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Practice management

Dr John Couch continues our series by looking at the requirements needed to earn points from practice management

Points achieved with complete ease

Management 1 Individual health care professionals have access to information on local procedures relating to child protection

Value one point

Ensure you have an up-to-date copy of your local child protection procedures, sited in an accessible place. All relevant team members should know this location and have working knowledge of the contents. For validation there should be a written protocol for accessing this information and team members will be questioned. An annual practice child protection procedures meeting is sensible.

Management 5 The practice offers a range of appointment times to patients which as a minimum should include morning and afternoon appointments five mornings and four afternoons per week except where agreed with the PCO

Value three points

There are much more than three points dependent on this indicator. Do not forget the 50 bonus points for access

target achievement. Practices that do not reach the

minimum standard should review their appointments now. Practices that have not yet taken part in the advanced access scheme should also look to incorporate any other

changes ­ such as triage ­ at the same time. Practices in

remote and rural areas can agree a less onerous package

with the PCO and still achieve this indicator. Discuss this with the PCO now.

Points achieved with good planning

Management 2 There are clearly defined arrangements for backing up computer data,

back-up verification, safe storage of back-up tapes and authorisation for loading programmes where a computer is used

Value 1.5 points

While this indicator is second nature to most fully computerised practices, many others do not yet follow these guidelines. The points value is minimal, but the suggestions are absolutely vital business practice as lost data or a computer crash are disasters. If you do not have a team member responsible for IT then elect one now. Take advice from your practice software provider and the PCO IT lead. Set up each of these points as soon as possible.

Management 3 The hepatitis B status of all doctors and relevant employed staff is recorded and immunisation recommended if required in accordance with national guidance

Value 0.5 points

Few practices currently follow this guideline. Once again the points value is minimal but the indicator is sound advice. GPs have a responsibility to themselves and their staff to ensure awareness of the risks and advice on immunisation and regular checks for antibody response. While not specifically part of the indicator, practices may also choose to review their protocol for reducing the risk of spread of blood-borne viruses to health care workers.

Management 4 The arrangements for instrument sterilisation comply with national guidelines as applicable to primary care

Value one point

Make one team member responsible for this issue. Check current guidance with your PCO or local infections control lead. Ask to be informed as soon as this is updated. Regulations have become much tighter, especially for practices using their own steriliser (see also management 7 indicator). Ensure you comply and are ready to adapt quickly to any changes. Draw up a written protocol.

Management 6 Person specifications and job descriptions are produced for all advertised vacancies

Value two points

This can be done as each vacancy comes up to ensure the right person for the post and avoid the risk of breaching the various employment Acts. At least one of the management team must have good working knowledge of relevant employment law and discrimination acts. Invest in a good course and update regularly. See the links suggested in the Blue Book. Practices with 15 or more employees should keep up to speed with the disability discrimination act via their PCO, especially with reference to premises.

Management 8 The practice has a policy to ensure the prevention of fraud and has defined levels of financial responsibility and accountability for staff undertaking financial transactions (accounts, payroll, drawings, payment of invoices, signing cheques, petty cash, pensions, superannuation and so on)

Value one point

Forget about the single point, practices stand to lose much more if they do not already operate, or fail to instigate, every item under this indicator. They are all vital in fraud prevention and running a tight financial ship. Use the Blue Book guidance as a basic starting point and ask advice from your accountant if you need any extra help.

Management 10 There is a written procedures manual that includes staff employment policies including equal opportunities, bullying and harassment and sickness absence (including illegal drugs, alcohol and stress) to which staff have access

Value four points

This is a natural extension to indicator 6. The same management team member should be responsible for drawing up the manual if not already done. It forms a core for human resources and employer risk management. Once again the Blue Book provides useful references. Remember that the manual must be used. All staff should know its location and contents.

Points achieved with real striving

Management 7 The practice has systems in place to ensure regular and appropriate inspection, calibration, maintenance and replacement of equipment including: a defined responsible person, clear recording, systematic pre-planned schedules and reporting of faults

Value three points

This is a tough one. Do not underestimate how many items fall into this category (check the HSE website It may not be possible to action in 2004/5, especially for larger practices and those with high equipment levels (ECG machine, defibrillators, spirometers and so on). Don't forget humble equipment such as sphygmomanometers, printers and refrigerators. There is also a cost consideration as outside companies will be used for more complicated items needing inspection and most equipment needing calibration.

Management 9 The practice has a protocol for the identification of carers and a mechanism for the referral of carers for social services assessment

Value three points

This indicator will take many practices some time to achieve. Few practices have an up-to-date register and some have

none at all. There is no easy way to draw one up. Start with carers whose name springs easily to mind, adding the appropriate Read code. Include the remainder and new carers opportunistically. Draw up a written protocol for

identification and referral to social services. Ensure the

whole team is aware of both and include in your team

training programme.

John Couch is a GP in Ashford, Middlesex

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