RACGP Standards for general practices
Frequently Asked Questions (FAQS)
What are the Standards?
Do the Standards apply to our practice?
Why are the Standards important to our practice?
How does our practice use the Standards?
How does our practice incorporate feedback from our
patients?
Are some criteria and indicators in the Standards more
important than others?
How do the Standards help reduce risk?
What is the value of peer review in our practice?
Does meeting the Standards protect our practice
legally?
Will the Standards change?
How does our practice become accredited against the RACGP
Standards (3rd Edition)?
What is the definition of a general practice for the
purpose of accreditation?
Where can we get a copy of the Standards (3rd
edition)?
What are the Standards?
The RACGP Standards for general practices form one of the benchmarks of quality and safety in Australian general practice and provide future directions for quality improvement. The Standards are developed by the profession for the profession, and incorporate consideration of the expectations of consumers and relevant stakeholders; this is the result of extensive consultation during the review of the Standards for general practices (2nd Edition). It was important that both experts in the profession and consumers be involved in the development of this 3rd edition of the Standards to ensure they are appropriate for Australian general practice.
The Standards outline the aspects of general practice that support high quality and safe comprehensive care, including attention to the services practices provide, the rights and needs of patients, quality improvement and education processes, practice management, and the physical aspects of a practice.
The Standards (3rd Ed) reflects a move away from the GP as the person solely responsible for the structures, systems and processes that deliver quality and safety, and a move toward recognising that each member of the practice team – and the team as a whole – contributes to quality improvements within a practice.
The Standards concentrate on the principles of quality and safety rather than prescribing exactly how a practice should provide care. The Standards are written in such a way that they apply to the diverse forms of general practice in Australia and are appropriate for all practices regardless of size or location. The Standards also recognise that different patients have different health care needs, and that practices may differ in the type of care they provide to patients. Practices can look at the principles of quality and safety outlined in the Standards and apply these to their situation, regardless of the uniqueness of their practice. As such, the Standards do not focus on current government programs (such as Enhanced Primary Care) nor require practices to participate in these in order to meet the Standards. The Standards are flexible, independent and owned by the profession; they are appropriate to general practice regardless of changes in government policy.
Where possible, the Standards are based on evidence of improvements in quality and safety in practice and patient care from clinical trials or large scale research, and where there is no other evidence, from current professional consensus. The Standards intend to concentrate on those areas of a practice that are considered critical by the profession in supporting quality and safety.
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Do the Standards apply to our practice?
The Standards have been written by the general practice profession,
specifically for general practices in Australia.
If your service is a general practice, then these Standards can apply to
your service. A general practice is defined as a service that provides
‘initial, continuing, comprehensive and coordinated medical care
for individuals, families and communities and which integrates
biomedical, psychological, social and environmental understandings of
health’.
One of the great strengths of general practice is its diversity. If your practice is a ‘general practice’ – even if it seems to have an unusual or unconventional structure – then these Standards can apply.
These Standards can also apply to Aboriginal health services that may be differently organised to private general practices, but which still provide general practice care to a distinct community.
These Standards can also apply to services that provide comprehensive care to general practice patients outside the normal opening hours of the patient’s practice. In recent years, a large number of different types of ‘after hours’ service provision have been developed. At the time of publication, only medical deputising services can be formally ‘accredited’ by using the Standards. It is anticipated that in the future, different types of services that provide general practice care outside the normal opening hours of practices will also be able to be assessed by using these Standards for general practices (3rd Edition). These Standards reflect the essential processes, systems and structures needed to provide comprehensive primary health care to the general practice patient population, and as such, they are also relevant to services that provide this care on behalf of a practice.
The Standards might also be relevant for health services that do not necessarily see themselves as ‘general practices’ but as ‘special interest practices’ in primary care, which, for example, focus only on one clinical area (eg. mental health) or one treatment modality (eg. acupuncture). The RACGP encourages all services that provide primary health care to consider these Standards as a framework that they can use for quality improvements. The vast majority of the Standards will be appropriate for these services, and the Standards provide a starting point for these services to consider the fundamentals of quality and safety in their systems and processes. These health services may choose to assess themselves against the RACGP Standards, though they are not general practices and will not be able to be formally accredited as a ‘general practice’.
The RACGP Standards for general practices outline the hallmarks of high quality and safe general practice care in Australia. The Standards are internationally recognised and have been used as the basis for development of standards for general practices in both New Zealand and Ireland.
Furthermore, other health care sectors are looking to the RACGP Standards as a viable framework for quality improvement and in recent years the Australian optometry profession has used them as a basis for developing their own practice standards.
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Why are the Standards important to our practice?
