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    Intermediate care clinics in headache Support for PCTs

    Introduction

    There are both economic and clinical arguments to develop headache services

    delivered by General Practitioners with a special interest in headache (GPwSI).

    However there is inevitably a gap between policy rhetoric and clinician reality.

    This paper offers support to PCTs who are considering setting up a GPwSI service

    in headache written from the perspective of GPs who have experience in

    delivering such a service.

    Background

    Headache the unmet need

    The economic, social and personal burden of headache in the community is

    substantial.1 Migraine alone affects 7.6% of males and 18.3% of females in

    England.2 Measures of health-related quality of life are similar to patients with

    other chronic conditions such as arthritis and diabetes 3 and worse than those

    with asthma.4 One in three migraine sufferers believe that their problem

    controls their life 5 and the impact extends to family and friends.6

    The majority of headache sufferers are reluctant to seek help with only 6.4/100

    female and 2.5/100 men consulting per year and the condition is often poorly

    managed by the GP.7 Although the majority of headaches are managed in

    primary care, because of the high prevalence of headache compared to other

    neurological conditions, up to 30% of neurology referrals are for headache but

    only a small number of neurologists have a special interest in the area and many

    referrals are inappropriate for a secondary care setting.8

    The development of intermediate care

    Reflecting these concerns, it has been suggested that intermediate care

    headache clinics staffed by general practitioners with a special interest (GPwSI)

    should support GP colleagues who would continue to provide first-line headache

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    care.910 This development is in line with NHS policy where despite the paucity of

    evidence, the hope is that intermediate care will provide more effective and

    efficient service delivery in local settings.11

    A GPwSI is a general practitioner who has developed enhanced skills so as to

    provide a variety of extended services in a primary or intermediate tier care

    setting that has traditionally been provided in secondary care. Figure 1 shows a

    more comprehensive definition although there has been considerable debate over

    this concept.12 GPs are already specialists in family medicine and it has been

    argued that this development would undermine the essence of general practice.

    General practitioners with special interests supplement their important generalist

    role by delivering high quality improved access services to meet the needs of a

    single PCT or group of PCOs. They may deliver a clinical service beyond the

    normal scope of general practice, undertake advanced procedures or develop

    services. They will work as partners in a managed service not under direct

    supervision, keeping within their competencies. They do not offer a full

    consultant service and will not replace local consultants or interfere with access

    to consultants by local general practitioners.

    Figure 1. Definition of a GPSI.

    Some practical advantages claimed for intermediate care are:

    Increased patient throughput and clinical capacity

    Services are more accessible to patients

    Encourages professional development

    May facilitate retention of medical staff by offering a broader range of

    interests

    Could release resources from secondary care to see more appropriate

    cases

    The economics of intermediate care

    From an economic perspective, when an intermediate care service is proposed,

    there are a range of inputs to be considered13:

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    The aims and objectives of the service change and whether the shift is

    acceptable to all stakeholders. For example, is the aim an addition to the

    services in existence, complementation, substitution or a combination of all

    three? Is the objective of the service to manage headache cases or just to

    exclude serious pathology and offer advice to the GP on ongoing

    management?

    What are the implications for other services that may be affected directly or

    indirectly? For example, the introduction of a new service may de-stabilise the

    delivery of secondary care services.

    What is the best increment in service development to undertake and how

    should the service be configured? What are the local values placed on the

    potential changes in outcome (clinical and non-clinical) and how do they

    reflect national priorities? Are new resources available or is disinvestment required from secondary

    care? If so, is this a practical option and can the released resources be

    identified?

    The effectiveness of intermediate care

    The difficulties in obtaining a rigorous and generalisable evidence base to

    address these questions are well recognised.14 15 In particular, there are

    difficulties in conflating outcomes into a single measure and there is a lack ofboth research resources and technical expertise. Developments will also

    depend on the local context of the health economy and the relationships

    between local stakeholders. There is only one study on the effectiveness of

    headache care delivered in an intermediate care setting.16 It was found that

    a GPwSI headache service can satisfy patients with similar headache impact

    as those seen in secondary care at lower cost.

