Jenner PracticeGovernance Policy

Introduction

This policy builds on the practice development sessions held with Paul Mullin during November 2012 and the July 2013 away day which focused on practice governance. Our learning throughout this time has led us to the conclusion that we need to ensure clinicians and staff are supported and patients protected.

During this time we have asked ourselves the following questions before developing the practice governance policy. StrategicDirection - What is our vision for it as a clinical business? What will it look like in 5 years time? How do we bring out the best from our staff and evolve roles to fit our strategic direction? How can we ensure clarity and transparency of roles and decision making; dispute resolution; understanding of self and others; good faith and trust. How do we challenge on issues, not on person; skilful giving and receiving of feedback?

The challenge for the practice participating in governance is to balance an appropriate degree of clinical autonomy and professional self-determination with a sense of collective responsibility for quality improvement. This policy will be referred to and updated as we move through the next three years.

Aims

The principle aims of practice governance are to improve the quality and the accountability of health care and the partners are committed to developing the organisational structures required for implementing our practice governance agenda. Practice governance embodies three key attributes which are recognisably high standards of care, transparent responsibility and accountability for those standards and a constant dynamic of improvement.

Practice governance underpins the practice’s statutory duty of high quality in delivering care that is safe, accountable and with the best possible patient experience.

Practice governance also focuses on experiences and learning, in order to improve on outcomes, improve the working environment, assess and where possible, anticipate risk and also eliminate or reduce risk or harm.

It addresses the following:

Patient Safety

Clinical Effectiveness

Patient Experience

Quality Assurance

Quality improvement

There are two areas within the practice governance framework; these are organisational and Clinical governance. The challenge for the practice is to integrate clinical and organisational governance in a way that ensures we maintain and improve the quality of patient care delivered by the practice.

There are two parts to the governance framework; these are clinical and organisational governance. They differ only in terms of the clinician’s code of conduct guidance as set down by the General Medical Committee and the Royal Collage of Nursing and Midwifery (see Roles & Responsibilities).

Organisational development and the effective establishment of clinical governance go hand in hand and we will focus on experiences and learning, in order to improve on clinical outcomes, improve the working environment, assess and where possible, anticipate risk and also eliminate or reduce risk or harm. Above all practice governance is about changing organisational culture away from a culture of blame to one of learning so that quality infuses all aspects of the practice’s work.

Organisational Governance

Organisational Governance is a structure for monitoring the actions, policies and decisions and specifies the rules and procedures for making decisions within the practice. The challenge for the practice participating in organisational governance is to balance an appropriate degree of autonomy and professional self determination with a sense of collective responsibility for quality improvement. We need to develop a culture of learning and create a supportive culture with good teamwork underpinned by clinical and organisational audits.

The principles of organisational governance apply to all who provide or manage patient care services and the practice team should aim to:

Create a culture of openness and transparency

Adhere to national and local best practice guidance

Develop stringent policies and processes (using simple check lists as a quick reference)

Develop robust accountability and responsibility arrangements

Set the direction and priorities for practice governance

Provide a framework to identify and manage areas of concern raised through reporting and feedback mechanisms

Ensure consistent standards of clinical management are applied to all areas within the practice

Ensure compliance with legislative and statutory requirements

We will seek patient participation and provide patients with the mechanism to feedback and contribute to the development of our services. We will view the practice from the patient perspective (in particular from patient survey results) and seek to implement feasible and beneficial ideas.

Implementation

Practice Governance Meetings (PGMs)

The partners have set up a Practice Governance Forum these meetings are the means by which we will develop the organisational structures required for implementing our practice governance agenda. They are a forum where we can evaluate what we do and why we do it. For every activity that goes on in the practice we can ask: What is the impact of this activity on quality improvement and patient safety? The PGMs are a means for us to establish an overview of practice activity and help direct the development of the practice.

The PGM is also a forum where concerns are raised, including complaints about staff, partners and systems. They include significant events. These concerns will be scrutinised and discussed and their impact upon the practice assessed. For each we can ask: Does this concern reveal anything significant about the quality of care we provide or not?

