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Independents' Day

Use computer templates to hit top quality scores

Do not underestimate the importance of templates and care pathways in getting the best from the quality framework, says Dr John Couch

You would have to have been on a desert island for the last 12 months to be unaware of the new GMS quality framework.

The new money ­ up to £40,000 annually for the average GP ­ and the improvements in chronic disease care that will result from the coming changes should provide sharp focus for all practices' minds and efforts. The prospect of GP league tables introduces a darker motivation.

Get efficient systems established

To maximise performance you should establish efficient systems now if you have not already done so.

The current 10 chronic disease categories will only be a starting point.

Other areas such as depression will be added and the targets in each category could be enlarged or raised in time. Having robust systems from the start will make you ideally placed to benefit both now and in future.

Regular meetings with the whole of the practice team to plan, co-ordinate and review proceedings are essential.

One or two key personnel, a partner and IT expert for example, can be charged with the overview and planning meetings.

Problems should also be reported to them. Full and regular use should be made of software quality framework performance search engines.

Ensure each team member knows what they are expected to do, from reception and administration staff to nurses and GPs.

It is especially important to keep locums informed as procedures will vary from practice to practice.

Facilitate and encourage training, problem reporting and general communication. Incorporate adequate clinic times and staffing. You may need extra expenditure to accommodate this: remember there will be the prospect of extra profit.

Accurate disease registers are vital. There is also little point spending time and effort initially if you do not keep them up to date. Review them at least every six months.

Make good use of computer systems to set up call and recall systems. Templates and practical care pathways will also be essential.

Finally, remember to audit progress carefully via regular computer searches to avoid nasty shocks on March 31, 2005, the cut-off date for the first year of the quality framework.

Templates rule OK?

Your framework score will not simply depend on patient contacts, measurement, effective treatment and outcomes.

You can do all these things to five-star level but if the data is not correctly Read coded you will be hard pressed to prove your points.

This is one of the important features of templates. If set up with careful Read coding they will provide all the searchable data required.

Added advantages include providing an idiot-proof method for comprehensive chronic disease checks, something GPs probably need more than nurses.

They also impart an element of medicolegal protection, making it more difficult to miss important points in history, examination and investigation.

Most GP software companies are releasing or are about to release their own templates, which contain all the relevant items and codes including exception reporting. Use these unless you are certain your current templates are coded accurately. You can always add extra items if you wish. Make sure all staff who are going to use them are familiarised quickly.

Establish care pathways

Like templates, care pathways can help maximise your framework performance. They help ensure uniform, effective and medicolegally-secure treatment. They can also help keep prescribing costs lower by directing the most cost-effective treatments.

Most GP software systems have the facility to include care pathways. The key points are to ensure they fit in with practice and locality protocols and to encourage GPs and nurses to use them. Switching on screen prompts facilitates the latter. Each practice should check the care pathway for the 10 chronic disease categories. Using them will be a difficult change for some team members. Once again discussion, training, feedback and inclusion of locums and GP registrars are all vital.

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