    Setting up an intermediate headache care clinicKey general background policy and implementation papers are:

    Implementing a scheme for general practitioners with a special interest.

    Department of Health/Royal College of General Practitioners April 2002.

    http://www.gencat.cat/ics/professionals/recull/bibliografic/2007_3/Impleme

    nting.pdf

    Assessment of the clinical effectiveness, cost and viability of NHS general

    practitioners with a special interest service. Department of Health,

    www.sdo.nihr.ac.uk/files/adhoc/34-34-briefing-paper.pdf

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    The process of planning, development and implementation of a General

    Practitioner

    with a Special Interest service in Primary Care Organisations in England.

    www.sdo.nihr.ac.uk/files/project/99-final-report.pdf

    NatPaCT provides a number of useful documents on setting up a general

    practitioner with a special interest including a step by step guide and an

    impact assessment framework - www.natpact.nhs.uk/cms/352.php

    Headache specific support can be found in the Action on Neurology project

    that provides useful general background information in the area of neurology.

    http://www.natpact.nhs.uk/uploads/2005_Apr/Action_On_Neurology.pdf

    Detailed descriptions of pilot headache intermediate care services can be

    found in:

    Action On Neurology. GPwSI Headache Clinic Pilot Site. Yorkshire Wolds and

    Scarborough, Whitby and Ryedale Coast Primary Care Trust, 2005.

    Action on neurology. Intermediate services for patients with headache and

    epilepsy Salford NHS Primary Care Trust and North East Yorkshire Healthcare

    NHS Trust, 2005.

    Competency requirements

    Guidelines have been developed by the Royal College of General Practitioners

    in consultation with other key stakeholders, defining the competencies

    required and governance arrangements. (www.doh.gov.uk/pricare/gp-

    specialinterest). Specific guidance has also been developed for headache.

    However, in practice areas of this guidance may prove impractical and it may

    be more appropriate for alternative competency frameworks to be developed

    by local stakeholders that reflect local circumstances.

    The appendix contains an example of accreditation policy for a GpwSI supplied by

    Devon PCT.

    Practical points to consider

    When a contract is being prepared, there are a number of practical points toconsider:

    i) What are the referral criteria to the clinic? Does it include children, acute

    onset headache

    ii) What diagnostic resources are available, in particular access to imaging?

    http://www.doh.gov.uk/pricare/gp-specialinteresthttp://www.doh.gov.uk/pricare/gp-specialinteresthttp://www.doh.gov.uk/pricare/gp-specialinteresthttp://www.doh.gov.uk/pricare/gp-specialinterest
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    iii) GPwSIs will need an identified mentor but what is the relationship with local

    secondary care providers? If the mentor is different from local specialists,

    they will also need to provide advice where needed.

    iv) How long will appointments be? Headache presentations are invariably

    complex and 30 minutes is minimum, 45 minutes ideal.v) What are the minimum audit criteria? For example, follow up rates, imaging

    rate, onward referral for tertiary opinion, diagnosis.

    vi) What are reasonable waiting list targets?

    vii) Is the GPwSI available for email or telephone advice?

    viii) Skill mix is an important issue. A headache nurse is a valuable

    contribution to a service and may provide a effective and cost effective

    addition - see Figure 2.

    ix) Headache is co-morbid with anxiety and depression. Is there a referral

    pathway to pychology services?

    Greater discussion about the patients understanding of the diagnosis &

    suggested management plan

    Time for the client to express concerns, worries and ask questions

    More detailed discussion about proposed medication use acute & prophylactic

    treatment

    The opportunity to carry out a lifestyle assessment using listening and

    negotiating skills to understand the patients lifestyle and agree a process of

    change necessary to achieve improvement in the headache profile

    Partnership working with the client to agree a preparation and action plan for

    the withdrawal of medication (medication overuse headache)

    Patients requiring extra support to have follow up

    Onward referral and communication with other healthcare professionals and

    specialities such as a physical activity co-ordinator and smoking cessation

    therapist.

