Facilitator helps practices to network in Torbay
(with June 2008 update)

Torbay 2008

An unusual but very positive situation exists with the practices looked after by PRIMIS+ facilitator, Sharon Strang, in the Torbay Care Trust area.

Sharon has 21 practices in her remit – an average ratio for a data quality facilitator. It is not how many practices there are, their population or type, or even the local area that makes Sharon’s remit different, but the way in which she works with her practices and helps them communicate with each other.

Every month, the practice managers meet up centrally to share best practice. This arrangement of cross-practice cooperation and openness is often overlooked as a valuable tool, but occurs successfully in Torbay despite there being five different clinical systems in use between the 21 practices.

Sharon commented, “The practices manage to work together exceptionally well. They all tend to share ideas and help each other despite the variety of clinical systems and their own unique problems.” Buoyed by this level of cooperation within her practices, Sharon is able to work in partnership with practices to help create generic templates and policies, which can then be easily tailored to individual practices or the requirements of each of the clinical systems in use.

However, as well as enjoying a high level of interaction between themselves, the practices also benefit from the significant amount of time that Sharon spends with them individually. This high-maintenance approach is something that Sharon prefers and has always provided and it also sits comfortably with Torbay Care Trust’s commitment to a high level of interaction within its communities and services.

Sharon’s background is in clinical audit and clinical governance. She worked as a facilitator at Torbay for some time, but then moved across to concentrate solely on clinical governance for two years. She was asked again to take up the role of facilitator with the introduction of the Information Management and Technology Directed Enhanced Service (IM&T DES).

Sharon‘s practices were all very keen to get started on the DES and (with one exception) submitted their intention to proceed straight away. One single-handed practice was advised not to sign up yet, as it had only recently been computerised and the practice staff needed time to get up to speed, rather than through any unwillingness on their part.

"All of the 20 practices working towards data accreditation have been really positive with good feedback coming from them," Sharon added. In preparation for the data clean-up work, practices have requested that their new staff be trained in the use of read codes. Sharon has arranged training for 96 new and existing staff to take place in January 2008. This is another example of the positive and proactive approach used at Torbay.

"At the trust, the IM&T department embraced the DES, quickly setting up a project team," said Sharon. This team comprised the trust’s seven assessors (a practice nurse, a GP and managers within the field of the DES) and also an Information Governance Manager, an IM&T Manager, the Assistant Director of Primary Care and other specialists. The team was briefed on all the components and issues of the DES and all members have undertaken the appropriate PRIMIS+ Assessor training, which they all found to be useful and informative.

Having a large IM&T DES team, representative of a wide range of roles, that is able to concentrate on data accreditation and the ultimate goal of the Summary Care Record has clearly given the practices in Torbay a fantastic starting point. The 20 practices are already well under way in their preparations by using the e-audit toolkit and cleaning up their data.

Assessments for the Torbay practices are planned for January 2008, as Sharon felt that it was better to give practices the maximum time to get ready, rather than rush them through. Despite the work that Sharon and the trust’s specialist Primary Care Team had previously done with practices, but exacerbated by Sharon being in another post for two years, she admitted that "It was a shock how much work there was for these practices. Thankfully they are all familiar with the e-audit and can use CHART, which has been a great help."

As the practices work towards being accredited for the IM&T DES, PRIMIS+ hopes to revisit Sharon and Torbay Care Trust to see their progress as they work towards the goal of uploading patients’ Summary Care Records to the Spine.

June 2008 Update

Although having just started a new role as NICE Implementation Facilitator at Torbay Care Trust, Sharon was able to update PRIMIS+ on recent local developments in the IM&T DES.

Eventually, 18 practices proceeded with data accreditation. Those that decided not to go ahead with the IM&T DES at this time all agreed to review their situation in three years’ time.

Of the 18 practices that did proceed, 17 were accredited for the full three years. These were a mix of practices who were accredited without proviso and a few that needed to complete some additional work, which was outlined in an action plan. Only one practice was accredited for a year.

Sharon, together with the practices and assessors, identified both positive outcomes and lessons to be learnt from Torbay’s IM&T DES process:

Positive outcomes:

• practices that already had good data and effective systems in place felt that accreditation recognised the quality of the practice and represented the consolidation of their work

• many practices were pleased because the DES highlighted the areas they were particularly doing well in

• the DES process effectively brought areas where improvement was needed to practices’ attention (in some cases where the need for improvement was not known)

Lessons learned:

• Torbay had a high number of assessors (clinical and non-clinical) which meant fewer practice visits for each individual. However, it also meant that keeping assessments and marking consistent was difficult. A lot of consideration was taken to ensure that practices were assessed equally by the different assessors

• additional training on the day-to-day function of a practice has been highlighted as a future need for assessors in Torbay. Assessors had a wealth of knowledge in their field of expertise, but needed more understanding of how a practice runs in order to better appreciate and assess the processes and evidence in place

• some practices felt that the assessment was too formal and interrogative and, to address this, Sharon changed the tone of the assessment and reworded some questions

• Sharon and the assessors had difficulties with benchmarking acceptable standards in some areas of the assessment. In the absence of national guidelines for many areas they felt some ‘pass’ criteria were too subjective and so Sharon and the assessors had difficulty in drawing their own ‘line in the sand’. However, they found drug to disease groups easier to assess, due to the traffic light system that was in place (red for warning, amber for acceptable with caution and green for acceptable)

• initially, the sheer volume of paperwork was a problem as it took Sharon two days to prepare the practice information for the first few assessments. Largely thanks to a combination of trial and error and assessors’ feedback on what information they used and what they did not need, Sharon was eventually able to cut down the paperwork drastically

• some practices had initially raised concerns that assessors would have to look at patient-sensitive information but, happily, this eventually proved not to be an issue. Sharon was able to identify those areas that needed investigating within a practice in advance (these areas were identified during practice visits and notes on them were included in the assessors’ documentation). For these areas, practices ran off their own evidence to give to the assessor which verified the situation or showed that they had systems in place to deal with any issues