Murray Lough

A qualitative study of why general practitioners may participate in significant event analysis and educational peer assessment

Objectives: To explore the influences and perceived benefits behind general practitioners’ willingness to participate in significant event analysis (SEA) and educational peer assessment. Design: Qualitative analysis of focus group transcripts. Setting: Greater Glasgow Primary Care Trust. Participants: Two focus group sessions involving 21 principals in general practice (GPs). Main outcome measures: GPs’ perceptions of the reasons for and benefits of participating in SEA and associated educational peer assessment. Results: Pressure from accreditation bodies and regulatory authorities makes SEA compulsory for most participants who believe more in-depth event analyses are undertaken as a result. Some believed SEA was not an onerous activity while others argued that this depended on the complexity of the event. SEA that is linked to a complaint investigation may provide credible evidence to patients that their complaint is taken seriously. Writing up an event analysis is viewed as an educational process and may act as a form of personal catharsis for some. Event analyses are submitted for peer assessment for educational reward but are highly selective because of concerns about confidentiality, litigation, or professional embarrassment. Most participants disregard the opportunities to learn from “positive” significant events in favour of problem ones. Peer assessment is valued because there is a perception that it enhances knowledge of the SEA technique and the validity of event analyses, which participants find reassuring. Conclusions: This small study reports mainly positive feedback from a select group of GPs on the merits of SEA and peer assessment.

Awareness and analysis of a significant event by general practitioners: a cross sectional survey

Objectives: To determine the extent to which general practitioners (GPs) were aware of a recent significant event and whether a structured analysis of this event was undertaken to minimise the perceived risk of recurrence. Design: Cross sectional survey using a postal questionnaire. Setting: Greater Glasgow primary care trust. Participants: 466 principals in general practice from 188 surgeries. Main outcome measures: GPs’ self-reported personal and practice characteristics, awareness of a recent significant event, participation in the structured analysis of the identified significant event, perceived chance of recurrence, forums for discussing and analysing significant events, and levels of primary care team involvement. Results: Four hundred and sixty six GPs (76%) responded to the survey. GPs from single handed practices were less likely to respond than those in multi-partner training and non-training practices. 401 (86%) reported being aware of a recent significant event; lack of awareness was clearly associated with GPs from non-training practices. 219 (55%) had performed all the necessary stages of a structured analysis (as determined by the authors) of the significant event. GPs from training practices were more likely to report participation in the structured analysis of the recent event, to perceive the chance of this event recurring as “nil” or “very low”, and to report significant event discussions taking place. Conclusions: Most GPs were aware of a recent significant event and participated in the structured analysis of this event. The wider primary care team participated in the analysis process where GPs considered this involvement relevant. There is variation in the depth of and approach to significant event analysis within general practice, which may have implications for the application of the technique as part of the NHS quality agenda.

An exploration of the knowledge, attitudes and practice of members of the primary care team in relation to smoking and smoking cessation in later life

Smokers aged 65 and over have been identified as a priority group for smoking-cessation interventions. However, despite confirmation of the benefits of cessation in later life and compelling evidence that interventions can be effective, studies have shown that members of the primary care team often fail to target this population. If these professionals are to be encouraged to broach the subject of smoking cessation with older people, it is important that barriers to the effective provision of interventions are uncovered. This article reports findings from a qualitative study that sought to do this by exploring the knowledge, attitudes and practice of members of the primary care team in relation to smoking/smoking cessation in later life. A purposive sample of health visitors, district nurses, practice nurses and general practitioners ( n = 41) working in the west of Scotland was recruited. Data were collected during face-to-face interviews using a semi-structured interview schedule. The interviews were transcribed and then analysed using content analysis procedures. While the participants were generally convinced of the benefits of cessation many believed that few older people manage to stop smoking successfully. A pessimistic view of the success rate of older smokers appeared to negatively influence practice. In addition, a number of the participants lacked confidence in their own counselling skills and/or had limited awareness of smoking cessation resources and specialist services. These factors also appeared to preclude the provision of effective smoking-cessation interventions. Finally, there was little awareness of the content of the UK Smoking Cessation Guidelines. The findings from this study, and a parallel study that explored the health beliefs of older smokers, have been used to develop smoking cessation training designed specifically for members of the primary care team who have contact with older people who smoke. The efficacy of the training is currently being evaluated.

Levels of agreement on the grading, analysis and reporting of significant events by general practitioners: a cross-sectional study

Background and aims: There is variation in the identification, analysis and reporting of significant events in general practice. Consistency is desired to optimise learning from, and reporting of, patient safety incidents. We examined levels of agreement among different groups of general practitioners (GPs) on the grading, analysis and reporting of selected significant event scenarios. Method: Cross-sectional postal questionnaire survey of 162 GPs split into five professional groups in the west of Scotland. Differences in grading severity and willingness to formally analyse and report seven significant event scenarios were examined using analysis of variance (ANOVA). Differences in proportions were calculated together with 95% confidence intervals. Results: 122 GPs responded (77%). No difference was found in the grading severity of significant events by GP groups. Increased grading severity was linked to the willingness of GP groups to analyse and report that event (p<0.05). A preference to anonymously report all event scenarios to a national educational body was reported (p<0.05). The majority of respondents were not willing to involve patients in relevant event analyses (83–100%). Conclusions: The strong levels of agreement suggest that GPs can prioritise relevant significant events for formal analysis and reporting. Focused guidance should be developed to encourage their engagement with the patient safety agenda, optimise learning from safety-relevant events and increase reporting opportunities. Exploration is required of the reasons why GPs may prefer an educational body as a potential reporting source or may be unwilling to include patients in relevant event analyses.

