Many individuals make a contribution to QOF targets you may wish to highlight in your appraisal your contributions, your development and your future developmental needs using this template.
|Describe areas of QOF responsibility||I am responsible for the Asthma and COPD sections of QOF|
|Describe other areas to which you contribute||I have a role in supporting the practice manager in the organisational areas of QOF|
|Describe the impact of QOF on the way you practice||Wow – have you got all day! There are many good things about QOF however I feel that I am constantly hounding patients to perform better, to re-attend, to take more drugs and to diet and exercise. Treating to target is all well and good but what about that last blood pressure reading of the year being 151/91 when you know the patient has had a very busy day and has rushed to make his appointment time? The cholesterol of 5.01? The computer driven “rewards” system sometimes takes common sense out of the equation. I would hope I have maintained my role as a patients advocate and have used skills to allow patients to make informed choices (e.g. I have a patient aged 93 who is on the IHD register by virtue of angina some 10 years earlier confirmed by a cardiologist. He takes no medication as now he has an almost totally sedentary lifestyle as his knees and hips will not allow him to get around much – he struggles up to the surgery! He was picked up in our call recall system and had his annual bloods. His cholesterol is 5.6 what do we do? I had a discussion with him about why we check cholesterol and explained that he would be called for tests etc and that his cholesterol was too high. His response was “well it has done me no harm so far”) There are so many examples along this line perhaps it is something that should be discussed at appraisal|
|Describe the impact of QOF on the way your practice functions||We are a training practice and as such our medical records have been summarised. We had disease registers in place. However on closer scrutiny the data was far from perfect with many patients appearing on registers they shouldn’t and many patients missed off registers. Despite QOF being with us for some time I am still having to verify patients into asthma/COPD/neither my partners are doing similar exercises in their domains. Read coding has been part of the problem with codes entered many years ago popping up in inappropriate categories. I don’t really understand the Read code system and perhaps this could be a learning need. The practice is now much more organised from the point of view of data capture. We have also developed some staff into different roles and I have been involved in some training of our nursing assistants. Is the practice a happier place? – no I feel that some of the team search for points to the exclusion of other things, on the positive side I think we are more of a team than we ever were. All partners have worked well on their own domains without exception there is however an undercurrent developing with regard to the amount of work that generates. I wonder how long it will take to either change the system (which of course the domains have already changed) or prove that this really does improve patient outcomes.|
|Describe the impact of QOF on your patients||More patients are receiving monitored, evidence-based healthcare. There is little doubt that there has been an improvement in the preventative care given to our patients with DM or IHD this has been achieved through a more effective call recall system and by treating to target. I think that patients now receive more recalls to the practice and perhaps they are more heath conscious (or heath neurotic). They appreciate the opportunity to feed back to the practice about the care they receive (see general patient satisfaction survey and specific survey regarding the minor surgery treatment). Has it impacted on informed choice? I hope not – this is something that worries me perhaps we could discuss this at appraisal|
|Do any learning needs fall out of your roles in QOF?||Obviously I need to keep up to date in the areas of Asthma and COPD – please see courses attended in other evidence presented. I have also attended a short course on practice organisational points (see certificate) this was worse than useless – but I tried. Re reading the tirade above I realise that I am concerned that QOF has changed the way that I practice – I think I will video my consultations and analyse them possibly with my partner who is the practice trainer.|
Patient and colleague Satisfaction surveys
Patient satisfaction surveys are no longer required for QOF, however, they are mandatory once in a five year cycle for revalidation. A colleague feedback questionnaire is now also mandatory in each five-year revalidation cycle and the facility for both of these is provided by Equiniti360Clinical who have the contract to provide this for all doctors in the NHS in Wales. This is free of charge to you, and meets all the GMC requirements. (Please note that this is not available to doctors in training grade posts or locums employed through locum agencies). Information on how to access the surveys is provided below.
You may also wish to read the following article on Multi source feedback (360’ appraisal):
Jennifer King’s article in the BMJ careers focus http://www.edgecumbehealth.co.uk/library/publications/360-appraisal/ begins:-
“Do you know what your colleagues and patients think of you at work? Do you see yourself as others see you? These are questionsthat many of us may prefer not to ask in case we dislike theanswers. But if you are a doctor you now have to provide evidenceabout your working relationships with patients and colleaguesto comply with the GMC's standards on good medical practice”
It highlights the positive (getting feedback) and negative (getting “bad” feedback) aspects of multi source feedback. If you decide to embark on this exercise you must be prepared for some less than excellent comments. It is also vital this is totally anonymous otherwise you are not likely to receive true responses.
The most important part of the exercise is the reflection, planning for change and need for development aspects which only come after the completed report.
The templates that follow provide a suggested structure to use when reflecting on both the patient and colleague survey. They are accompanied by a template for your nominated ‘supportive medical colleague’ (SMC) to use in feeding the results back to you and you may wish to forward this to them. Your colleague (and you if acting as SMC) could use the SMC form as evidence for Domain 3 of your appraisal (Communication, Partnership and Teamwork). The completed documents can then be discussed with your appraiser.
