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Quality Control in Primary Care

Quality Control in Primary Care

The Quality Framework (QF) is defined by the General Medical Council. It should be used as a mechanism for driving improvement and for demonstrating the value of the education we provide, both in educational and financial terms.

Quality 'Assurance' sits with the GMC and should ensure that patients, doctors and the public have confidence that our Postgraduate Medical Education and the resulting outcomes meet the nationally defined standards.

In order to achieve this, the GMC approves training posts and programmes, the GP curriculum that underpins the training, and the methods of assessment for achieving the Certificate of Completion of Training (CCT). Continued approval is based on self-assessment, annual trainee and trainer surveys plus LETB annual reports, RCGP reports and the cycle of the GMC QA visits to the LETB.

Quality 'Management' (QM) describes the process by which organisations (such as our LETB) ensure that the education and training that they are responsible for meets the GMC standards. This is our approval and re-approval process for trainers and training practices and the secondary care post reviews conducted by the Quality Team of the LETB.

Quality 'Control' (QC) is the outcome of visits or virtual evaluations of trainer information.

Within the Primary Care Directorate the quality control workload is incorporated into the work of the Associate Postgraduate Deans (APDs), the Locality Programme Directors and managers. We liaise with the LETB Quality Team which monitors our processes and outcomes.

The GP directorate will provide information with respect to robust quality control in the form of an evidenced annual report to the LETB Quality Scrutiny Board.  

Enhanced Quality Control

Enhanced quality control can be defined as the mechanism by which the Provider LETB ensures demonstrable compliance with the standards set by the regulator in a way that meets the needs of the commissioner's Assurance processes.

We aim is to provide robust quality monitoring and reporting, with equity and consistency in standards, ensuring a drive for continuous quality improvement, and the provision of the robust evidence required by both commissioner and regulator. The planned structure will build on current strengths and address the recognised weaknesses.

The GP Directorate Enhanced Quality Control processes are subject to external review as part of the visiting process. 

Implications for;

At practice level
  • Clinical and Educational supervisors are responsible for the quality monitoring of their teaching and education provision within the practice environment. This is accomplished through feedback and peer review. The evidence of achievement of adequate standards is collected in the portfolio of information reviewed at re-approval every 3 years and used as supporting information for the Revalidation process.
  • The specialty programme supports the trainers with this process.
  • This Quality monitoring is reviewed regularly by the Specialty Programme using the trainee Eastmidlands Online Survey (EMOS) survey completed at post-exit, review of the educational supervisor reports, and feedback received from trainees during the programme training days. This is triangulated with the collated programme results in the annual national training survey.
  • The Programme directors are expected to address any issues that arise promptly, and report on them and any required actions in their regular reports to the Academy.
  • Concerns about a practice or educational or clinical supervisor would result in a triggered visit before the planned re-approval date.
At programme level
  • The programme directors are responsible for the quality monitoring of the education within their patch. They evaluate the standard of teaching on their programmes with feedback and peer review, assess educational and clinical supervisor reports and review trainee and trainer feedback information provided by surveys. They provide reports every 4 months to their patch APDs and Academy.
  • Regular Programme Director contact with the training community and the trainees fosters a culture of problem sharing and reflection on training delivery which supplements the formal feedback methods.
  • Patch APDs triangulates the reports with EMOS and national training survey results and other feedback. They should be informed about significant issues and are available for advice and support. 
  • The performance of the programme directors is formally reviewed at their annual appraisal, when supporting information showing evaluation of teaching and quality monitoring of practices and hospital placements should be reviewed, along with other performance standards.
  • Issues with programme quality are brought via the Head of the Academy to the directorate Senior Team, by the patch APD for discussion and action planning and, if required, a triggered visit to the programme is arranged.
  • Some externality is provided through shared working with APDs and PDs from other schemes during the re-approval process
In Secondary Care Hospital placements
  • Secondary care clinical supervisors are responsible for the quality of their education.
  • Some of this education can be assessed by the GP Programmes.
  • The clinical supervisor reports are assessed by GP educational supervisors in practices and by the programme directors.
  • The programmes directors review the survey feedback from trainees and receive direct feedback on training days. 
  • Issues are addressed by engagement with the unit or consultant concerned.
  • Issues are reported to the patch APD, who provides input if required, or refers to the relevant Head of the GP Academy for collaboration with secondary care.  
  • There is a two way information sharing process with the Quality team and Programmes to inform Trust Visits. The visits can then explore issues raised by trainees, and provide feedback to the Programmes and APD from secondary care.
At APD 'Patch' level
  • The quality control in the programme is reviewed and triangulated with the results from the national trainee and trainer surveys and survey, and with other feedback.
  • The performance of the programme directors and the programme manager is evaluated.
  • There is initial management of trainee and trainer performance issues, with feedback to the head of the GP Academy, or referral for advice. 
  • There is initial management of secondary care issues with reporting to the head of the GP Academy , or referral for advice
  • There is responsibility for ensuring effective communication to the programmes and GP educators of regional and national perspectives and initiatives.
  • There is responsibility for programme engagement with LETB processes
  • The patch APDs provide information to the Heads of Academies (copied to the GP Dean as part of the reporting mechanism on portfolio progress).
  • Practices and Trainers are approved and re-approved. Engagement of the APDs in the re-approval / approval process promotes cross-LETB standardisation.
  • The performance of the APDs in this role should be evaluated by peer review and feedback. Standardisation of the process is reviewed by the School Board.
At Academy level
  • The quality control within the patches is reviewed and assessed. A collated report is produced annually by the head of each of the two Academies and presented to the School board.
  • The report includes a review of triangulated patch reports and programme performance, review and analysis of trainee results, and summary details of the management of any significant issues. This is presented to the School board for review.
  • Externality is provided during the report review and challenge process by the School board members including the other East Midlands GP school.
The GP School board
  • Ensures patient safety
  • Ensures there is delivery of the GP Curriculum
  • Calibrates the quality control procedures of all the locality training programmes to ensure consistency across EM.
  • Reviews the quality of the recruitment and selection and educational review processes (Annual Review of Competence Progression (ARCP))  and targeted training support to trainees in difficulty
  • Monitors Less than full time training (LTFT) and Out of programme activities (OOP)
  • Provides a wider perspective to promote the sharing of good practice.
  • Provides a final recommendation of practices, GPs and training placements for GMC approval.  
  • Facilitates the acquisition of specialist resources.
  • Provides externality to the Academy Quality reports, through the use of RCGP faculty, trainee and lay representation, with scrutiny from the other Academy.
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