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Proof of good medicines management

Auditing your prescribing will help you with appraisal and revalidation, says Professor Ruth Chambers.

Good medicines management is an integral part of a GP's professional practice. So even if we do not yet know exactly what will be required for revalidation, check now that you are a consistently good prescriber and can demonstrate this. Doing so will help you to prepare for when revalidation starts in the near future.

I have used diabetes prescribing as an example here. However, if the way your practice is organised means that you see only a few people with diabetes, choose a clinical field where you lead or one area where you see plenty of patients and make medicines management decisions.

Stage 1: Standards of practice
Describe the standards of practice to which you aspire. Ensure you consistently base your prescribing of medication on the best evidence for the clinical condition.

You could possibly add the caveat that you have to prescribe within the resources available.

Action: To show these standards are real, set them in the context of a clinical field.

For example, you might propose that your prescribing for patients with type-2 diabetes is consistently in line with NICE guidance and other national guidelines.

Stage 2: Actual management
Next describe what your aspired-to standards look like in real life. Describe which medicines you should be using according to best practice and then, what your actual medicines management consists of.

Action: Use the prescribing you have been doing over the previous year or six months together with outcomes for the type-2 diabetes patients concerned, captured by their HbA1c or BP, for instance.

Stage 3: Desirable improvement
When you set out the evidence of your good prescribing, be honest about what your weaknesses were and how you have corrected them.

Weaknesses may be in relation to your own professional learning needs or some element of inadequate services provided by your practice or practice team.

Action: Organise an audit of your own prescribing habits (as opposed to those of your GP or nursing colleagues in the practice team) showing how you managed the last 20 patients you have seen with type-2 diabetes.

Compare what you actually did with what you should have done. Add in a significant event audit - maybe of a patient with a raised HbA1c. Do this either to see where your own medicines management or that of the team fell below expected standards or how you may have motivated the patient to better self-care.

Look at patient access to chronic disease management services and how well you are playing your role in teamwork. Perhaps you are teaching the nursing staff about best practice in diabetes care, or monitoring repeat prescribing?

Stage 4: Knowledge gaps
Describe how and what you have learnt that has plugged the gaps in your knowledge, skills or way you actually practise, or the ways in which the practice provides services to patients.

Hopefully this will show how your own learning or changes made to the practice organisation have improved the outcomes for patients described in Stages 1 and 2.

Action: This learning might be a mix of updating workshops; reading up on the subject and evidence that you have reflected upon what you have learnt; a one-to-one meeting with a primary care organisation prescribing adviser, or an in house practice educational meeting.

Stage 5: Summary of learning
Summarise the evidence of your learning in the portfolio in which you are collecting evidence for your next annual appraisal and, eventually, for revalidation.

The format in which this evidence will be required is so far unknown, however, it could be a standard e-portfolio for all UK GPs.

Action: For the time being, it will be best for you to keep your documents well organised in an electronic format that suits you.

Professor Chambers is a GP principal 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), just visit our discounts section.


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