SOUTH EAST REGION VOCATIONAL
TRAINING FOR GENERAL PRACTICE OXFORD
DEANERY
VISITING ASSESSORS REPORT
Part 1
1. Trainer Dr. P. von Eichstorff
Address East Oxford Health Centre,
Manzil Way, Oxford, OX4 1XD
Date of Visit 6th December 2002
2. Assessors Mrs. Elizabeth Judge
Dr. Martin Wakeford
Dr. Pawan Rander
Dr. Peter Havelock
3. Summary and Recommendation
a) For the Practice: this practice
has been through many changes over
the last year, doctors, managers,
staff and computer and they have
managed all these transitions with
great aplomb and effectiveness. This
is exemplified in the development in
the use of their computer. It was
only a year ago that they changed to
an EMIS system while using Lloyd
George notes as their practice
records system. Now in less than a
year they have an up and running
electronic appointment system, they
are virtually paperless in their
clinical records and there is great
consistency in the use of the
computer by all the clinical staff.
Not only is their clinical use of
the computer very impressive but
their non-clinical use of the
computer by electronic e-mail within
and without the practice is
exemplary. They have a good tool
that they are using well.
The overall impression is that the
practice is a very happy place.
People like working there and many
of the staff have worked there for a
very long time. The two newer people
to the practice, Ahsan, the
Registrar, and Tabitha the Retainee,
speak very well of the practice, as
do all the attached staff who enjoy
their contact with the East Oxford
Health Centre. They recently had a
practice away day with many
objectives and great involvement of
all the staff in the discussions and
plans.
The practice is obviously
patient-centred with good
availability of appointments and a
high quality of access to all
clinicians. They have used their
diversity of patients to a strength
in the use of health advocates and
focussing services on clinical and
cultural needs. This leadership
comes from the doctors and nurses in
the practice.
Clinically we had the impression
that there was a high quality of
clinical care, both in audits done
and acted upon, comparative data
with other practices from the Oxford
MAAG is favourable and of a high
quality with regular clinical
guidance meetings and audit meetings
with written minutes and plans with
individual doctors and nurses taking
responsibility for this development.
Each of the doctors has a working
Personal Development Plan. Although
Maggie Perrin, the Practice Manager,
has only been in the practice 18
months, she is a real strength,
continuing to develop systems within
the practice and having an influence
in the PCT externally.
Oxford Deanery Practice Criteria:
This practice meets all the Oxford
Deanery criteria.
Our recommendations for further
development:
1) The practice already has an
active plan for the computerisation
of paper
summaries of past clinical data.
There is a very robust system for
updating new
summaries and getting clinical data
onto the computer. We would support
the
activities developed by the practice
to get past data on and encourage
them in
their commitment to keep to an
August date line for this. The value
of having this
information on the computer will
reap benefits in further quality
work.
2) Though there were good protocols
for a number of clinical disease
areas many of
them were not updated and in some
cases clinically out of date. We
would
encourage the initiative that the
practice is in the throes of
protocol development
and we would encourage them to a)
involve all clinicians, b) get as
much of this
as electronic as possible, c) add
quality markers into the protocol
development
that would link to further audits
and so quality assurance in a number
of areas is
feasible, d) develop working
templates and encourage the practice
to use these,
e) have lead clinicians responsible
for driving this through. There is
also
movement in the practice to develop
non-clinical protocols that we would
encourage.
3) We were impressed by the
development of the practice nurses
but they are under
a lot of work pressure and would
encourage the practice to continue
to try and
influence the PCT to have more
practice nurse time, this might help
them include
nurse triage within their services.
There is also a need within the
practice for a
clinical audit/information
manager/clerk that would help in the
quality assurance
drive.
4) The whole refurbishment of the
East Oxford Health Centre site is a
great
opportunity for the practice and a
new building would be beneficial for
all sorts of
reasons. The practice is well aware
that these changes also might be a
threat to
some of their strengths, i.e. their
cohesiveness, their patient focus
and their drive
to high quality.
In Conclusion:
The East Oxford Health Centre
practice is providing excellent care
in a friendly happy
atmosphere.
b) For the Trainer
Peter von Eichstorff is a well
informed and well prepared trainer.
He is well read with
many sources of information, both
clinical and teaching at his finger
tips. He is
prepared for training, aware of the
issues and has the tools available
to him. His
fluency at the computer and in the
digital use of video recordings will
help
considerably in this matter. We saw
from his teaching, video and
discussion of his
own consultations that he has
insight into his strengths, and
indeed his weaknesses
and knows what recommendations he
would make to himself to improve.
