Frequently asked questions about the Standards

What are the Standards?

The RACGP Standards for general practices (4th edition) (the Standards) are a template for quality care and risk management in Australian general practice. The Standards are developed by the profession for the profession to help general practice teams deliver better health outcomes for their patients.

The Standards focus on safety, quality and accountability – they do not prescribe how a practice should provide clinical care.

Why are the Standards important?

The RACGP Standards for general practices (4th edition) are important because they keep Australian general practice at the forefront of safe, high quality primary healthcare delivery in Australia. The Standards provide a practical framework for patient safety, quality healthcare and innovation in general practice.

Practices which strive to meet and sustain the Standards are making a demonstrable commitment to quality improvement for the direct benefit of their patients and local communities.

Are all the Standards equal?

It could be argued that some standards are ‘more equal’ than others in the sense that some standards have an overarching impact on patient safety and quality healthcare (eg Criterion 3.1.1 Quality improvement activities and Criterion 3.1.3 Clinical governance) while others have a more specific focus (eg Criterion 5.3.1 Safe and quality use of medicines). However, the Standards are designed as a comprehensive and integrated framework where each component (whether standard, criterion or indicator) plays an important part in the overall objectives of patient safety, quality healthcare and quality improvement.

Some indicators are deemed by the general practice profession to be of central importance to quality and safety. These indicators are marked with a ‘flag’ and are considered mandatory. Indicators which are not marked with a ‘flag’ are considered discretionary and generally suggest areas that practices could usefully be working toward.

The 4th edition Standards are less prescriptive than earlier versions and leave it to general practices themselves to determine how they will demonstrate compliance with particular requirements. Any formal assessment process against the RACGP Standards needs to be based on common sense and should not seek to penalise or exclude practices on the basis of technicalities.

Do the Standards apply to our practice?

If your practice is a general medical practice – even if it seems to have an unusual or unconventional structure – then the Standards for general practices (4th edition) are applicable.

General Practice
The RACGP defines general practice as ‘the provision of patient centred, continuing, comprehensive, coordinated primary care to individuals, families and communities’. The Standards are wholly relevant to general practices which meet this definition.

Special Interest Practices
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. Special interest practices may focus on a single clinical area, eg. mental health or skin cancer or a single treatment modality, eg. acupuncture.

Services providing care to specific populations
The Standards may apply to primary health care services that are not organised like an office based private general practice, but which nevertheless provide general practice care to a distinct community, eg. Aboriginal Medical Services, community health services or mobile clinics caring for homeless people.

The RACGP has worked extensively with the Aboriginal Community Controlled Health Organisation to develop an interpretive guide on the RACGP Standards.

Services providing care outside normal opening hours
There are several options for the provision of care outside normal opening hours, or the advertised opening hours of a practice. Some practices use their own GPs to provide care or alternatively use a local cooperative of GPs or a medical deputising service. Where a deputising service is not available practices may have an agreement with a local hospital. Some practices use a combination of all these arrangements.

Except where specifically indicated, all standards, criteria and related indicators are applicable to services providing care outside normal opening hours.

How do the Standards help our practice improve?

The Standards provide a practical framework for patient safety, quality healthcare and innovation in general practice. The concept of using practice specific data to identify areas for improvement and implement change along the lines of a Plan-Do-Study-Act cycle is embedded throughout the Standards and has a particular focus in the following Criteria:

Criterion 1.2.1 Practice information
Criterion 2.1.2 Patient feedback
Criterion 3.1.1 Quality improvement activities
Criterion 3.1.2 Clinical risk management systems
Criterion 3.1.3 Clinical governance.

Practices which meet and then sustain all the Standards on a day-to-day basis should be well placed to implement quality improvements as an effective business activity.

How do the Standards help our practice manage risk?

The 4th edition Standards are based on a framework of good governance - a framework which ultimately makes all members of the general practice team accountable for patient safety and high quality clinical care.

Risk management is an inbuilt component of the 4th edition Standards, so practices which meet and then sustain all the Standards on a day-to-day basis should be well placed to manage risk effectively.

There are particular standards and criteria which focus very explicitly on risk management and practices are encouraged to pay particular attention to these eg:

Criterion 1.2.2 Informed patient decisions
Criterion 1.4.1 Consistent evidence based practice
Criterion 1.5.2 Clinical handover
Criterion 1.5.3 System for follow up of tests and results
Criterion 1.6.2 Referral documents
Criterion 1.7.1 Patient health records
Criterion 2.1.2 Patient feedback
Standard 3.1 Safety and Quality
Standard 3.2 Education and Training
Standard 5.3 Clinical support processes.

Every system in a general practice is vulnerable to errors. Not all vulnerabilities in general practice will have an adverse impact on patient care. However, vulnerabilities can occur in a sequence producing a harmful outcome. For example, the thermostat on the vaccine refrigerator may stop working properly, causing the temperature of stored vaccines to decrease to freezing. If the temperature of the vaccine refrigerator was not recorded when the thermostat became faulty, the potency of vaccines may be compromised and go unnoticed. If the compromised vaccine is used to immunise a patient, then the patient’s level of immunity will be compromised and the patient will be at risk of contracting the related disease.
In summary, the Standards help general practices manage risk by providing integrated pathways for preventing vulnerabilities in practice systems designed to support safety and quality.

Practices are encouraged to seek advice from their medical defence organisation if they have concerns about a particular problem or risk.

In addition, practices are reminded of their responsibility to comply with relevant jurisdictional legislation. 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.

**How can our practice use the Standards?**

Self assessment against the Standards
The RACGP encourages all services that provide primary health care to consider the Standards as a template for quality improvement and risk management. Most standards and related criteria will be relevant and will enable practices to build the fundamentals of quality and safety into their systems.

Primary health services which do not meet the RACGP definition of general practice and are therefore unable to be formally accredited against the Standards, are nevertheless able to use the Standards to conduct a self assessment of their performance.

If a practice is undertaking its own self-assessment against the Standards, it may be helpful to discuss the assessment informally with trusted colleagues. A ‘fresh set of eyes’ over practice systems can assist in identifying areas where the practice does really well and areas where the practice needs to improve. Most importantly, peers can provide feedback on quality improvement activities – they can help the practice verify if changes based on practice data have brought about intended outcomes.

Independent accreditation against the Standards
When the RACGP Standards are used as the basis of an accreditation process, practices are expected to meet the Standards at all times, not just on the day of the accreditation survey. This is important for the safe and effective care of patients.
Any formal assessment process against the RACGP Standards needs to be based on common sense and should not seek to penalise or exclude practices on the basis of technicalities.

The only model of third party review supported by the RACGP for the Standards is by two or more surveyors who meet defined selection criteria and where at least one surveyor is a GP.

What if I have another question about the Standards?

If you have another question, first check the RACGP Standards for general practices (4th edition) for the information you are seeking. Use the index to find explanatory material and related resources which may cover your query.

If you can’t find the information you are seeking within the Standards, you may like to contact the Standards Team within the Clinical Improvement Unit at RACGP. Send your query here.

The Royal Australian College of General Practitioners

RACGP Standards for general practices