as producing clear, professional and comprehensive letters.

Audits

Audits are now an essential element of practice rather than simply a research tool. Although your system's Q&O software contains important in-built searches, there are increasing numbers of alternative ones required. Ensure that as many personnel as possible are able to perform audits. Most GP systems make this task relatively easy (some more than others!).

Training is important to build and disseminate skill levels so we can all make use of computer audit. At the same time find out the easiest way for audit reporting. Although most systems allow simple print-off, in many cases, more complicated results can be exported to EXCEL which allows graphs and charts to be produced.

Find out also how to mail merge patient lists from audit. This makes mailshots so much easier.

Practice presentations

Modern software such as Microsoft Office affords all practices the ability to produce helpful and professional documents and presentations, whether for patients, colleagues, PCT or internal consumption.

Consider all areas of your practice work that could benefit from this and arrange appropriate training. You could, for instance, consider a practice newssheet for your waiting room or posters for your noticeboard.

Remember, that most GP software has a leaflet section that can be used opportunistically in consultations and to produce supplies for the leaflet rack.

Practice meetings and training sessions can be made more effective by the use of presentation software such as Powerpoint.

For small groups a computer screen can be used but for larger groups the use of a projector is very helpful. As these can now be purchased for under £1,000, larger practices in particular should consider getting one.

Such presentations carry more impact and interestingly the presenter is prompted to produce a more 'complete' product! A projector is also extremely effective in larger group computer training as it avoid the struggle to get a decent screen view.

Finances

If you still maintain written accounts and bookkeeping you really are in the dark ages. Computer software saves considerable time and makes cash-flow forecasting, audit and reporting so much easier.

If you are setting this up make sure you check with your accountants first. They will almost certainly recommend a system that is compatible with their own. This makes year-end reporting considerably easier and should save on accountancy fees.

Ensure you are getting as much from your finance package as possible. Personnel using this must have adequate training for the systems and subsequent upgrades.

E-mails

Communicating both internally and externally is made far easier by the use of e-mails in all but the smallest practice.

With staff and partners busy maximising the new contract and framework points, it can be very difficult to arrange meetings when all can attend. Provided everyone checks their e-mails at least twice daily, efficient and fast decisions and changes can be made. The option for attachments also reduces paper and makes amendments straightforward.

Make sure all are trained to use

e-mails via software such as Outlook and your GP software system where necessary. This should be a priority for new team members. Keep address books up to date and use group mailing where possible.

Make absolutely full use of IT help provided by your PCT. And remember that teaching, setting up new software and hardware will be greatly facilitated if you have a practice IT expert too.

John Couch is a GP in Ashford, Middlesex

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