Nigel Sparrow

Establishing the continuing professional development needs of general practitioners in their first five years after training

AIMS To identify existing and preferred methods of accessing CPD for GPs in the first five years of independent practice. To establish areas of CPD need for this group. To quantify how many First5 GPs are currently part of a small group and if they undertake CPD in this format. To investigate how First5 currently fund CPD and how much they would be willing to invest in CPD per year. METHODS Online survey of RCGP members who have been on the GP register for less than five years. RESULTS First5 GPs access CPD in a variety of formats. CPD provision around practice management and leadership aimed at GPs in their first five years is currently lacking. Many First5 GPs already belong to a small group but more than half find undertaking CPD in the small group is challenging. Most First5 GPs self fund their educational activity and would like to spend £500 or less per year on CPD. CONCLUSION Cost-effective CPD tailored to the needs of GPs in their first five years of independent practice and delivered in a variety of formats is lacking in some educational areas. First5 GPs require formal written guidance on delivering CPD in small groups.

Practice accreditation: the European perspective

Accreditation has different meanings in different healthcare settings.1 A complex picture emerges from reviews of healthcare accreditation schemes worldwide but two key features are common — promoting change and professional development.2 Accreditation in primary care settings is generally seen as a way of assessing and benchmarking the performance of general practice care across a broad range of clinical and organisational domains.3 It describes a formal process of self-assessment and external and independent peer review to encourage best practice and can result in recommendations for continuous quality improvement of safety and quality.4 Buetow and Wellingham have suggested five ways in which accreditation may be used.3 These are quality control (mandatory, externally set, minimum predetermined acceptable standards), mandatory regulation (legal or safety standards), continuous quality improvement (to demonstrate excellence above a minimum standard), information giving (to enable comparison between providers by patients and policy makers), and marketing (to showcase services available). Compared with hospital environments, which have a long history of accreditation, general practices have been considered more difficult and less important to accredit.5 However quality problems, caused in part by system failures6 rather than individuals,7 have led to a growing emphasis on the team or organisation as the unit of analysis in quality improvement initiatives. Despite this, with notable exceptions such as the evidence base underpinning the use of the European Practice Assessment (EPA) programme8 there is still a relatively limited evidence base demonstrating the effectiveness, cost effectiveness, and appropriateness of accreditation.9,10,11 A representative from each member country of the European Association of Quality in General Practice (EQuiP) was asked to complete a detailed survey in December 2011 about their countrys health system, and practice accreditation scheme, achieving a 100% response rate. Nine countries have practice accreditation …

The first5 concept.

The concept of First5 recognises the challenges faced by GPs at the end of training and comprises five pillars, which could help to support new GPs through the first 5 years of independent practice. The world of general practice is constantly changing and it is important that new GPs can be supported to develop the confidence and skills required to meet the demands of the new healthcare world.

The CQC inspections: what they mean for general practice

The Care Quality Commission (CQC) is the independent regulator for Health and Social Care providers in England. CQC started to inspect general practice in April 2013 using a compliance focused model. Between April 2014 and September 2014, CQC piloted a new inspection methodology for general practice. As of late November 2014, over 500 GP practices have been inspected with this new methodology, which was rolled out nationally from 1 October 2014. The new inspection regime reflects a significant culture change in the CQC. We have moved away from a regulation-focused approach, to a more holistic assessment of the quality of care by asking five key questions: Our inspection teams are also different; comprising an expert inspector and a GP specialist advisor. In addition, practice nurses, practice managers, and ‘experts by experience’ (members of the public who have had substantial experience of using services) may also be part of the team, making an inspection more of a peer-review process than before. In keeping with our commitment to transparency about our regulatory approach, we published our GP ‘intelligent monitoring’ (IM) risk bandings in November 2014.2 IM is a tool we use to prioritise which practices to inspect and is information we have already been publishing about the acute sector for over a year. We acknowledge that the decision to make this data publicly available caused some controversy within the profession. We publish the results of our IM to promote greater transparency and better understanding of our work. IM is not our judgement on the quality of care. Our inspection visits are central to the way we make judgements, informed by local intelligence, the views of other …

First5®—a UK initiative relevant to the global general practice community

In 2009, the Royal College of General Practitioners (RCGP) in the UK created the First5® initiative to support new GPs through the first years of independent practice. For new GPs, finishing training and taking the first steps into a career in family medicine is an exciting but also challenging time. The RCGP and fellow Wonca organizations are well placed to support young colleagues through this transition period. The First5® initiative is based around five key pillars, which help to support new GPs by ensuring they are well represented, supported and encouraged by their member organization. Peer support, mentoring, career guidance, revalidation and tailored continuing professional development are just some aspects of the programme. This article describes the origins and key components of the concept then explores the progress which has been made to date. The challenges faced by new practitioners are not unique to the UK, or indeed to general practice, and we hope that the First5® initiative will inspire colleagues across Europe and around the world.

Response from the CQC: the importance of effective leadership.

The intention of the special measures framework is to make patients, providers, and commissioners aware that we have serious concerns and to identify the need for urgent coordinated support within clear timescales. As you highlighted,1 there can be local awareness of issues long before the CQC inspects. We strongly back the need for earlier identification …

Carers and the NHS

There has been much discussion on the kind of workforce needed to deliver the NHS of the 21st century. It should, therefore, be surprising that the UKs largest health and care workforce has so far been overlooked by these discussions. However, if you look at the job descriptions for these workers, it is easy to see that, for them, being forgotten is not unusual. Working hours: 24 hours a day, 7 days a week. Training: none. Support: none. Career prospects: none. Holidays: none. Pay: up to £1.50 per hour (for those lucky enough to qualify for benefits). With pay and conditions this poor, no wonder family carers are estimated to save the NHS £67 billion1 or more per annum. The scale of this contribution is staggering. Each year, 2 million of us move in and out of unpaid caring for a sick, disabled or older relative or friend who is unable to manage on their own. There are around 6 million carers in the UK at any one time and 1.2 million of those are caring for over 50 hours each week.2 The perception that the majority of carers are women is belied by the 42% of male carers uncovered by the last census. In fact, the majority of us will either give or receive care at some point in our lives. Caring can take its toll both physically and emotionally, with the carers own health and wellbeing suffering as a consequence of their caring responsibilities. Half of carers report a longstanding illness, with 72% of people caring for 50 or more hours reporting that caring adversely affects their health,3 and many live on low incomes and in poor housing. In 2002, Torbay Council and Manchester PSSRU used General Health …