Striving for – and achieving – the profession’s standards are important to your practice for a number of reasons:
- All general practice professionals want to improve care and patient safety, and the Standards provide an overview of the important components of a general practice that are central to these improvements
- The Standards provide a structured way for your practice to assess itself in relation to quality and safety, before considering what changes may need to be made
- Achieving the Standards – whether through self assessment or a formal accreditation process – demonstrates that your practice is providing high quality, safe and effective care as determined by your profession
- Engaging in a quality improvement cycle and periodically returning to the Standards to reassess your practice can help to keep your practice’s development on track and to determine if quality improvement changes have achieved your intended outcomes
- Using the Standards provides an opportunity for the GPs and staff members in your practice to come together as a team to consider quality improvement. The Standards cover many areas and achieving them requires the collaborative effort of your whole practice team
- Engaging in quality improvement and meeting the RACGP Standards demonstrates to your patients that your practice is serious about providing the highest quality and most comprehensive care possible.
How does our practice use the Standards?
The Standards have been written by the general practice profession for use by general practices. Practices can self assess against the Standards as part of their quality improvement process, or they might collaborate with other practices to assess each other.
The Standards are structured as a hierarchy. Each standard describes an element of practice activity that is critical to quality and safety.
Each standard has a number of specific criteria that separate the standard into several components. Each criterion describes a process that your practice can use to meet the standard. Each criterion has explanation notes to provide assistance to your practice in assessing against the criterion. The explanations provide further detail, definitions of terms, and assistance for your practice in considering ways in which you might be able to demonstrate achievement of the criterion. The explanations provide a detailed description of the RACGP’s position on the related issues and are the authoritative view on the interpretation of the criterion. Given the changing and dynamic nature of general practice in Australia, it is possible that some explanations might be augmented between the publication of this edition of the Standards and the publication of a 4th edition, in order to provide further clarity on issues as they arise. Refinements to explanations will be well publicised by the RACGP and placed on the RACGP website at www.racgp.org.au/standards.
Each criterion is followed by a number of indicators that provide ways for your practice to demonstrate that it has achieved that criterion. There are indicators that require demonstration of the processes used to meet the criterion; others that require your GPs and staff to be aware of those processes; still others that require documentation of your processes; and, finally, indicators that ask for patient feedback on your processes.
You can assess your practice against each criterion and its indicators to determine whether you have achieved the standard. At times your practice may find some indicators are not applicable to you; if this is the case in your practice, it is important to consider why they do not apply and if your peers would agree. Practices can use the following means to demonstrate how they achieve the standards, criteria and indicators:
- interviews with the GPs in your practice
- interviews with staff who provide clinical care (such as general practice nurses)
- interviews with administrative staff in your practice (such as practice managers or receptionists)
- direct observation of your practice
- reviewing your patient health records
- reviewing your practice documentation (such as your practice policy and procedures manual, practice information sheet, quality assurance and continuing professional development [QA&CPD] data, Health Insurance Commission data or appointment schedule)
- patient feedback (such as conducting a patient survey or running a patient discussion forum).
How does our practice incorporate feedback from our patients?
It is essential that your practice has some mechanism to gain feedback from patients. This might be through the use of a patient survey in which patients are asked to complete a questionnaire about your practice, or through the use of a focus group discussion (where patients are invited to come together to discuss their views on your practice and services), or it might be through some other method that is appropriate for your patient population. Patient feedback provides an informed consumer view about your practice, and may identify strengths and weaknesses that your practice team has not considered. Patient feedback is critically important for identifying opportunities for improvement. It is important to show that your practice has used patient feedback in implementing improvements.
Patient feedback is not only valuable for individual general practices; it also plays an important role in further developing the profession’s standards for general practices. Consumers – including individual patients and consumer organisations – were involved in the development of this edition of the Standards and all their suggestions were carefully considered. Many of these suggestions from consumers have been incorporated into the Standards (3rd ed) (such as the inclusion of information about the National Relay Service for patients who are deaf). Other suggestions were not considered to be feasible across the breadth of Australian general practice (such as the suggestion that practices consider providing height adjustable examination couches to assist patients with physical disabilities), although this is a level of responsiveness to which practices may aspire.
Are some criteria and indicators in the Standards more important than others?
Some standards are easy to measure; and others are more difficult to assess. There is evidence that experienced GPs and other general practice professionals can – and do – make informed judgments about those aspects of general practice that are not easily measured or quantified. These might be important aspects of quality that could be improved in the practice.
The general practice profession considers that some indicators are of central importance to quality and safety. These ‘key’ indicators are marked with a flag symbol next to the indicator. This assists your practice to determine that you have achieved the critical aspects of the criterion. Indicators that do not have ‘flags’ are still important and provide guidance to your practice about other ways it might demonstrate its quality and safety. These are often indicators that the profession thinks are important to include in the Standards, but which are more challenging for some practices to achieve.
How do the Standards help reduce risk?
