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Compiling evidence of best practice

Start collecting evidence of good practice to prepare for revalidation, says Professor Ruth Chambers.

We know that revalidation will start to happen soon - probably around 2010. We know that the GMC will be the body that relicenses all doctors, and that the RCGP will recertify GPs every five years.

What we do not yet know is exactly what sort of evidence doctors will have to submit about their competency and how they perform at work. Nor do we know how much of that evidence will be the same for both relicensing and recertification or for annual appraisals.

However, it is not too early to start preparing. GPs should be in the habit of collecting examples of their work for appraisal, so it is just a small step to prepare for revalidation too.

Here is an example of how you might show that you are up-to-date in your treatment of patients with asthma.

You can adapt this six-stage pathway plan for asthma so that it applies to any other clinical condition you treat.

Stage 1: Best practice
As an excellent GP, you manage your asthma patients according to best practice and you give patients information about their health problems in a way they can understand.

Action: Describe this care and how it is delivered.

Stage 2: Service outcomes
Make sure you have a consistent approach to the long-term management of asthma; most patients have a patient-held updated asthma action plan and patients' repeat medication is regularly monitored.

Action: Identify what you and other team members need to learn regarding the management of patients with asthma.

Stage 3: Identify learning needs
Undertake a significant event audit of the next patient you see in surgery whose asthma is poorly controlled or is admitted to hospital as an emergency. Was your management structured and consistent compared with best practice? Were there access problems?

Action: Ask another GP or colleague to comment on how your care of the patient might have been improved. Identify any knowledge of skills gaps.

Stage 4: Service needs
This is closely linked to Stage 3. Collect all your patient information leaflets or other health aids such as audio tapes or DVDs relating to asthma. Look at the text to evaluate whether the content is readable, appropriate and accurate.

Invite several asthma patients or representatives from your practice patient participation group to comment.

Audit repeat prescription requests from all patients asking for asthma medication over the period of a month and establish the extent to which irregular or incorrect prescribing is happening.

Action: Decide your service needs and make and carry out a learning and action plan.

Stage 5: Educational programme
This should suit your learning needs, learning style and resources available. You and practice colleagues could arrange an in-house educational session after one of you has attended an updating workshop on asthma care and revised your practice protocol for asthma. The clinical lead for asthma could give tutorials to others in the team.

Action: Discuss the services that the practice provides for people with asthma, how to improve patient action plans, the kind of information patients need and monitoring repeat prescriptions.

Stage 6: Document performance
This record should include your performance and competence for managing asthma. Record your learning, audit results, updated asthma protocol and subsequent changes in the way you practise and have modified patient systems in your practice.

Action: Include the revised asthma leaflets or new resources you have obtained.

Professor Chambers is a GP and Professor of Health Development at Staffordshire University.

Book Offer
GPs can buy 'Revalidation: Prepare now and get it right' by R Chambers, G Wakley and P Bright published by Radcliffe Publishing for £15.96 (full price £19.95) plus p&p by calling 01235 528820 and quoting GP DISCOUNT.

Or, if buying online at www.radcliffe-oxford.com, key in GP DISCOUNT when prompted to pay.

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