    Figure 2 some potential advantages of a nurse working in an intermediate care

    headache clinic

    Clinical resources and support

    Guidelines

    SIGN guidelines - www.sign.ac.uk/guidelines

    British Association for the Study of Headache guidelines - www.bash.org.uk

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    Support material

    Headache: a practical manual. Kernick D, Goadsby P (Eds) Oxford University

    Press 2008.

    A manual directed at the general practitioner with a special interest.The University of Lancaster run modular diplomas in headache. These are

    dependent on demand.

    www.exeterheadacheclinic.org.uk - contains patient information and advice

    sheets particularly for medication use which can be downloaded.

    BASH has a GPwSI group. (Contact [email protected])

    Patient organisations

    Migraine Trust - www.migrainetrust.org

    Migraine Action Association - www.migraine.org.uk

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    APPENDIX

    Policy and Procedure for the Accreditation ofGeneral Practitioners with a Special Interest

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    Document Status: DraftVersion: V1

    DOCUMENT CHANGE HISTORY

    Version Date Comments (i.e. viewed, or reviewed, amended,approved by person or committee

    Draft V1 13/09/08 Draft policy for commentDraft V1.2 12/11/08 PEC for commentDraft V1.3 14/01/09 Final draft

    Linkedstrategies,policies andotherdocumentsDissemination

    requirementsDevon PCT has made every effort to ensure this policy does not have theeffect of discriminating, directly or indirectly, against employees,patients, contractors or visitors on grounds of race, colour, age,nationality, ethnic (or national) origin, sex, sexual orientation, maritalstatus, religious belief or disability. This policy will apply equally to fulland part time employees. All Devon PCT policies can be provided in largeprint or Braille formats if requested, and language line interpreterservices are available to individuals of different nationalities whorequire them.

    Authors: October 2008 Jenny Winslade Assistant Director Patient Safety andQuality

    Names and roles of Contributors, user engagement etcDenise White, James Wright, Anne CameronDocumentReference:

    Standards For Better Health Relevant to standard(s):- C7aRelevant to Trust objective:-Directorate: -Provider Development.

    Review Dateof approveddocument:

    January 2010

    EINA Date:

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    Contents

    SectionPag

    e

    1 Introduction 1

    2 Purpose 1

    3 Scope 2

    4 Responsibilities 2

    5 Definitions 2

    6 Recruitment and Selection 3

    7 Assessment Guidance and Training 5

    8 Training 6

    9 Governance 6

    10 Service Accreditation 7

    11 Patient Safety 8

    12 Audit and Monitoring 8

    13 Implementation 9

    14 References and Further Reading 9

    Appendices

    A Accreditation Process 10

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    Jenny Winslade Page 10 12/06/2013

    1. Introduction

    1.1 The Department of Health released guidance in 2007 in relation to theaccreditation for General Practitioners with a Special Interest (GPwSI) andPractitioners with a Special Interest (PwSI). The guidance sought to ensure that allGPwSIs & PwSIs have the required combination of training and experience thatwill enable them to practice safely and to take on new and expanded roles. This

    policy will ensure that governance structures are in place for GPwSIs and PwSIs sothat services provided by GPwSIs and PwSIs deliver high quality care within thecommunity.

    1.2The appointment of GPs and Practitioners with special interests is an important partof the PCTsstrategy to enable faster local access to services that will deliver highquality services and reduce waiting times. Convenient and accessible community-based services enable patients to receive the right care in the most appropriatelocation.

    1.3 Clinicians will also benefit from the opportunity todevelop their specialist knowledge,skills and competencies, which will enable them to undertake a greater variety of

    work. GPwSIs and PwSIs ultimately supplement their core generalist role bydeliveringadditional high quality services that are designed to meet the needs ofpatients within the community.

