Clinical data | Audit | Use of guidelines | Access to clinical information | Prescribing | Human resource management | CME | Practice meetings | Sharing information with patients | Significant events | Handling of emergencies | Learning from patients | ||
1 | All notes and external data (discharge letters, etc) are registered on computer | No clinical audit | No policy for following guidelines | No system for storage and locating clinical information is available | No audit data on prescribing is available | Not relevant (single-handed practice with no staff) | No CME arrangements exists for GPs and staff | Practice team meetings are not arranged | No written patient information available | Significant events are recorded | No resuscitation equipment or acute box is available | No system for collecting feedback from patients | 1 |
2 | As above and non-digitalised correspondences are scanned or registered on computer | Data collection exercises conducted but incomplete audit cycles | The practice team adapts clinical guidelines for use in the practice | Textbooks and peer-reviewed journals and guidelines at limited locations | An analysis of prescribing is available | Practice staff has written contracts | CME arrangements for GPs and staff are in place | Practice team meetings occur infrequently and at irregularly | Patient information available, but unsystematic and random | Significant events are reviewed at team meetings occasionally | A written formulary guides practice teams' handling of medical disasters | Informal arrangements exists to collect feedback from patients | 2 |
3 | Lab data registered on computer | Occasional audit cycles | The practice team takes steps to implement the use of guidelines in the practice | As above and renewed regularly | Prescribing data are discussed by the practice team | Wages are in accordance with labour marked contracts | Budgets are allocated for CME for GPs and staff | Practice team meetings occur regularly | Patient information in waiting areas on general health topics | Significant events are reviewed at team meetings regularly | Resuscitation equipment (oxygen) and an acute box with relevant medications is easily available | Formal arrangements exists to collect feedback from patients | 3 |
4 | As above and all consultations are ICPC-coded but only on chosen diagnoses or incompletely | Regular audit cycles completed, but only for a few chronic conditions | Clinical guidelines are integrated into daily clinical practice | As above and used during consultations | A local formulary guides prescribing and renewals | Practice staff receives induction training | GPs spend their annual allowance and staff make use of their four annual days for CME | Practice team meetings occur regularly and are well organised | Patient information in waiting areas on various clinical conditions | Significant events generate organisational changes from time to time | A practice team member takes on responsibility for maintenance of the resuscitation equipment and relevant medications | Feedback from patients is reviewed at practice meetings | 4 |
5 | As above and external material ICPC coded but only on chosen diagnoses or incompletely | Regular complete audit for a wide range of chronic conditions performed regularly | Use of guidelines on a few chronic conditions are reviewed by clinical audit | As above and internet based information available at limited locations | Prescribing patterns is regularly reviewed by practice team and result in changes to policies | Practice staff has job descriptions | Practice team discuss the learning subjects most valuable for the team members personally and the practice as an organisation | Regular, agenda led practice meetings with agreed minutes and action points | Patient information quality assurance is conducted | Significant events are analysed clinically and organisationally | All practice team members are familiar with the written resuscitation formulary | Feedback from patients results in organisational changes | 5 |
6 | As above and all consultations ICPC coded on all diagnoses | Regular complete audit for a wide range of chronic conditions performed regularly | Use of guidelines on a wide range of chronic conditions performed regularly | Internet based information available at the clinical desktop | As above for all major drug types | Practice staff has annual appraisals | As above and linked to the practice development plan | As above, plus arrangements that ensures that action points are fulfilled are in place | Clinical information systems capable of providing a range of patient information | As above, and analysis is discussed at staff meetings | A practice team member takes on responsibility for induction training of resuscitation to new team members | The practice involves patients in planning services | 6 |
7 | As above and external material is always ICPC coded | As above and data send to an external database | As above and data reviewed by an external agency | All clinicians use internet based information during consultations | Prescribing specialists provides practice specific advice on practice prescribing data | Staff appraisals are formalised | Arrangements that ensures that knowledge achieved by GPs and staff through CME is shared with practice team | As above plus involvement of extended team of community-based healthcare staff | Electronic information resources available for patients in waiting areas | As above and analysis generate organisational changes | The practice team perform training exercises in resuscitation at least annually | Patient-led organisational changes are evaluated | 7 |
8 | Results of all investigations, including x-rays available on computer | Systematic audits are shared with the public | As above and data are shared with the public | All clinicians are skilled at using the internet to find information during consultations | Prescribing specialists provides practice specific case-based advice on specific ordinations | Practice development plan is discussed with practice staff | All team members receive external support in order to plan their CME | As above plus collaboration with social care services | Individually tailored information provided to patients about harms and benefits | The impact of a significant event analysis is evaluated | Resuscitation procedures are quality-assured | Patient feedback systems are integrated into the performance of the organisation | 8 |
CME, Continuing Medical Education.