Aiming for Excellence RNZCGP Standard for NZ General Practice 2011 Dr Chris Fawcett Maureen Gillon Waveney Grennell

1. Aiming for ExcellenceRNZCGP Standard for NZ General Practice 2011 Dr Chris FawcettMaureen Gillon Waveney Grennell

2. Aiming for Excellence– what is it & who uses it? • RNZCGP Standard for NZ General Practice • Reinforces the unique character & contribution of general practice • Makes the values of general practice explicit • Provides a guide to building a platform to manage increasing diversity and complexity to facilitate a patients journey • Is the standard used by 800 practices in the CORNERSTONE programme • Increasingly used by other sector organisations as a benchmark

3. Review of Aiming for Excellence RNZCGP Governance • RNZCGP Council • RNZCGP Board • RNZCGP Professional Practice Expert Advisory Group • Aiming for Excellence Expert Advisory Group Sector interest • General practices • RNZCGP Programmes; CORNERSTONE, Education, MOPS • CORNERSTONE Assessors • NZ College of Practice Nurses NZNO • PMAANZ – practice managers • Wellington School of Medicine – clinical effectiveness work • General Practice Networks • Consumer/communities • Health & Disability Commissioner • PHOs • DHBs • NGO/Community sector, Te Wana • MOH • Health Quality & Safety Commission • Health IT Board • ACC

4. The Development Team:Aiming for Excellence Expert Advisory Group • Dr Chris Fawcett (Chair, CORNERSTONE Chief Censor) • Dr Jane Burrell (Chair, Professional Practice Expert Advisory Group) • Dr Tane Taylor (GP, Te Akoranga a Maui, CORNERSTONE Assessor) • Dr Jim Vause (GP Te Akoranga a Maui, GP Assessor) • Dr Jocelyn Tracey (GP, PHO Performance Programme) • Dr Malcolm Dyer (GP, PHO Performance Programme) • Dr Jane O’Hallahan (RNZCGP Group Manager Professional Practice) • Dr Keri Ratima (GP, RNZCGP Tumauaki Maori Principal Advisor) • Helen Bichan (Service User) • Jane Ayling (CORNERSTONE Assessor, Practice Nurse, NZNO) • Rosemary Gordon (CORNERSTONE Assessor, ProCare Quality Manager) • Hayley Lord (Quality Manager, Midlands Health Network) • Luis Villa (Advisor, Midlands Health Network) • Kevin Rowlatt (Practice Manager) • Waveney Grennell (RNZCGP CORNERSTONE Manager) • Jeanette McKeogh (RNZCGP Senior Policy Advisor, legal) • Madhukar Mel Pande (Advisor, Research) • Helen Glasgow (RNZCGP CORNERSTONE QI Coordinator) • Dr Roshan Perera (Academic Advisor) • Dr John Wellingham (Peer reviewer) • Stella McFarlane (Peer reviewer) • Maureen Gillon (Project Lead)

5. Method • First consultation phase – 6mths • Review of quality landscape & literature • Feedback from CORNERSTONE practices & assessors on 2009 version • Legal, safety and risk criteria updated • Other criteria reviewed • A4E working group – rebuild • Testing for SMART – specific, measurable, achievable, relevant, timely: • Notified general practices, networks and sector organisations • Consumer workshops • Practice visits • Sector workshops • Targeted organisations • Second consultation phase • Refinement by A4E Working Group • Peer review • A4E Expert Advisory Group Handover & recommendation • Signoff by College Board & Council

6. Result of feedback on previous version Improved relevance and acceptability: • Legal safety & risk measurements were revised and updated • Duplication stripped out • Reduced number of indicators and criteria • Clarity was improved • More emphasis on the patient journey – integration, continuity, transfer of care • Emphasis on results • Greater emphasis on clinical effectiveness • Standards ratified by College

7. A new structure was developed to reflect current thinking by the College 4 areas: • Patient experience • Practice Environment & Safety • Clinical Effectiveness Processes • Professional Development Purpose: • Focus on improving outcomes for patients Improving outcomes for patients

8. Improved understanding about the intent of criteria • Needed to improve specificity of each criterion • Removal of the guide to interpretation to improve understanding and enable the CORNERSTONE programme to provide better advice to practices • Introduction of a rationale Indicator 16 The practice ensures effective infection control to protect the safety of patients and team members Criteria Rationale

9. A focus on supporting the patient journey Supported by the findings from the Voyage to Quality work – R. Perera, more emphasis on: • Clinical effectiveness • Systems to manage patient care • Robust information • Transfer of care • Continuity • Integration

10. Next steps: Enabling clinical effectiveness • A General practice Quality System • RNZCGP Quality Framework • New three year structure incorporating clinical effectiveness requirements for CORNERSTONE • Clinical Effectiveness Modules • A CORNERSTONE resource library – practice access to modules • Clinical outcome indicators • The Healthcare Quality Measures NZ – library of indicators (Patients First) – practice access to clinical measures • Clinical management tools – PHOs • Patient self management • Feedback loops – results • Publish the Profile of CORNERSTONE General Practices 2009-2011

11. Principles

13. Example

14. Practice Environment

21. CORNERSTONE • Practices in the CORNERSTONE programme use Aiming for Excellence standards to develop their practice systems • Total number of general practices in NZ – 1086 • Registered with programme – 757 (70%) • Accredited Cycle 1 – 640 (59%) • Accredited Cycle 2 – 81 (62%) • PHO – 69 (prior to amalgamations) • DHB – 21

22. Next • Continue to accept feedback on Aiming for Excellence • Establish closer links with general practices to identify clinical effectiveness opportunities • Work with other general practice and primary care organisations to support patient improvement opportunities