    2. Purpose

    2.1 The purpose of this policy is to set out the framework by which the PCT will ensurethat there are robust processes for the recruitment ofclinicians as GPwSIs orPwSIs and through the development of services that a high quality, safe andefficient service isprovided to patients. The policy will also set out the process ofreaccreditation, which should be defined in the terms of the contract and shouldbe an explicit period, at the end of which the clinician (and the service in whichthey work) should be re-accredited.

    2.2The process of accreditation should assure patients and commissioners that clinicalservices are operating within a clear and quality assured clinical pathway wherethe highest possible standards of Patient Safety are maintained.

    2.3This document sets out a framework for addressing the quality standards required inthe design of new services to be led by a GPwSI or a PwSI and may also be usedas a checklist for clinicians and managers workingto develop these services. Theprinciples addressed within this policy are transferable to policyformulation for allpractitioners with a specialist interest.

    2.4This policy represents best practice when redesigning services and is relevant to anyservice development that requires groups of practitioners to undertake specificwork on behalf of the PCT or practices e.g. employed medical practitioners orconsultants. These clinicians may form part of practice based commissioning bidsor local enhanced services that involvecontracting with clinicians

    3. Scope

    3.1 The scope of the policy will cover the identification of suitably qualified GeneralPractitioner/ Practitioners who operate outside of the scope of normal practice andincludes:

    The appointment process for suitable candidates

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    Maintaining clinical standards (CPD, accreditation, revalidation andsupervision processes)

    Clinical/ Service audit to ensure the service need is being met and desiredoutcomes are achieved

    The care pathway for the GPwSI & PwSI service must define the specifics of the

    practitioners activity, including who they will treat and how

    3.2 The policy will apply without exception to all new GPwSI services and in additionmust be regarded as best practice for current GPwSI and employed specialistservices. Where a medical contractor or GPwSI has been providing specialistcommunity services for an extended period a judgement should be maderegarding the competence and experience of the practitioner and theaccreditation process described within the policy. Where a service is clearlyproviding high quality care in the community that service should not beinterrupted in the implementation of the policy.

    4. Responsibilities

    4.1 Duties within the Organisation

    Directors are responsible for the implementation of this policy within their owndirectorates. Clinicians and managers who are developing services will need toensure that the policy for accreditation of GPwSI is adhered to as part of thecommissioning process.The contracting process should ensure that reaccreditation is defined within theterms of the contract and is an explicit and reasonable period.

    4.2 Consultation and Communication with StakeholdersThe policy will be agreed and consulted upon with key stakeholders who willinclude the Local Medical Committee and the Joint Staff Partnership Forum.

    5. Definitions

    The definition of a General Practitioner or Practitioner with a Special Interest is defined bythe department of health as:

    A GP or a Pharmacist with a Special Interest who supplement their core generalist roleby delivering an additional high quality service to meet the needs of patients. Workingprincipally in the community, they deliver a clinical service beyond the scope of theircore professional role or may undertake advanced interventions not normally undertakenby their peers. They will have demonstrated appropriate skills and competencies todeliver those services without direct supervision.

    (Department of Health, 2007)

    6. Recruitment and Selection

    6.1 Recruitment & Selection

    Recruitment and selection will meet the Department of Health Safer RecruitmentGuidelines (2005) which will include Criminal Records Bureau Disclosure, WorkPermits and Occupational Health Screening. It is expected that contractors willmeet the same immunization standards required of NHS employees. Theknowledge, skills and formal qualifications required for the service will be defined.For GPwSI this may include one or more of the following:

    Formal Medical qualifications and full registration with the GMC with anyadditional qualifications being evidenced.

    Clinical assistant post for at least 6 months duration, in the chosen speciality,within the last 12 months. This should include at least one session per weekwithin the speciality under the supervision of an appropriate practitioner forexample a Consultant or a suitably experienced GPwSI .

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    A reference, which details suitability for the post from a Consultant in thenamed specialty or a suitably experienced GPwSI. The reference must be froman individual who has supervised the GPwSI within the last 12 months and canvouch for their competence. It should also detail the type of supervisionprovided

    The competencies and formal qualifications required for each post will be definedthrough the clinical pathway. Applications to become a GP Specialist Practitionerwill include evidence of the following:

    Description of the service the applicant will provide a detailed descriptionof the service and their role within that service.