If so what shall we do about it? These concerns will be recorded at the PGM but their management may well be devolved to other meetings depending on importance.

An outline of a standing agenda would include – patient and staff feedback, access and workload audits, quality improvement/assurance, risk management, information governance, performance identification and management. We can modify these if required.

In keeping with the ‘overview’ function of the PGMs, it will be appropriate for various leads within the practice to feed back from other meetings- the patient group, Nurse and Reception teams meetings and from the Information managementgroup (QOF, QP, IG & IM&T) plus external meetings such as the LMC, Neighbourhood/Federation and Child protection. In addition, the PGMs will inform and be informed by the Clinical sessions.

What will the ‘outcome’ of the PGMs be? At one level these will be items or concerns that need to be addressed. At a more strategic level, the PGM ‘listens’ and responds to what is going on in the practice. The PGM provides strategic direction to practice activity with a view to quality improvement

Elements of OrganisationalGovernance

Learningand Development: The practice is committed to the continuous training and development of our staff, both in the area of job related skills training and lifelong learning for personal development.

Our staff is one of our greatest assets and helping them to develop is crucial to the achievement of the organization’s goals. All training practices and procedures will endeavour to support individuals to strive to achieve these goals which will be linked to the development of the practice.

Information Governance: provides a framework to bring together all the legal rules, guidance and best practice that apply to the handling of information. Information governance ensures necessary safeguards for, and appropriate use of, patient and personal information. The requirements cover all aspects of information governance including; data protection and confidentiality; information security; information quality; health/care records management and corporate information.

Information Management: We will seek to improve data quality and the collection, management and use of information within the practice systems. We will determine the system’s effectiveness in detecting health problems, defining priorities, identifying innovative solutions and allocating resources to improve health outcomes. We will make full use of information available in clinical and non- clinical decision making.

Risk Management:Includes performance systems for identifying and improving poor performance via risk management training in order to reduce risks to patients, risks to practitioners and risks to the organisation. Risk management involves consideration of the following:

Risks to patients: compliance with statutory regulations such as our Health and Safety, PMS contact, CQC and the CCG can help minimise risks to patients. In addition, patient risks can also be minimised by ensuring that systems are regularly reviewed and questioned – for example by significant event audit and learning from complaints.

Risks to practitioners:ensuring that clinicians work in a safe environment and are helped to keep up to date are important parts of quality assurance.

Risks to the organisation: poor quality is a threat to any organisation. In addition to reducing risks to patients and practitioners, organisations need to reduce their own risks by ensuring high quality employment practice (including locum procedures and reviews of individual and team performance), a safe environment and well designed policies on public involvement. We will operate a system of Significant Event Reporting to encourage review, feedback and learning from incidents in an open and no-blame culture. All significant events will be discussed and documented within the forum of the practice governance clinical review meeting.

Performance Management:Managing performance requires us to reconcile caring for and developing our staff whilst ensuring that team and practice objectives are achieved. For instance, we need to be supportive if, for example, a member of the team needs help and encouragement to get through difficulties or challenges. On the other hand we need to focus on accountability responsibility where, for example matters of health and safety or essential processes or policies are concerned.

A huge number of performance problems can be tracked back simply to a failure to explain and agree expectations and/or a failure to understand and provide the help that the person needs. These are the responsibilities of the practice not the employee.

Performance Monitoring: With the best will in the world there will be times when poor performance is revealed and this must be addressed promptly and effectively. If performance is sufficiently poor, action to protect patients must be taken. Problems with underperformance might become evident through the review of annual appraisals, revalidation, Patient surveys and complaints.

Action will include an assessment of the doctors, nurses, receptionists and managers in the context in which they work. Some underperformance is due to poor systems of care, and some is due to underresourcing. Where it is due to an individual, the cause may be a health problem or a personal/family problem or problems with competency or behaviour.

Clinical Governance

"Clinical governance is a system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish." (Scally and Donaldson 1998).

It is the review of clinical performance, the refining of clinical practice as a result and measurement of performance against agreed standards – a cyclical process of improving the quality of care.