He is well supported by his practice
and particularly by Tom
Nicholson-Lailey the
current trainer and we feel they
would be a very strong teaching team
with active
support of the rest of the practice.
He is involved with the Vocational
Trainers
Scheme in Oxford and planning to
become more involved by teaching the
Registrars
on their day release course.
He meets all the Oxford Deanery
criteria for teaching. Our
recommendations are
few.
1) The community nurses, though very
pressed for time, would like to be
involved more with teaching and we
suggest joint teaching/learning
sessions
with the Health Visitors and
District Nurses together with the
other Registrar
in the East Oxford Health centre
that might save time and be
beneficial to all
parties.
2) Though there are a lot of books
and electronic resources around the
practice,
and these though listed on a library
list, are not as easily searchable
or
accessible as possible. These could
be better categorised and made more
readily available to the Registrar.
We found Peter von Eichstorff an
effective, enthusiastic teacher and
we think
Registrars within the East Oxford
Health Centre will get a very good
deal, both from
himself and the practice.
There is a request from the practice
to get Tom Nicholson-Lailey and
Peter von Eichstorff
synchronized so they have the same
re-accreditation visit in the
future. We feel that Peter
von Eichstorff could be reassessed
in a little longer time if this made
it easier.
We discussed with the practice the
possibility of two or more learners
in the practice. At
present the practice is a little
limited for space, although they
could easily accommodate an
enhanced Registrar or a part time
Registrar together with a full time
Registrar but would be
unable to take two full time
Registrars until the new buildings,
when the accommodation is
completely sorted. We think it is
likely that they would be able to
take two full time learners in
the practice.
Part II
4. Sources of Information
a) Documents OXVT3 Application form,
OXVT5 Previous Assessors Report x 2,
OXVT7 Registrar report, OXVT10
Course Organisers report.
b) Partners met
Dr Tarrant Stein,
Dr Georgina Robson,
Dr Tom Nicholson-Lailey,
Dr Peter von Eichstorff,
Dr Kathryn Ward
c) Registrar met
Dr. Ahsanulla Alvi.
Retainer met
Dr. Tabitha Winnifrith
d) Principal staff met
Maggie Perrin Practice Manager,
Jeanette Rose Senior Nurse,
Maureen Cox Practice Nurse,
Marie Malloy Receptionist/Clerk,
Lorraine Ayres Receptionist/Clerk,
Rita Foster Receptionist/Clerk,
Trish Goddard Receptionist/Clerk,
Heather Patterson Receptionist/Clerk,
Christine Williams
Receptionist/Clerk,
Alison Stubbs Receptionist/Clerk,
Rosalie Simpson Receptionist/Clerk,
Heather Paterson Phlebotomist,
Paman Steer Counsellor,
Patricia Glynn District Nurse,
Nina Billen District Nurse,
Di Rose District Nurse,
Gilly O'Mara Health Visitor,
Jayne Marshall Health Visitor,
Tina Brandon Nursery Nurse
e) Videos seen
Consultation x 2. Tutorial x 1.
Part III
5. The Trainer
a) Professional values
b) Clinical competency
From the records, discussions,
videos and general atmosphere within
the practice we felt
that Dr. Peter von Eichstorff had
the highest professional values and
clinical
competence.
c) Preparation for training
Peter has recently completed the New
Trainers Course and got a great deal
out of this.
He had done the majority of the work
for the certificate but due to
family and practice
commitments was unable to complete
it. We found him very knowledgeable
and well
prepared for his teaching.
d) Contribution to local scheme and
relationship to Course Organiser and
Registrar
Group.
He is a regular attender at the
Oxford Trainers Group and is looking
forward to getting
involved in the day release course.
e) Relationship to Registrar
Though the current Registrar is the
responsibility, of Tom
Nicholson-Lailey, Peter has
been involved with him throughout
his year and enjoys the close
contact that he has had
with him.
6. The Training
a) Overall aims (and relationship to
Priority Objectives)
Peter has clear overall aims based
on a number of different texts which
he was able to
show us and discuss with us.
b) Negotiation of aims, objectives
and methods
c) Formative Assessment
He is clear about assessment methods
and is thus able to negotiate clear
objectives. He
is very aware of the different
teaching methods and is looking
forward to using these with
his intended registrar in February.
d) Curriculum planning (initial and
continuing)
He has plans about a curriculum that
is based on his overall aims and
that of the needs
of the Registrar.
e) Log (nature and quality)
The current Registrar has a
computerised log shared on the
practice intranet with his
Trainer. This is something that
Peter will adopt when he takes over
the responsibility of
the trainings. He has his own ideas
about additions and improvements to
this. It is also
added to by other members of the
practice.
f) Methods, use of resources
In the present training situation
the Registrar has regular teaching
from other members
of the practice. This is something
that we would welcome and suggested
that the
attached staff be involved in this
if possible.
