Most audit tools are based around the idea that improving systems and processes leads to better patient care. In general practice, although much of what we do is in teams, there is a large emphasis on the personal care and the relationship between an individual doctor and the patient. The structure of general practice in the UK is changing with as many as a quarter of GP’s choosing to work outside the traditional practice-based delivery of health care and to have portfolio careers, work mainly or entirely in out of hours or work flexibly as a locum.
In Wales we tend to recognize the working pattern of GPs under one or more headings, partners, salaried, retainers, sessionals, out of hours and finally returners. Traditional system based audit may exclude some of these groups from examining their own practice. Even working within a settled practice environment an individual may wish to look more closely at the individual relationship between doctor and patient. This section includes a number of examples of audits that can easily be performed at that level.
Most of the systems and process audits rely on historical data collected electronically at a defined point in time. Most personal audits will rely on the individual collecting data in real-time or by the retrospective analysis of short bursts of activity. When examining these personal aspects of care the data collected is often subjective and equally there are few examples of national standards to benchmark against, these issues require some form of external objectivity be applied to the interpretation of the data sets. It is imperative therefore that this type of audit is discussed with a colleague, a mentor or at appraisal.
The same process stages apply to this type of audit as to the audit cycle. It is imperative that once you examine your current practice appropriate changes are planned and improvement noted as appropriate through further data collection.
GPs that find themselves working outside traditional practice-based environments can still use audit to influence systems. Examples of this could be an individual that has noticed a potential flaw or weakness within the organisation for which they work, if this issue were raised as a potential significant event, audit of that system may be suggested and performed by the GP concerned. It is recognized that funding and protected time may be difficult to obtain.
Available example audits are shown on subsequent pages (Please note all examples given demonstrate only the first audit cycle)