RACGP Standards for general practices
Development of the RACGP Standards for general practices 4th edition
The RACGP Standards for general practices (4th edition) were developed by the National Expert Committee on Standards for General Practices (NECSGP) in close consultation with general practice stakeholders - GPs, nurses, practice managers, patients and a range of external organisations. In its comprehensive consultation process, the RACGP received feedback from nearly 700 individuals and organisations. This included feedback through submissions, online surveys, focus groups run by the RACGP and Divisions, field trials and seminars.
The development of the Standards (4th edition) was essentially a 2 stage process.
Stage 1: Review of the Standards (3rd edition) via an online survey which attracted almost 2000 logins and formal written submissions from 60 stakeholders including consumers.
Stage 2: Review and trial of draft Standards (4th edition) via written submissions, online surveys, focus groups and field testing involving nearly 700 individuals and organisations.
Issues that have influenced the 4th edition Standards
The Standards are designed to accommodate key trends in the contemporary general practice environment including:
1. Evolution of general practice teams
The Standards reflect a move away from the GP as the person solely
responsible for quality and safety systems and acknowledge that other
practice team members can and do contribute expertise in risk management
within the practice.
2. National Safety and Quality Health Service
Standards
The Australian Commission on Safety and Quality in Health Care (ACSQHC)
is developing a set of National Safety and Quality Health Service
Standards that will form part of a national accreditation scheme.
The RACGP has incorporated key elements of the new ACSQHC National
Standards into the RACGP Standards for general practices
(4th edition) to ensure the Standards remain contemporary
and congruent with the national health reform process.
The new 4th edition criteria based on ACSQHC National Standards include:
- 1.5.2 Clinical handover
- 3.1.3 Clinical governance
- 3.1.4 Patient identification
- 5.3.1 Safe and quality use of medicines.
3. E-health initiatives
The RACGP Standards have been updated to allow for evolving
national e-health initiatives including standardised electronic health
records and unique patient identifiers.
The criteria which reflect e-health initiative include:
- 1.7.1 Patient health records
- 1.7.2 Health summaries
- 3.1.4 Patient identification
The RACGP has also updated and produced a new edition of the RACGP Computer security guidelines, which provide in-depth guidance and tools to assist practices to understand and implement the RACGP Standardsin these areas.
4. Consumer engagement
During the consultation process for the 4th edition Standards,
consumers raised particular issues including:
- continuity of care, especially in relation to timely access to health information when a record transfer is requested
- access to height adjustable beds was considered important by many patients particularly the elderly and people with a disability and this is now a flagged indicator
- patients want to be informed of changes made by a general practice in response to their feedback and this preference is expressed in a new unflagged indicator.
5. Feedback on patients’ experience of
general practice
Patient feedback is a fundamental component of quality improvement. In
the past, patient feedback focussed on a patient’s satisfaction
with a health service. However, more recent advances in the field of
patient feedback suggest it is more important to ask patients about
their experience of healthcare.
The RACGP therefore commissioned advice on the best way for practices to collect patient feedback. As a result, the RACGP has produced a new resource for members entitled Patient feedback guide: learning from our patients.
The tools used to measure patient feedback need to be rigorous to ensure the integrity of data subsequently used by practices for quality improvement purposes. For this reason, the Standards require practices to obtain patient feedback using a validated patient experience questionnaire that has been approved by the RACGP, or by using practice-specific methods (survey or focus group or patient interviews), that adhere to the requirements outlined in the Patient feedback guide available on the RACGP website from mid November 2010).
6. Collection and recording of Indigenous status
In 2007, the Council of Australian Governments (COAG) signed a
National Indigenous Reform Agreement for inter-jurisdictional
cooperation to improve the health and wellbeing of Aboriginal and Torres
Strait Islander people. This initiative, better known as ‘Closing
the Gap’ in Indigenous disadvantage, requires general practices to
improve their procedures for identifying their Aboriginal and Torres
Strait Islander patients.
COAG has accepted the
National best practice guidelines for collecting Indigenous status
in health data sets released by the Australian Institute of Health
and Welfare (AIHW) in 2010, as the national identification standard.
The Standards reflect this initiative in Criterion 1.7.1E
Patient health records.
7. Compliance with legislation applicable to general
practices
In general, references to legislation have been removed in the RACGP
Standards for general practices (4th edition) as
federal, state/territory and local legislation override any
non-legislative standards. On occasion, legislation is cited in the
Standards where it is particularly important to a defined
aspect of general practice, eg. Criterion 4.2.1 Confidentiality and
privacy of health information.
Field testing the Standards
In addition to a comprehensive consultation process, the RACGP undertook in-depth field testing of the proposed 4th edition Standards to ensure the new Standards proved workable in the field. The field testing comprised test visits by surveyors, self assessments by general practices, online questionnaires and focus groups involving surveyors and general practice teams.
After analysis of the field test results by RACGP researchers, the NECSGP used field test data to refine several proposed changes to the Standards.
Official launch
The RACGP Standards for general practices (4th edition) were formally approved by the RACGP Council in September 2010 and officially launched at GP10 – the annual RACGP conference – on 8 October 2010.