Many of you know Carn-Brae, the practice has been in operation for about 40 years and, no, I haven’t been there that long, even though some patients think I have.

I have been at the practice for almost 16 years, with the last five as manager. During that time I have seen many changes, with GPs and staff coming and going.

General Practice has changed and evolved over the years, especially recently with an emphasis placed on being proactive with regard to patient care in addition to all aspects of compliance.

All of this brings me to our participation in the Australian Primary Care Collaborative (APCC) program.

When first approached by the Ballarat Division, I thought “I really don’t know whether I can be bothered with all this, I have enough to do“.  And, to be honest, for a few weeks, I did find it a bit daunting, there was quite a bit of reading to do and then I needed to learn how to navigate around the APCC website, enter data each month and complete PDSA cycles (Plan, Do, Study, Act). The GPs were a little bemused about the whole thing and the prevailing attitude was; what’s in it for them?

As time went on and after attending 2 workshops in Melbourne, I found that I had much more of a grasp on the whole concept of what the Collaboratives was trying to help the practice to achieve.

We have only been involved since October last year and I feel that we have made pretty good progress.

For example, practice meetings; these were held fairly infrequently and were too informal.  We now have regular monthly meetings with a written agenda, one of the staff takes minutes and all staff attend. We have found these meetings very valuable for open discussion regarding practice procedures and new initiatives.

Being involved in the Collaboratives really forced us to clean up our clinical data on our computer systems. In October last year the practice population as calculated by the PEN Clinical Audit Tool was over 26,000. This did have to be addressed because all our calculations regarding different groups within the practice would be totally inaccurate.  We have used a number of strategies to address this including inactivating non-active and deceased patients (those of you with MD3 would be able to do this much more quickly than our manual work needed with MD2).  We had some patients still on the system who were 120 and even 150 years old!

After diligent and ongoing work, mostly done by our reception team going through patient lists and inactivating patients one by one, our practice population now stands at just over 6,000.  We are very happy with this outcome.

PDSA (plan do study act) – this concept was a little difficult to understand at first and initially, the process of entering data and writing up the PDSAs on the APCC website was a bit bewildering.  This is where the division’s ongoing help and support was invaluable.

Through the workshops that Dr Frank Marton and I attended, we gained an understanding of the whole process.  The workshops, I should point out, were very well organised and the speakers were informative and entertaining.

I am now becoming used to having a head full of “PDSA possibilities”. It affects you like that!! And it’s amazing how the process just rolls along.  I need to keep in mind that the Collaboratives Program is made up of small steps, which, when you look back, have made quite a substantial difference to the practice already.

We now have up-to-date diabetes and CHD registers.  Helen, our practice nurse has been involved in some of the PDSAs regarding consistent coding for diabetes (eg Type 1 and Type 2) and for CHD. Data has been corrected to be consistent across the practice and the GPs are cooperating by using uniform coding when entering their data.

We have improved quality of care for people with diabetes by conducting searches using Medical Director and the PEN Clinical Audit Tool to ascertain which patients need review appointments, HBA1c blood tests etc.

We have also enlisted the services of Lachlan Campbell, Diabetes Nurse Educator, for weekly clinics.  This has worked very well.

We have conducted patient surveys and have run capacity and demand studies.  We are reviewing these at present to see if our appointment system can be improved.  As you all know, this area can cause a lot of stress, both for reception staff and GPs.  The Collaboratives Program does supply many strategies for improvement in this area of access.

When you are participating in this type of program, it is always beneficial to get an idea as to how you are going with it all. The APCC sends feedback graphs every month and we can benchmark ourselves against other practices in Victoria and Tasmania.  This feedback has shown that we have made excellent progress.

Contact Michelle MacGillivray (michellem@bddgp.org.au) for more on collaboratives, or Tanya Gradolf (tanyag@bddgp.org.au) about the PEN clinical audit tool.

Tags: practice management