Introduction

As part of the ongoing development of the RACGP Standards for general practices (5th edition) (the Standards), the RACGP conducted a third consultation phase with the profession, general practitioners (GPs), patients and other stakeholders.

The third consultation phase involved:

• the release of the second draft of the 5th edition Standards from 6 June – 30 September 2016

• the release of the second draft of the Resource Guide for the RACGP Standards for general practices (the Resource Guide) from 6 June – 30 September 2016

• a large-scale pilot of the second draft of the 5th edition Standards from 6 June – 30 October 2016

• the release of the Patient Feedback Guide from 3 October – 31 October 2016.

The RACGP invited stakeholder input through multiple avenues including:

• written feedback to the Standards Unit

• written feedback via a prepared survey for the large-scale pilot participants

• verbal feedback.

All information relating to the third consultation phase of the 5th edition Standards was available to stakeholders on the RACGP website.

The third consultation phase

The third consultation phase required feedback from the profession and stakeholders on:

• the content in the explanatory material for each Criterion in the Standards

• any Indicators that stakeholders felt would be difficult to meet in the Standards

• any Indicators that were not clear in the Standards

• any Indicators that were deemed not applicable to a practice in the Standards

• the second draft of the Resource Guide

• the streamlined requirements for the revised Patient Feedback Guide and the consolidation of multiple patient feedback resources into one publication.

During the consultation phase, there were over 2200 downloads from the dedicated standards development webpage www.racgp.org.au/standardsdevelopment

Documents available for stakeholders to download included:

• word and pdf versions of the second draft of the 5th edition Standards

• word and pdf versions of the Resource Guide

• a summary of the second consultation phase

• 5th edition Standards – frequently asked questions

• word and pdf versions of the revised Patient Feedback Guide

• 5th edition Standards development webinar.

Standards for general practices (5th edition)Third consultation phase – summary

3Consultation

RACGP Standards for general practices (5th edition) – Third consultation phase – summary

The RACGP received feedback from 25 organisations and 29 individual respondents on the second draft of the 5th edition Standards, the Resource Guide and the Patient Feedback Guide resulting in more than 650 items for consideration.

The range of stakeholders who provided feedback included:

• general practitioners

• practice managers, nurses and other staff

• Aboriginal Medical Services

• after-hours services

• medical defence organisations

• primary health networks

• peak bodies and government agencies

• registered training organisations

• accreditation agencies and surveyors.

The large-scale pilot

The large-scale pilot of the second draft of the 5th edition Standards was conducted from 6 June to 30 October 2016. Overall, 66 practices, 34 general practitioner (GP) surveyors and 29 co-surveyors completed the pilot visits.

The large-scale pilot aimed to test the feasibility, acceptability, achievability and applicability1 of the second draft of the 5th edition Standards.

Practices and surveyors were asked to complete a survey and respond to a number of questions about each Indicator. Surveyors who participated in the pilot were provided with an overview of the 5th edition Standards via an information session and webinar.

Practices who participated in the pilot ranged in size (number of FTE) and location (urban to rural and remote locations). In addition, two Aboriginal Medical Services participated in the large-scale pilot.

Changes between the first and second draft of the 5th edition Standards

The most substantial changes between the first and second drafts are listed below.

• The addition of the ‘Demonstrating how you meet this Criterion’ section – a list of some of the mandatory and optional ways a practice can choose to demonstrate how they meet the Criterion.

• The removal of the word ‘should’ throughout the Standards to leave only ‘could’ and ‘must’.

• Changes to requirements for the presence of a third party during a consultation with a GP. In the first draft, practices were required to obtain patient consent and document the presence of any third party. In the second draft of the Standards, practices are required to obtain patient consent and document that consent only when the third party is introduced by the practice.

• Changes to the order of the Standards in the Core module so that Standard 1 is now ‘Communication with patients’.

• Changes to Indicators so that some are not flagged.

• The simplification of some of the language used in Standard 3 ‘Practice governance and management’ of the Core module.

Summary of stakeholder feedback

The feedback received on the second draft of the 5th edition Standards, the Resource Guide and the Patient Feedback Guide was wide, varied and constructive. The feedback has been summarised below.

General feedback on the second draft of the 5th edition Standards

• Antimicrobial stewardship:

− Throughout the development of the Standards, stakeholders have advocated for the inclusion of antimicrobial stewardship in the Standards.

• My Health Record:

− A number of stakeholders referred to My Health Record and the fact that it has not been mentioned in the Standards.

• Advance care planning:

− Throughout the development of the Standards, stakeholders have advocated for the inclusion of advance care planning in the Standards.

Second draft of the 5th edition Standards — Core module

• Criterion C1.3 – Informed patient decisions:

− Recommendations to include Indicators reflecting the commitment to patient participation in order to be consistent with the Australian Charter of Healthcare Rights.

− Suggestions that the Standards provide further guidance for practices when handing over the patient to self-management rather than handing over to another clinician.

1 Feasible – the Indicator is possible to do and realistic for the practice to complete Acceptable – the Indicator is satisfactory or agreeable, and reasonable for the practice to complete Achievable – the Indicator is able to be met by the practice Applicable – the indicator is applicable to the practice.

RACGP Standards for general practices (5th edition) – Third consultation phase – summary

• Criterion C2.1 – Respectful and culturally appropriate care:

− Further clarity was suggested in relation to patients’ religious beliefs and cultural backgrounds.

− Further information required for practice strategies to respond to religious and cultural needs of the patient population.

• Criterion C2.2 – Presence of a third party during a consultation:

− Change the terminology in this Criterion from ‘party’ to ‘person’.

Second draft of the 5th edition Standards — Quality Improvement (QI) module

• Criterion QI1.3 – Improving Clinical Care:

− Suggestions to flag this Indicator and enhance the wording to include the use of patient and practice data to ensure improvements to clinical practice.

• Criterion QI2.1 – Health summaries:

− Percentages required for both allergies and health summaries to be included in the Indicators.

Second draft of the 5th edition Standards — General Practice module

• Criterion GP3.2 – Practice equipment:

− Suggestions regarding the specific personal protective equipment requirements of the Pandemic Flu Kit (2014) to be included in the indicator.

Second draft of the Resource Guide

• Include additional resources in the areas of health records and information privacy.

• Removal of resources that have become out of date and/or replaced.

• Include a link to the Resource Guide in the 5th edition Standards introduction page.

Patient Feedback Guide

• The patient feedback requirements do not allow after-hours services to collect feedback in a meaningful way.

• The patient feedback process does not adequately address the needs of Aboriginal and Torres Strait Islander people.

• Additional information on the volume of questionnaires required and what constitutes a full-time equivalent GP.

• Additional information to assist practices with understanding the importance of conducting patient feedback to improve quality in health care.

• Additional information on the RACGP approval process for patient feedback methods.

• Additional information on the need to protect patient identities when they are involved in patent feedback.

• Additional information on when patient identities can be known and when to ensure they remain unidentifiable and confidential.

• Additional information to alert practices to the potential for overburdening or over-representing patient groups in the feedback process.

Next steps

Feedback received from this consultation phase and the large-scale pilot was considered by the RACGP Expert Committee – Standards for General Practices and has been used to inform the third draft of the 5th edition Standards.

The feedback from this consultation phase will also be used when updating the next draft of the Resource Guide and Patient Feedback Guide.

The RACGP will launch the 5th edition Standards in October 2017.

Further information can be found at www.racgp.org.au/standardsdevelopment

racgp.org.au Healthy Profession.Healthy Australia.