As satisfaction surveys are anonymous and a wide sample of patients used it is likely that the practice and the individual will receive some negative feedback. Overall ratings of doctors by patients may not match the doctor’s expectation and a lower rating than expected could lead to a demoralised individual. It is for this reason that your nominated ‘supportive medical colleague’ receives the survey information first and releases it to you.
Patient survey available here.
|You have now received a summary of responses from your patients and had the opportunity to discuss it with your nominated Supportive medical Colleague (SMC). You may wish to consider the following when reading through the results and also consider the feedback from your SMC.|
|Are the responses in line with my own self-rating?||Mostly they exceeded my own view, with the time pressures we are under and knowing that issues beyond our control make getting an appointment so difficult, I was delighted and heartened to see so many patients rating me as ‘outstanding’ whereas I had rated myself as ‘good’|
|If better than I was expecting, what areas in particular exceeded my own self-rating? Why might this be?||‘Listening’ and ‘assessing the medical condition’ were better than expected as I feel rushed so much of the time, I feel that the patient centred skills I developed on the VTS are often not allowed to come to the surface. I find this reassuring that patients feel that I do listen and then go on to make a good medical assessment. I can only assume these skills are now innate.|
|If some areas were lower than my self-rating, what were these and why might this be?||Given the above, I was then disappointed that not all of the responses for explaining about the ‘condition and management’ and also for ‘involving the patient in decisions’ were not as highly rated. Some had marked me as ‘good’ and there was one’ satisfactory’. I feel that in an effort to finish the consultation within 10 minutes, I rush the last bit and become more doctor centred. I will try to remember that explaining more to patients about their condition and management ultimately will save time as there will be greater compliance and less revisits, also, there are different phrases I could use when discussing treatment options that will quickly enable the patient feel become involved. Discussing this further with my appraiser may help.|
|What (if any) text entries were helpful in explaining the responses?||There were no negative comments so I feel better about the lower scores as discussed above, I feel that anything really significant would have been mentioned here, also, there were many comments such as ‘great doctor’, ‘always makes me feel at ease’ ‘listened to’ etc.|
|Are there any development opportunities suggested by the results?||I will revisit my consulting skills as discussed above and be more patient centred at the end of the consultation as well as at the start|
|Were there any further insights and / or development opportunities arising from discussion with my SMC?||My colleague did not consider the slightly lower ratings in any way significant and stated that he would feel very happy to have the same response. He did agree with my suggestions on consultations skills however as this is always good practice.|
Colleague survey template available here.
|You have now received a summary of your colleagues’ responses and had the opportunity to discuss it with your nominated Supportive medical Colleague (SMC). You may wish to consider the following when reading through the results and also consider the feedback from your SMC.|
|Are the responses in line with my own self-rating?||Mostly I was pleased and relieved, all of the average scores were above my predictions.|
|If better than I was expecting, what areas in particular exceeded my own self-rating? Why might this be?||Questions 1 to 5 relate to my skills as a doctor and I really wasn’t sure what the view was of this core part of my work as we work effectively in isolation. I guess they pick up on views expressed by others or through reading my medical record entries. We don’t have much of a barometer by which to measure the quality of our clinical expertise, the high score given suggesting that colleagues would approach me for advice is encouraging.|
|If some areas were lower than my self-rating, what were these and why might this be?||I was disappointed and puzzled by some of the scores though. Despite the overall score in some areas being higher than those given for the average doctor, there were within those scores some lower ratings for ‘Time management’, ‘Commitment to improve quality of service’ and ‘contributes to the education and supervision of students and junior colleagues’. For a start, we don’t even have students and though I am senior partner, I wouldn’t say any of my colleagues were junior. Time management! I arrive first, get all my paperwork done before surgery and finish on time with all work finished before leaving. I don’t understand what ‘Commitment to improve quality of service’ even means! I can only think its contributing to practice meetings and discussing the future of the practice and services. I chair the meetings as senior partner and offer an experienced view on new proposals so that people don’ t get carried away – most things have been tried in the past already. My SMC couldn’t shed any light on these comments either though did point out that almost all other ratings were ‘outstanding’. Perhaps discussing this further with my appraiser will help.|
|What (if any) text entries were helpful in explaining the responses?||There were very many uplifting responses but one comment was ‘it may be helpful to let the practice manager chair the meetings as this would allow the doctor to participate more in the meetings rather than get sidetracked by facilitating and them and recording the minutes’. I had considered my role an important one in ensuring that proper process was followed but perhaps others may perceive this as being less involved in the discussion. Discussing this further with my SMC confirmed that although he had not written the comment, he suggested that most other practices use their practice manager for this role as it frees up all the clinical personnel to have a more involved discussion. I will consider this further and discuss with my appraiser also.|
|Are there any development opportunities suggested by the results?||The lower score for ‘Time management’ continues to confuse me. I think it may be worth exploring this further at a practice meeting – in a non-judgemental way of course! It could be an open-ended discussion about perceived work load and whether any redistribution is needed.|
|Were there any further insights and / or development opportunities arising from discussion with my SMC?||We discussed and agreed as above|