    Education, training and development submission of evidence to includemandatory training i.e. resuscitation, courses attended and personaldevelopment plans aligned to the role.

    Clinical governance and quality activities to be undertaken with aminimum of one project to be submitted annually to ensure patient safetyand a focus on clinical and cost-effectiveness.

    Demonstration of clinical support, a clinical support proforma should becompleted by supporting clinician

    6.2 Membership

    Membership of the Royal College of GPs or Physicians is encouraged.

    6.3 Pre-accreditationThe PCT where appropriate in order to develop specific expertise and serviceswithin community settings may approve a provisional accreditation period. Thiswill have a defined scope that will regulate the scope of practice for the clinicianand will include training and development and supervision of practice. Theaccreditation panel will decide on the appropriateness of a pre-accreditation

    phase on a case by case basis.

    6.4 Interview Process

    If the clinician is deemed to have successfully met the minimum criteria aninterview panel will be convened which will formally assess the knowledge, skillsand competencies of the clinician within the field of practice, evidence ofcontinuous professional development and their organisational and managerialcompetence.

    The Panel will include: a director of the PCT or appropriate deputy

    PCT Medical Advisor

    a senior commissioner;

    a senior professional representative from the PEC or Local PharmacyCommittee;

    a representative of the LMC

    PCT Lead Pharmacist or a GP from the local faculty of the RCGP

    a lay person or Non-Executive Director

    a senior clinician, ideally the local lead clinician from within therelevant speciality.

    The clinician must demonstrate through the interview process

    appropriate and necessary levels of skill and competence to fulfil therole described

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    a clear understanding of the role that they are being asked to fulfil

    in depth knowledge of the appropriate local clinical pathway

    commitment to ongoing training, clinical updates and educationthrough appraisal and use of Personal Development Plans;

    Have in place appropriate peer review and mentoring arrangementsfrom an appropriate clinician within the field of practice with referencesor reports from clinical assessors

    6.5 Service Visit

    An inspection or assessment visit may be required where the service is dependentupon premises and equipment, such as the Primary Care Surgical Scheme (PCSS).Visits may be undertaken as part of the contractual review process and shouldinclude Infection Control.

    6.6 Contracts

    All contracts for GPwSI and PwSI will include sufficient detail to ensure that PatientSafety is maintained and that services improve quality through ensuring thatappropriately qualified practitioners are delivering the service. The Patient Safetyand Quality Lead, the PEC Chair and members of the PEC will be able to provideadvice on the frequency of supervision sessions, appropriate supervisors andappropriate Continuing Professional Development.

    The contract will also need to demonstrate evidence of current professionalindemnity insurance that, takes full account of the GPwSI or PwSI role.

    The PCT will further ensure through the contract that there is a review of the costeffectiveness of the services to demonstrate appropriate use of resources.Remuneration will be agreed as part of the contracting process.

    The contract will also specify named consultant or GPwSI back up for the clinicianthat should be available at all times.

    7. Assessment Guidance and Training

    7.1 Competency Based Assessment

    The content of the assessment will be based on areas of Good Medical Practiceand will be based on the following principles

    The overall assessment system must be fit for a range of purposes;

    The individual components used will be selected in light of the purpose andcontent of that component of the assessment framework.

    7.2 Method of Assessment

    The methods that will be used will comprise of:

    GPwSI/ PwSI prepared self assessment

    systematic observation of clinical practice by an appropriate clinician andstructured evaluation, which may include other appropriate multimediae.g. video.

