Staff IT skills are vital to maximise contract income
Paul Cundy is
co-chair of the GPC IT joint committee and a GP in Wimbledon, south-west London
Not only the GPs but also the practice staff must exploit computers to the full to maximise the benefits of the new contract, says Dr Paul Cundy
No practice can survive the new GMS contract without all the clinicians and staff using computers to the full. To get your staff up to speed there are a range of things that can be done, but the essentials are motivation, education and ongoing support.
Familiarising your staff with IT cannot be done in a rush, so you need to be developing a long-term plan that is tailored to your practice's needs. These are some of the elements it should contain.
Give staff and GPs protected time
We all know how difficult it is to think when you are under pressure, let alone learn new skills, so protected time to develop IT skills is crucial.
Discuss with your PCO having a series of sessions or half-days for the practice to prepare for the contract. The PCO may also be able to offer financial or other support.
Remind them it is in their own interest that practices should do well under the new contract.
Motivate your staff
First, you need to impress upon staff the changing nature of general practice as a business. I have met
many practice staff who think they are state employees and who have no idea they are in fact employed by a small business.
Its worth making this point because there's a fundamental change coming the business that employs the staff will no longer be paid simply on
how many patients it can cram in. Up to 30 per cent of its income will now come from what it actually
does to patients. Staff really must understand this,
and must understand that IT is essential if patient care
is to be effective and the business is to flourish.
Second, you must persuade staff to read the contract documents (all too few GPs have actually read the new blue books from cover to cover, and they should have).
Showing your staff the detail will make them feel more closely involved with the practice and will encourage them to come up
with new ways of doing things. It will also concentrate your mind and force you to know what you are
Third, allow staff to share your work give them a sense of ownership of the practice. Once they have read the blue documents they will realise that large parts of the quality and outcomes framework have nothing to do with what the GPs are doing the staff are the key.
The organisational and holistic elements are areas that could be managed by the staff on their own with intelligent use of IT. So get them involved, giving them the responsibility for these areas, perhaps under the leadership of the practice manager.
There is no reason why the practice staff shouldn't be responsible for the non-clinical parts of the quality and outcomes. They could also run the regular checks to see how you are doing against the indicators in the quality framework. They could prepare for the annual visit from the PCO. And of course they need to prepare to carry out patient surveys.
Fourth, give staff a financial incentive. Most successful businesses run a financial reward system
for their employees. Consider running schemes that reward your staff if you do well in the quality and outcomes points.
Educate your staff
Now your staff are motivated, the next step is to give them the required skills you need to train them.
Start with the basics. The European Computer driving licence (www.ecdl.nhs.uk) is a good start for most employees and is available to all NHS workers. It will ensure all your staff understand the basics about computing and information management.
Introduce selected members of staff to the concepts of 'information governance'. Handling electronic data requires a slightly different mindset to handling paper records.
Certainly your practice manager should read the revised 'Good Practice Guidelines' (www.RCGP.org.uk) which has been developed by the GPC and RCGP and sponsored by the Department of Health.
Move on to specific training for the contract through programs run by your PCO, system suppliers and supplier user groups. I have also heard of some practices using commercial companies.
Data quality program
PRIMIS is the only national program that deals with data quality and is based on use of the computer systems we have in general practice at the moment.
The PRIMIS (www.primis.nhs.uk/pages/default.asp) network has local facilitators and should play an important role in preparation for the contract. PRIMIS doesn't have the capacity to train each and every practice but it should be able to work with your PCO to facilitate local skills learning and can act as a source of educational materials.
Read codes training
One critical element will be training in Read coding, perhaps the most crucial element that needs to be addressed rapidly. You need to start collecting this information from January of 2004.
The weekly medical press and the monthly educational magazines are all producing contract-related advice and the codes are now published. Don't forget in-house learning if you have anyone who's an expert in his or her own field.
Summarising is a separately funded part of the contract but it plays into the quality and outcomes framework because it is all about consistent data management.
Summarising does not have to be done by doctors or nurses. A good summarising protocol should be usable by a suitably trained member of staff. Some companies now offer services as well.
Any program of change needs ongoing support and evaluation. You'll need to have regular, perhaps monthly, meetings to find out how things are going, what's working and what's not. These could be linked to your monthly progress reports. By providing support you will be more likely to carry your staff with you.
Finally, be prepared to innovate. Some of the quality and outcomes procedures rely on knowing things about all of your patients, even the ones who only ever come to the front desk. What about training a receptionist to take blood pressure or blood samples?
Remember the contract is about quality of outcomes, not who does what.
The essentials in training your staff in IT
· Impress on staff the changing nature of general practice
· Persuade them to read the contract documents
· Give staff ownership of the practice
· Give them a financial incentive
· Encourage staff to participate in the European Computer Driving Licence
· Introduce selected members of staff to the concepts of information governance
· Give specific IT training to staff through programs run by your PCO, system supplier and private companies
· Have regular (perhaps monthly) IT meetings with staff
· Be prepared to innovate