Peter is aware of the access to
electronic information and intends
to use this intensively
with his Registrar. A move we would
welcome.
Maggie Perrin joined the Practice 18
months ago after a career in the
educational sector.
Her role in the training and
development of Registrars - planning
and overseeing the
induction into the Practice and
facilitating the Primary Health Care
team's continuing
contact throughout the year in
support of the Trainer - is an
important, and developing,
one.
Maggie has provided training during
the year in Practice Finance (the
red book, TVPCA
and Links) as well as Human
Resources, and recognises that there
is scope for more
formal tutorials from herself and
others, particularly in the current
climate of change and
development in the NHS.
Community Nurses are involved in the
Registrar's induction and thereafter
the
Registrar has access to the
nurse-led baby clinics. However,
workload and staffing
issues currently prevent them from
being fully involved in the tutorial
programme and
they would hope for a more formal
involvement, with perhaps the
possibility of providing
combined teaching for both Health
Centre Practices.
g) Communication with team, practice
and release course
There is very good communication
within the team and a happy friendly
place, as
reported by all members of the
primary health care team.
h) Tutorials (time, technique and
value)
Tutorials are protected time and
have been found extremely valuable
by the current
Registrar and he has felt very
supported for his summative
assessment and is going to
continue his project work into
enhanced training.
i) Arrangements for Summative
Assessment
Part IV
7. The Practice in Training
a) Contribution of Partners,
administration and nursing staff
This practice has been a Training
Practice for many years and has a
very positive
attitude towards training and all
the partners and staff are involved.
Non-clinical staff participate in
the Registrar's induction,
discussing their roles with
him/her on an individual basis and
looking at IT issues. Thereafter
there is a continuing
range of informal contact and
mentoring.
b) Appointment of Registrar
Deanery centred.
c) Workload of Registrar (and
practice if appropriate)
The Registrar reported that the
workload was very balanced with a
lot of time at the
beginning for learning and
development becoming busier as the
year goes on. He feels
very able to cope with a normal
practice workload but in no way
feels that he is being
overworked.
d) Arrangements for night and
weekend work
At the start of the year the
Registrar is on-call for the
partners practice for occasional
nights, developing after 5 or 6
months to become a member of the
Co-operative with a
member of the practice always
covering.
e) Supervision of clinical practice
All partners help to supervise
clinical practice and he felt very
supported.
f) Library (quality and use)
There are a number of books within
the practice, in different rooms
with reasonably
comprehensive library in the
Registrars room. We suggest that
clearer cataloguing of
these would be helpful, together
with a greater sharing of medical
websites that the
Registrar might find useful.
g) Working environment - clinical,
training (room for Registrar)
Though at first sight the working
environment of East Oxford Health
Centre seems
rambling, dated and crowded it is an
environment that provides all that
is necessary
but the practice are looking forward
to future plans for the
redevelopment of the site and
being able to have better premises.
The Registrar has his own room.
8. The Practice as a deliverer of
Health Care
a) Acute care (and emergencies)
b) Chronic care
c) Preventative medicine
From the records systems, protocols,
use of templates and audits we felt
that the clinical
care in the practice was of a high
level. We checked the care of
diabetics within the
practice and although the IDD
patients are looked after by the
hospital the non-IDD
patients were all up to date with a
high quality of care reported in the
records.
Receptionists actively manage the
appointment system and
responsibility for its smooth
operation has recently been devolved
to Marie Malloy in her new role as
Patient Services
Manager. A proportion of
appointments are pre-booked for
acute need and released on
the same day. Additional morning
'extras' are logged on a 'Doctors
Extra' clinic
providing a 'sit and wait' clinic of
5-minute appointments which are
shared between the
GPs. Additional evening 'extras' are
seen opportunistically. The
Registrar participates
in this system.
Visits are recorded on the visits
screen and are normally assigned to
the 'usual
doctor'.
A nurse-led telephone triage clinic
has been a success, but to develop
the full potential
of this service nursing resources
will need to increase.
