RACGP Standards for general practices 4th edition
Preamble
RACGP Standards for general practices (4th edition): A template for quality care and risk management in contemporary Australian general practices
The RACGP Standards for general practices (4th edition) (the Standards) provide a template for quality care and risk management in Australian general practice.
The Standards are designed to keep Australian general practice at the forefront of safe, high quality primary healthcare delivery in Australia.
The Standards have evolved with the changing landscape of Australian healthcare and reflect contemporary practice (see Appendix A).
The Standards provide a framework for the continuing development of well performing practice teams to enable them to focus on quality care and risk management.
Keeping the Standards current
It is important that the RACGP Standards for general practices reflect contemporary general practice and pave the way for quality improvement and innovation.
The RACGP Standards for general practices (3rd edition) were released in July 2005, with a revised edition published in July 2007.
The RACGP Standards (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.
Issues that have influenced the 4th edition Standards
The Standards are designed to accommodate key trends in the general practice
environment:
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 (eg. infection control).
The language of the 4th edition Standards reflects this evolution where:
- ‘general practice team’ refers to all those who work in the practice – both administrative and clinical, and
- ‘clinical team’ refers to those members of the practice team who provide clinical care to patients.
2. Impact of healthcare reform
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 to ensure the RACGP Standards remain contemporary and congruent with the national health reform process (see Appendix B).
The new criteria from the ACSQHC National Standards reflected in the RACGPStandards include:
- Criterion 1.5.2 Clinical handover
- Criterion 3.1.3 Clinical governance
- Criterion 3.1.4 Patient identification
- Criterion 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 initiatives include:
- Criterion 1.7.1 Patient health records
• Criterion 1.7.2 Health summaries
• Criterion 3.1.4 Patient identification.
The RACGP has also updated and produced a new edition of the RACGPComputer security guidelines, which provide in-depth guidance and tools to assist practices to understand and implement the RACGP Standards in 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 (see Criterion 2.1.1D Respectful and culturally appropriate care)
- access to height adjustable beds which was considered important by many patients, particularly the elderly and people with a disability; this is now a flagged indicator (see Criterion 5.1.1G Practice facilities)
- • patients wanting to be informed of changes made by a general practice in response to their feedback; this preference is expressed in a new unflagged indicator (see Criterion 2.1.2E Patient feedback).
5. Using patient feedback for quality improvement
Patient feedback is a fundamental component of quality improvement. In the past, patient feedback focused 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 RACGP Standards stipulate that practices must obtain patient feedback by 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 Learning from our patients (www.racgp.org.au/standards).
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 RACGP Standards reflect this initiative in Criterion 1.7.1E Patient health
records.
7. Compliance with legislation applicable to general practices
It is the responsibility of general practices 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 theStandards where it is particularly important to a defined aspect of general practice (see Criterion 4.2.1 Confidentiality and privacy of health information).
8. Removal of criteria/indicators
The RACGP Standards (4th edition) include three less criteria and 38 less indicators. The following principles governed such decisions:
- Merge RACGP Standards (3rd edition) criteria of similar themes (see Criterion 1.2.4 Costs within our practice and Criterion 1.2.5 Costs for referred services)
- Remove RACGP Standards (3rd edition) criteria where legislation supersedes the Standards (see Criterion 5.3.1 Schedule 8 medicines)
- Remove indicators relating to patient feedback and provided a patient feedback guide entitled RACGP Patient feedback guide: Learning from our patients.
Accreditation
Many practices choose to be assessed against the Standards by an independent third party to gain formal ‘accreditation’ against the RACGPStandards.
Achieving independent accreditation against the Standards shows patients that your practice is serious about providing high quality, safe and effective care to standards of excellence determined by the general practice profession.
The only model of third party review supported by the RACGP for these Standards is peer review where one surveyor must be a general practitioner (see Appendix C).
The RACGP envisages that formal accreditation against the RACGP Standards will be based on common sense and will not seek to penalise or exclude practices on the basis of technicalities.
Previously, the RACGP Standards dictated how practices should demonstrate compliance with the Standards (eg. interview, document review, observation). Those requirements have been removed from the RACGP Standards (4th edition) so that practices themselves and peer surveyors can now decide how practices demonstrate achievement of the RACGP Standards.
The explanatory material which accompanies each criterion is designed to provide guidance to practices on satisfying each of the related indicators.
How will the RACGP Standards evolve?
This edition of the RACGP Standards is one more stage in the continuing process of standards development. The RACGP Standards will always be subject to the ongoing scrutiny of the profession and the community at large. In order to incorporate feedback from the profession, new research evidence, advances in knowledge and changes in the way primary healthcare is delivered in Australia, the RACGP will update the Standards as required.
It is envisaged that the process for updating the Standards will include addenda published as necessary, with new editions published from time to time whenever a significant change in the general practice environment dictates the need for a major process of consultation and review.
RACGP support for practices
In developing the RACGP Standards (4th edition), the RACGP was mindful of the resources required by general practices to achieve the Standards. The RACGP will continue to support practices to implement the Standards, through the provision of education sessions and high quality tools such as:
- RACGP Infection control standards for office based practices (4th edition)
- RACGP sterilisation records suite
- RACGP schedule 8 medicines record books (practice and doctors bag size)
- RACGP Patient feedback guide: Learning from our patients
- RACGP Computer security guidelines (3rd edition)
- 10 tips for safer patient care
- RACGP Pandemic flu kit.
Further information and support to practices can be obtained from the RACGP standards team by phone (03) 8699 0414, or email (standards@racgp.org.au).
We welcome your feedback
The RACGP National Expert Committee on Standards for General Practices welcomes feedback on the Standards.
Comments may be forwarded to:
Chair, National Expert Committee on Standards for General Practices
The Royal Australian College of General Practitioners
1 Palmerston Crescent
South Melbourne, Victoria 3205
Telephone 03 8699 0414
Facsimile 03 8699 0400
Email standards@racgp.org.au
Website www.racgp.org.au/standards
► This symbol means a particular indicator is ‘flagged’ or mandatory; indicators which are not ‘flagged’ are discretionary.