    Introducing a system of competency assessment within the workplace has the

    following advantages:

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    The assessment of working practices is based on what is actually done inthe workplace, and predominantly carried out in the workplace itself

    Better reflection of routine performance

    Allows assessment of several aspects of the clinicians knowledge; skill andperformance

    The panel assessment will also include objective assessment via audit orother methods in outcomes of care, process of care and volume

    7.3Self Assessment

    Accreditors must ensure the GPwSI/ PwSI has prepared a self-assessment thatincludes:

    statistical summary of service provided

    clinical audit data and resultant actions of follow up

    audit of patients experience

    critical re-appraisal of how service could be further improved considering across-section of structure, process, outcome and patient experience

    a strategy for further improving the quality of the service participate in at least one service quality and governance project

    provision of a minimum of three such projects over a three-year period

    additional training or development requirements

    7.4Assessment and Evaluation

    Evaluation within the assessment framework will include judgements in relationto:

    Consultation with simulated and actual patients

    Case record review, including out patient letters and letters to referringpractitioners

    Case based discussions

    Oral presentations

    360 degree assessment

    Patient surveys

    Audit projects

    Significant event audit

    In addition where a pre-accreditation phase has been agreed clear training, professionaldevelopment and supervision records should be produced and assessed.

    7.5Reaccreditation

    Reaccreditation should take place every three years as a minimum and a formalprocess will be followed that must be related to the service to be delivered. Theapplicant must provide a detailed description of their role within the proposedservice

    The GPwSI/ PwSI application should be submitted at least one month before re-accreditation is required.

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    8. Training

    8.1 Training will include requirements for Continuing Professional Development andregular professional updates. The clinician is responsible for ensuring this takesplace, the PCT may provide assistance in access to training which would be

    negotiated as part of the contracting process. Training programmes must beapproved and accredited by an appropriate body. The GPwSI/ PwSI must provideevidence that this has been done prior to appointment and that it will continueafter appointment.

    8.2 The GP/practitioner must undergo annual appraisal with a trained appraiser inthat specialty. The contract must detail the named clinician support for thespecialist practitioner.

    9. Governance

    9.1 Context

    The function of accreditation is to ensure fitness for purpose throughaccreditation of both the services themselves and the individual practitionersworking within them.

    9.2 Accountability

    In order to avoid conflicts of interest there will be clear accountability to the PCTBoard through the PEC and the Patient Safety and Quality Scrutiny Committeefrom the accreditation panel. Accountability will also be demonstrated throughDirector level membership of the accreditation panel.

    9.3 Monitoring

    The PCT will set up and manage a locally held list of accredited GPwSIs and PwSIsto include length and dates of accreditation, details of speciality and ensure it ismade available for public inspection. In addition the PCT will record theverification of registration, Continuing Professional Development and annualappraisal

    9.4Discontinuation

    If the GPwSIs/ PwSIs work is discontinued, or the individual is unable to use theirspecialist skills for a period longer than twelve months, they must be re-accredited before they can work again as a GPwSI/ PwSI. This may includeabsence for ill health or extended maternity leave.

    10. Service Accreditation

    10.1 Governance

    The services within which GPwSIs and PwSIs work are also required to beaccredited. GPwSI/ PwSI services will only be safe and effective when deliveredwithin a high quality and safe environment.

    10.2 Regulation

    The Healthcare Commission (or its successor, Care Quality Commission) definethe standards required of all providers of NHS services within Standards for BetterHealth. All contractors will be expected to be compliant with Standards for BetterHealth.

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    10.3 Specific Guidance

    The PCT will also utilise specialty specific guidance to identify any requirementsrelating to specific services.

    10.4 Premises

    All premises must be accredited prior to the commencement of the service.Contracts cannot be issued until this process is complete and compliance isdemonstrated. Within six months of starting, a subset of the accreditors groupmay wish to visit the service.

    For details of the pathway for individual and service accreditation, see AppendixA.

    11. Patient Safety

    11.1 Incident Reporting

    The GPwSI and PwSI will be required to identify report and learn from all patientsafety incidents through significant event audit and must meet the requirementsset out by the Healthcare Commission in accordance with Standards for BetterHealth. All incidents must be reported to the PCT as set out within the contractand it is expected that the clinician will work in accordance with Devon PCTs

    Incident and Serious Untoward Incident (SUI) Reporting Policy.