9. Data Handling
a) Records, type and quality,
including visitors check audit
b) Computer and use
The practice has changed over the
last 12 months from Lloyd George
MREs to fully
computerised, with computerised
appointments system and all clinical
entries being
recorded on computer and the notes
kept in the filing cabinet for the
majority of
consultations. Our audit confirms
that the practice has each clinical
entry on the
computer that the summarisation in
the practice has a system for
including these which
is robust, they have about 30 of
back data on the computer but when
we checked the
paper records they had accurate
summaries on the paper. They have
staff employed
and their plan is to have all the
paper records transferred to
computer by August 2003.
From the evidence of changes over
the last year we are certain that
this will happen.
c) Audit activity
The practice has done a number of
audits with the support of Oxford
MAAG using
MiQuest. Their figures make very
good comparison with other practices
in central
Oxford. They are looking forward to
having complete back data on the
computer to
enable them to create their own
figures in chronic disease areas
related to the protocols
that are in development. See
recommendations.
The Practice Manager feels that an
additional staffing resource - audit
clerk-is needed
if the Practice is to maintain
up-to-date audit and statistical
information.
Part V
10. Management function
a) Decision making (planning,
implementation, evaluation)
Maggie is developing her role and
has helped steer the Practice
through a period of
immense change with a new Partner
and Practice Nurse, and building
developments
providing extra office and waiting
room space as well as an additional
consulting
room. The patient database has been
transferred from their original
system to EMIS
(and not without problems of data
loss/corruption), the Practice has
become virtually
paper less and e-mail is being fully
exploited. The next year will bring
further
challenges as the team begins to
implement the development plan
resulting from the
Practice 'Away-Day' in September,
and assimilates the wider changes
within the
NHS that will provide the catalyst
for further development.
The Practice is a very cohesive and
patient-centred group committed to a
high level
of patient care. Partners, Registrar
and Practice Manager meet regularly
to plan
and monitor development and everyone
is invited to participate in regular
meetings
that encourage individual
involvement in strategic as well as
day-to-day management
issues: weekly PHCT meetings, weekly
Receptionist/Admin meetings to which
Nurses are invited every third week
and which GPs may also attend,
depending on
the topic under review.
The team is involved in clinical
governance issues and significant
event analysis,
building on an established tradition
of informal and supportive
brainstorming of
problems. The Registrar is involved
in the planning, decision-making and
communication process from the
outset.
b) Organisation and systems
The Practice team is headed by
Maggie Perrin and is a well managed
and
professional organisation. Maggie is
well supported by the Partners, who
each lead
in specific areas; she is very
appreciative, too, of the support
given by staff when first
joining the Practice and the way
they have responded to change. The
entire team is
committed to ensuring that the
Practice runs smoothly and
efficiently to provide a
good service to patients, and
maintain a tidy, welcoming and
relaxed environment.
The Practice has become fully
computerised during the past year,
and all
consultations, prescribing and
appointments are computerised, as
are registration
and 10S links to the HA. Links to
the path labs will be activated when
the new
encryption service becomes available
to the Practice; there is also NHS
net/e-mail
access.
An ongoing development is the
summarising of patient records -
following the data
transfer to the new system plans are
in place, supported by a one-year
grant, to
check/replace corrupted data to
enable a clear and accurate patient
record. All
targets are met, although sometimes
only the lower target in the case of
children's
immunisations and ways of ensuring a
higher take-up are being examined.
Robust
systems are in place, supported by
protocols and manuals, but Maggie
expects to
review these during the coming year.
The Practice has recently been
assessed for Quality Team
Development and is waiting for the final report. The
team found it a very positive and
worthwhile
experience in that it highlighted
the Practice's strengths and
priority areas for
development (which the PHCT is now
keen to take forward) and provided
an
excellent preparation for this
training assessment
c) Staffing structure and legal
aspects
Staff turnover is low and a
proportion of staff have enjoyed
working in the Practice for
many years. Staff have contracts of
employment and job description and
the
appraisal process for staff, access
to external courses, in-house
training, and 'away-days' are seen as an essential
component of personal development
and the
attainment of a satisfying working
environment. Individuals demonstrate
support
and respect for each other and
positive attitudes to change and
development.
d) Working environment -
administration
Additional space, provided by recent
building works, an imaginative use
of existing
space and a comfortable reception
area provide an attractive and
welcoming
environment for staff, patients and
visitors alike.
e) Future
Ultimately the PCT are planning to
redevelop the whole site through the
Local
Improvement Finance Trust (LIFT)
initiative, designed to attract
capital investment.
This is some way ahead but will
bring new challenges for this team.
11. Other features.
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