It underpins and informs the work of healthcare services at every level and in every capacity. It is a unifying term used to describe a systematic approach to the following elements:

Elements of Clinical Governance:

Clinical effectiveness: is a measure of the extent to which a particular intervention works. The measure on its own is useful, but decisions are enhanced by considering additional factors, such as whether the intervention is appropriate and whether it represents value for money. Clinical practice needs to be refined in the light of emerging evidence of effectiveness.

Quality Assurance:The measurement and comparison of standards, monitoring of processes and an associated loop that confers error prevention

Education and Training: It is no longer considered acceptable for any clinician to abstain from continuing education after qualification – too much of what is learned during training becomes quickly outdated. The continuing professional development(CPD) has been the responsibility of the PCTs and now NHS England and it has also been the professional duty of clinicians to remain up-to-date.

Openness: poor performance and poor practice can too often thrive behind closed doors. Processes which are open to public scrutiny, while respecting individual patient and practitioner confidentiality, and which can be justified openly, are an essential part of quality assurance. Open proceedings and discussion about clinical governance issues should be a feature of the framework.

Clinicians

Every general practitioner and nurse needs to understand the principles underpinning clinical governance and use them in their professional practice.

The principle aims of clinical governance are to:

Improve the quality and the accountability of health care.

The adoption of a moral principle that commands the clinician to place the needs of patients before his or her own convenience or interests

Clinical governance includes identifying and responding to poor practice

Create a supportive culture with good teamwork underpinned by clinical audit.

We will encourage team working across the practice, establish a “no-blame” learning culture, and provide an open and equal working relationship with colleagues.

Roles and Responsibilities of Doctors, Nurses and the Reception, Data and Administrative teams

Doctors

At all times clinicians observe the principles of Good Medical Practice within the practice as set down by the General Medical Council and participate fully in the revalidation process.

Participate fully in the annual appraisal scheme with complete and supporting documentation including up-to-date appraisal and revalidation folders and an agreed continuing professional development plan and make such information summary statement available immediately to all the other partners and practice manager at their request, incorporating the 360 feedback.

Attend sufficient continuing medical education sessions or undertake sufficient study time to ensure that he/she keeps up to date with current medical opinion.

Take all such steps as the partners shall from time to time agree to achieve in respect of the patients registered with the practice the standard of services set out in the PMS Contract and any other services which may be agreed by the Super Majority of the partners and which would result in financial penalties for non-compliance.

For further information and guidance please refer to the following:

Practice Partnership Deed

Practice Service Level Agreement

RCGP Clinical governance guidance

GMC – Good medical practice

GMC – Raising and acting on concerns about patient safety

Practice Nurses

The Principles were developed by the Royal College of Nursing in partnership with the Department of Health (England), the Nursing and Midwifery Council, and patient and service user organisations.

The Code is the foundation of good nursing and midwifery practice, and a key tool in safeguarding the health and wellbeing of the public.The people in your care must be able to trust you with their health and wellbeing.

To justify that trust, you must:

Make the care of patients your first concern, treating them as individuals and respecting their dignity. Work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community

Provide a high standard of practice and care at all times

Be open and honest, act with integrity and uphold the reputation of your profession

As a professional, you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions. You must always act lawfully, whether those laws relate to your professional practice or personal life.

Failure to comply with this code may bring your fitness to practise into question and endanger your registration.

At all times clinicians observe the principles as set down by the RCN and participate fully in the practice appraisal process. Attend continuing education sessions to ensure that she/he keeps up to date with current medical opinion and take all steps to ensure the service provided is in line with the strategic direction of the practice.

For further information and guidance please refer to the following:

RCN Standards of care

GMC – Raising and acting on concerns about patient safety

Reception Data and Administrative Team

Roles and Responsibilities

Support the equality, diversity and rights of patients, carers and colleagues, to include:

Acting in a way that recognizes the importance of people’s rights, interpreting them in a way that is consistent with practice procedures and policies, and current legislation

Respecting the privacy, dignity, needs and beliefs of patients, carers and colleagues

Behaving in a manner which is welcoming to and of the individual, is non-judgmental and respects their circumstances, feelings priorities and rights.