    11.2 Record Keeping

    Accurate, contemporaneous and comprehensive records are essential in thedelivery of high quality patient care. Information about the clinical care of patientsshould be recorded in their clinical records including presenting symptoms,diagnosis and records of treatment documenting each episode of care.

    Records are also utilised for teaching, research and clinical audit as well asproviding evidence in the event of litigation. GPwSI and PwSIs are required towork with the commissioners in line with the PCT's Record Management Policy

    11.3 Complaints

    The GPwSI/ PwSI should ensure that a full and positive response is provided to allcomplainants, whether their complaint was made verbally or in writing, in linewith the PCT complaints policy.

    Complaints are valuable feedback as part of the service improvement programmeand must be reported to Devon PCT. Lessons learnt will be shared across theTrust in order to rectify mistakes, omissions or misunderstandings and to learnfrom those experiences to improve the quality of services in the future.

    12. Audit and Monitoring

    12.1 Clinical Audit

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    Evaluation of the programme where the GPwSI/ PwSI is operating is essential tothe improvement of quality and will be built into the commissioning process. Inaddition to this, the clinician must produce at least one audit per year that relatesto their activity within the service e.g. record-keeping audit or evidenced-basedpractice. This will include dissemination of the results to others to ensure learningfrom outcomes.

    12.2 Monitoring

    The clinician should agree the areas for quality monitoring and audit with the PCT.

    Audit/monitoring arrangements may include amongst others: Outcomes of Treatment

    Follow-up rates/complication rates/complaints

    Onward referral rates to Consultants and other professionals

    Investigations

    Access times

    Patient satisfaction

    Cost effectiveness Premises and Equipment

    Referral rates

    DNA rates

    13. Implementation

    13.1 Re-accreditation process to begin as soon as possible for all GPwSIs/ PwSIs inaccordance withthe national guidance.

    13.2 All new GPwSIs/ PwSIs are required to be accredited in accordance with thenational guidance.

    14. References and Further Reading

    Implementing a Scheme for General Practitioners with Special Interests (DH and RCGP,April 2002)www.dh.gov.uk/pricare/gp-specialists/gpwsiframework.pdf

    Implementing a scheme for Nurses with Special Interests in Primary Care (DH April 2003)http://www.dh.gov.uk/assetRoot/04/06/60/13/04066013.pdf

    Implementing a scheme for Allied health professionals with Special Interests (DH April2007)http://www.dh.gov.uk/assetRoot/04/06/60/14/04066014.pdf

    Implementing Care Closer to Home: Convenient Quality Care for Patients: accreditation ofGPs and Pharmacists with Specialist Interests (DH: April 2007) www.dh.gov.uk

    Policy and Procedure for the Recruitment and Accreditation of GPs and Practitioners withSpecial Interests. Lincolnshire PCT

    Safer Recruitment guidelines for NHS Employers (2005)http://www.dh.gov.uk/en/Managingyourorganisation/Humanresourcesandtraining/Modernisingprofessionalregulation/Preandpostemploymentchecks/index.htm

    Related PCT Policies, Procedures and Documents

    Patient Safety and Quality Strategic Framework (2008), Devon PCT Incident Reporting Policy Corp 10, Devon PCT

    http://www.dh.gov.uk/pricare/gp-specialists/gpwsiframework.pdfhttp://www.dh.gov.uk/pricare/gp-specialists/gpwsiframework.pdfhttp://www.dh.gov.uk/assetRoot/04/06/60/13/04066013.pdfhttp://www.dh.gov.uk/assetRoot/04/06/60/14/04066014.pdfhttp://www.dh.gov.uk/en/Managingyourorganisation/Humanresourcesandtraining/Modernisingprofessionalregulation/Preandpostemploymentchecks/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Humanresourcesandtraining/Modernisingprofessionalregulation/Preandpostemploymentchecks/index.htmhttp://www.dh.gov.uk/pricare/gp-specialists/gpwsiframework.pdfhttp://www.dh.gov.uk/assetRoot/04/06/60/13/04066013.pdfhttp://www.dh.gov.uk/assetRoot/04/06/60/14/04066014.pdfhttp://www.dh.gov.uk/en/Managingyourorganisation/Humanresourcesandtraining/Modernisingprofessionalregulation/Preandpostemploymentchecks/index.htmhttp://www.dh.gov.uk/en/Managingyourorganisation/Humanresourcesandtraining/Modernisingprofessionalregulation/Preandpostemploymentchecks/index.htm
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    Jenny Winslade Page 18 12/06/2013