Acceptability and educational impact of a peer feedback model for significant event analysis

Context  A model of independent, external review of significant event analysis by trained peers was introduced by NHS Scotland in 1998 to support the learning needs of general practitioners (GPs). Engagement with this feedback model has increased over time, but participants’ views and experiences are largely unknown and there is limited evidence of its educational impact. This is important if external feedback is to play a potential role in appraisal and future revalidation.

Exploring stakeholders' views of medical education research priorities: A national survey

Setting research priorities is important when exploring complex issues with limited resources. Only two countries (Canada and New Zealand) have previously conducted priority‐setting exercises for medical education research (MER). This study aimed to identify the views of multiple stakeholders on MER priorities in Scotland.

Attitudes to the identification and reporting of significant events in general practice

The new National Patient Safety Agency (NPSA) aims to facilitate the mandatory reporting of relevant significant events. A questionnaire survey of 617 general practitioners was undertaken and 466 responses were received (76 per cent). A minority (18 per cent) agreed the reporting of adverse incidents should be mandatory, while a majority (73 per cent) agreed that they would be selective in their reporting in a mandatory system. Most (75 per cent) favoured a local anonymised system of reporting. A difficulty in determining when an event is “significant” was acknowledged by 41 per cent of respondents and 30 per cent agreed significant events were often not acted on. Less experienced respondents were more likely to have difficulty in determining when an event is significant (p = 0.01). The success of the NPSA system may be obstructed by the mandatory requirement to participate and in the difficulty for some in determining when an event is “significant”.

What Factors Impact on General Practitioners’ Engagement with Appraisal? A Qualitative Evaluation In Scotland

Although appraisal has gained acceptance as a supportive and developmental process, it has been proposed that it should become an explicitly summative element of revalidation. This study aimed to explore the views of general practitioners (GPs) in Scotland about appraisal in the light of the proposed changes. The method used semi-structured interviews with a sample of 18 GPs who have undergone appraisal at practices throughout Scotland. The interviews were transcribed in full and a thematic analysis conducted. The study showed that the majority of interviewees derive some benefit from appraisal – mostly in planning learning needs and through the support provided by a confidential discussion with Education for Primary Care (2008) 19: 615–23 # 2008 Radcliffe Publishing Limited

Medication safety: using incident data analysis and clinical focus groups to inform educational needs

RATIONALE, AIMS AND OBJECTIVES Medication-related safety incidents are a source of concern to patients, policy makers and clinicians. The role of education in improving safety-critical practices in health care is poorly appreciated. This pilot study aimed to initiate collective discussion among professional groups of clinical staff about a range of medicine-related patient safety issues which were identified from a local incident reporting system. In engaging staff to collectively reflect on reported medication incidents we attempted to uncover a deeper understanding of local contextual issues and potential educational needs. METHODS A mixed method study was conducted involving categorical analysis of 1058 medication incident reports (Phase 1) and the use of three mixed focus groups of clinical staff (Phase 2) in three acute hospitals in one locality in NHS Scotland. RESULTS Focus group transcript analysis produced four main themes (e.g. the medical role) and 12 related sub-themes (e.g. pharmacological education and skill mix for administration of medicines) concerning medication-related practices and possible educational interventions. CONCLUSIONS While it is necessary to review reported incident data and disseminate the educational messages for the improvement of quality, this traditional risk management process is inadequate on its own. Reporting systems can be enhanced by collective examination of reported information about medicines by local clinical teams. We identified a strong message from the focus groups for learning about each other and from each other, and that the method piloted may be an important inter-professional mechanism for improvement.

Attitudes towards health inequalities amongst GP trainers in Glasgow, and their ideas for changes in training.

WHAT IS ALREADY KNOWN IN THIS AREA: Recent government policy has emphasised the important role that GPs have to play in addressing health inequalities. The RCGP curriculum asserts the importance of gaining a better understanding of health inequalities during GP training. GP training in Scotland continues to take place in disproportionately affluent areas. WHAT THIS WORK ADDS: This is the first study to look at attitudes of GP trainers towards health inequalities and to explore their ideas for changes in training that may address health inequalities. There were noticeable differences in the views of GP trainers--both in terms of the causes of health inequalities and the role of primary care in tackling inequalities--depending on whether they were based in more affluent or more deprived practices. Practice rotations were suggested by all groups as a means to give GP trainees exposure to the particular challenges of both affluent and deprived practice populations. SUGGESTIONS FOR FUTURE RESEARCH: Pilot studies of practice rotations between deprived and affluent areas would be of value. Evaluation of nMRCGP assessments (particularly the Clinical Skills Assessment, CSA) with regard to representativeness of general practice in deprived areas should be considered. Further qualitative research into the attitudes of GP trainees towards health inequalities, and GP trainers from different--less deprived--practice areas, would also be of interest. [corrected].