Every system in a practice is vulnerable to errors. Ideally, each general practice system would operate perfectly. The reality, however, is that general practice equipment, policies and procedures, external systems (such as other health professionals), patients, GPs, and their staff are all vulnerable to mistakes, errors and ‘failures’. For example, the thermostat on the vaccine refrigerator may stop operating properly and cause the temperature of the vaccines stored in the refrigerator to decrease to freezing.
Not all vulnerabilities in general practice have an adverse impact on patient care (eg. the vaccine may continue to be effective as the temperature did not decrease sufficiently to deactivate it). However, vulnerabilities can occur in a sequence. For example, the temperature of the vaccine refrigerator was not recorded when the thermostat became faulty; the potency of varicella vaccine was compromised due to the decrease in temperature; and that vaccine was administered to a patient who subsequently contracted chicken pox.
Given this, the Standards provide ways of checking for vulnerabilities in practice systems that are important to safety and quality. Meeting each of the integrated criteria establishes a form of safeguard for patients and practices, closing the ‘holes’ in the system.
It is essential that your practice meets all the standards and criteria to be confident you have minimised the chance of an error occurring and have increased the safety and quality of the care your practice provides. When assessing your practice against these Standards, you might identify areas in which it could improve. You may wish to prioritise these improvements if you want to make a number of changes. Some improvements may take a period of time to implement and determine if they have worked; the important issue is that your practice actively works toward those improvements.
What is the value of peer review in our practice?
If your practice is undertaking its own assessment against the Standards, you might consider discussing the assessment informally with a trusted colleague. A ‘fresh set of eyes’ over your practice systems can assist in identifying areas that your practice does really well, as well as those that require improvements. Peers can make judgments that take into account all factors, not just the inspection of a checklist that could be conducted by a trained person. Peers can also provide feedback to your practice on innovative ways you could improve, and you can exchange ideas on what will work best in your practice’s environment. Most importantly, peers can provide feedback on your quality improvement activities – they can help you identify if your changes have brought about the intended outcomes or if there are other things you can do to improve quality. Many practices choose to be assessed against the Standards by a third party to gain formal ‘accreditation’ against the RACGP Standards. This process moves beyond self assessment and involves a structured assessment of your practice. The only model of third party review supported by the RACGP for these Standards is by peers who are working in your profession. In recognition of the wide variation within Australian general practice, any formal assessment process against the RACGP Standards needs to be based on common sense and needs not seek to penalise or exclude practices on the basis of technicalities.
Does meeting the Standards protect our practice legally?
During the review of the Standards for general practices (2nd Edition), the RACGP commissioned a legal opinion on a number of areas of the Standards. In addition, all medical defence organisations in Australia were consulted as to the priority areas they thought needed to be included. In preparing this edition, the RACGP has considered these views and weighed the medicolegal risk to GPs and practices, the benefits to patient safety and the feasibility of practices implementing these practice systems. In issues of high medicolegal concern (such as the follow up of tests and results in criterion 1.5.4), the RACGP has endeavoured to prepare standards that reflect what would reasonably be expected of a practice. Practices are encouraged to seek further advice from their GP’s medical defence organisations if they have concerns about a particular issue.
General practice health care operates in a dynamic, constantly changing environment. The Standards concentrate on sound principles of quality and safety in the delivery of this health care, however practices should be aware of relevant and changing state, territory or federal legislation that may impact on the way they work.
Will the Standards change?
This document is one more stage in the continuing process of standards development. There will never be a final Standards for general practices document; only a set of current standards. The Standards will always be subject to re-evaluation, consultation and the ongoing scrutiny of the profession. In order to incorporate new evidence, advances in knowledge, changes in the way primary health care is delivered in Australia, and to foster the quality improvement culture in general practice, the RACGP endeavours to revise the Standards every 3 years. Over time, what is required to satisfy one edition of the RACGP Standards may no longer adequately reflect normal, good general practice and the RACGP Standards need to be reviewed and updated to incorporate these changes. A history of the development of standards in general practice is outlined in Appendix A. As general practice in Australia continues to progress, so the Standards will continue to evolve. Over 85% of practices in Australia have embraced the concept of standards for general practices.
How does our practice become accredited against the RACGP Standards (3rd Edition)?
Your practice can self assess against the RACGP Standards for General Practices (3rd Edition), however if the practice would like to be formally accredited against the RACGP Standard (3rd Edition) please contact the accreditation organisations listed below.
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Australian General Practice Accreditation Limited Tel: 1300 362 111 Email: info@qip.com.au |
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Quality Practice Accreditation Limited (GPA Accreditation
plus) Tel: 1800 188 088 Email: gpa@gpa.net.au |
What is the definition of a general practice for the purpose of accreditation?
Definition of General
Practice and General Practitioner.
Where can we get a copy of the Standards (3rd edition)?
Members of the RACGP may download a copy of the RACGP Standards for general practices (3rd Ed) free of charge. Click here to login with your username and password and download a copy.
To purchase a copy of the RACGP Standards for general practices (3rd Ed) follow the link below.
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