bash intermediate care guidance

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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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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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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.

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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)

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