    Records Management , Devon PCT, CG008

    PCT Complaints Policy, Devon PCT

    Equality Strategy 2007-2010, Devon PCT

    Independent Practitioner Performance, HR 26 Devon PCT

    GP Appraisal, HR 27 Devon PCT

    Devon PCT Records Management Policy 2007

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    Appendix A Accreditation Process

    Source Implementing Care Closer to Home: Convenient Quality Care for Patients:accreditation ofGPs and Pharmacists with Specialist Interests (DH: April 2007) www.dh.gov.uk

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    References

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    1 Terwindt GM, Ferrari MD, Tijhus M, Groenen S. The impact of migraine on quality oflife in the general population - The GEM Study. Neurology2000;55:624-629.

    2 SteinerT, ScherA, Stewart F, Kolodner K, Liberman J, Lipton R.The prevalence and disability burden of adult migraine in England and their relationships toage, gender and ethnicity. Cephalalgia 2003;23(7):519-27.

    3 Solomon G, Skobierand F, Gragg L. Quality of life and well being of headachepatients: measurement by the medical outcome study. JAMA 1989;262:907-13.

    4 Terwindt G, Ferrari M, Tijhus M, Groenen S, Picavet H, Launer L.The impact of migraine on quality of life in the general population - The GEM Study.Neurology2000;55:624-629.

    5 Dowson A, Jagger S. The UK migraine patient survey: quality of life and treatment.Curr Med Res Opin 1999;15(4):241-253.

    6 Lipton R, Bigal M, Kolodner K, Stewart W, Liberman J, Steiner T. The Family Impactof Migraine: Population-based Studies in the US and UK. Cephalalgia 2003;23(6):429-440.

    7

    Forward SP, McGrath PJ, McKinnon D, Brown T, et Al. Medication patterns ofrecurrent headache sufferers: a community study. Cephalalgia 1998;18:146-51.

    8 Sender J, Bradford S, Watson D, Lipscombe S, Reece T, et al. Setting up a specialistheadache clinic in primary care: general practitioners with a special interest in headache.Headache Care 2004;1(3):165-171.

    9 Dowson A. Lipscombe S, Sender J, et al. New guidelines for the management ofmigraine in primary care. Curr Med Res Opin 2002;18:414-39.

    10 Recommendations for the organisation of headache services. British Association forthe Study of Headache: London, 2001.

    11

    Implementing a scheme for General Practitioners with a special interest. Dept ofHealth and Royal College of General Practitioners: London, 2002.(www.doh.gov.uk/pricare/gp-specialinterest)

    12 Shaping tomorrow. British Medical Association. London, 2002.

    13 Kernick D. Developing intermediate care provided by general practitioners with aspecial interest: the economic perspective. British Journal of General Practice 2003;53:553-556.

    14 OCathain A, Musson G, Munro J. Shifting services from secondary to primary care:stakeholders views of the barriers.Journal of Health Service Research and Policy1999;4:154-160.

    15 Kernick D, Mannion R. Developing an evidence base for intermediate care deliveredby GPs with a special interest. British Journal of General Practice 2005;55(521):908-909.

    16 Ridsdale L, Doherty J, McCrone P. A new GP with a special interest headache service.British Journal of General Practice 2008;58:478:2483.

    http://www.doh.gov.uk/pricare/gp-specialinteresthttp://www.doh.gov.uk/pricare/gp-specialinterest