Clinical Governance

Call recording with blocked numbers

Doctors have reported difficulty in getting the call recording system to work when a number does not accept calls from lines without CLI (caller line identification). There is a workaround for this which can be found in the Memos section

Out of Area Patients

If you have not already received this by e-mail, please read the guidance which can be found in the Memos section

Reminder to doctors

Debbie sent this reminder round today, I have copied it below in case you have missed it:

  • Complete HV Toughbook in real time during each Home Visit.
  • GP's are responsible for the HV padlock key - removal, storage and return (Drivers/Admin staff should not have access to these to safeguard themselves). Please do not ask them to do so. This padlock should always be locked again on return from Home Visits
  • Home Visit Prescription pads - these must be stored in the HV box at all times. All prescription pads must be returned to the GatDOC drugs room whilst not be used. Do not retain in consulting rooms or any other area.
  • Return the Drug keys and lock the cupboard at all times
  • Lock computer when unattended and always log off at the end of shift.

Clinical Handover Report

It is important that in an unscheduled care service where doctors are working shifts that work is handed over safely and effectively at shift changes. To support that we have a new handover report form which doctors might wish to use to ensure that doctors coming on shift and admin staff are aware of any issues.
It can be found in the Forms section.

GPC Advice re Flu Prophylaxis

There has been some controversy about requests from NHS England regarding prescription of prophylaxis for influenza.
The GPC has recently received advice from its lawyers which can be found in the
Memos section.

GatDoc Policies

I have updated the GatDoc policy folder today. Although there should be little that you are not already aware of, may I remind you that it is your responsibility to ensure that you are familiar with the policies of the organisation.

Clinical Concern Form

There is a new form available for you to record clinical concerns or near misses so that we can follow them up.
It can be found in the
Forms section

Punctuality

It has been reported back that, on occasion, duty GPs have left the Service prior to the next GP arriving on site for their duty.

This can leave the Service short-handed for a period and whilst everyone is keen to finish their duty on time, the workload of the Service needs to be taken into consideration.

Of course the answer would be for all GPs to arrive on site on time for their duty start time but we realise that there may be rare exceptions when an in-coming might be delayed.

Also, when an in-coming duty GP fails to arrive on site and it is necessary to activate the Standby duty GP then it may take some time for the Standby GP to arrive on site and the out-going duty GP should remain on duty until the Standby arrives.

The duty fee of the delayed GP will be amended as appropriate.

Please remember the above when leaving your duty and take it into consideration

Home Visits

This last weekend we breached our targets on Home Visits on a number of occasions. The targets are: 2 hours for and Urgent HV and 6 hours for a Routine HV. The clock starts when the patient first contacts the service.

Part of the problem appears to be that the GP on HV duty is not starting visits as ass as possible and is probably helping out in the WIC.

It is important that as soon as a HV is identified then a duty GP should start visiting and reminders to this effect from Reception and driving staff should not be ignored. In addition, good communication between the Centre and the cars is essential so that the GPs and Drivers are aware of approaching breaches so they can prioritise.

We will be closely monitoring the timely start of Home Visiting and expect all GPs to be aware of the service expectations and targets.

Home Visits

Following a recent complaint can I remind everyone about the prioritisation of home visits. For routine visits the timescale is within 6 hrs and for urgent visits within 2 hrs. Whilst only a few will fall into the urgent category consideration also needs to be taken about the workload at the time.

Supplying Medicines from Stock

There has been an issue raised about supply of medicines from the GatDoc or Walk-in Centre stocks when there are local chemists open. I felt I needed to remind doctors of the regulations surrounding medicines supply. It is a breach of medicines regulations for a doctor to supply any medication when there is a local pharmacy open except under the personally administered arrangements.. The Walk-in Centre nurses may do this under the terms of their PGDs, but doctors may not.
It may be very tempting “just to get the medication while the patient is present”, but you should resist that temptation. We would not want to see someone from the local NHS team making a referral to the GMC.

Borrowing Medicines

There have been instances where GatDoc doctors have been asking Walk-in Centre staff to supply medicines which are not kept in the GatDoc drug cupboard. This puts the Walk-in Centre staff in a difficult position because they should not be doing this. If you feel a patient needs a medication which is not in the GatDoc cupboard, please supply them with a green script for the medication.
The medications in the GatDoc cupboard are stocked in line with national and local guidelines. If you feel that a particular medication should be kept in the cupboard, please let me know and I will review the request with the pharmacists.

Lab Results

We have had a meeting with the QE path lab today to discuss lab results.

We have agreed a schema for calling the OOH service, it is slightly more generous than the national recommendations.

The idea is that OOH doctors should only be advised if there is an unexpected abnormal result that is outwith the safety parameters. Therefore if a patient has chronic renal failure for example, the OOH doctor should not be called unless renal function has significantly deteriorated. The board would be grateful if doctors could monitor results and advise us of calls which fall outside this agreement.

New Policies

As promised (threatened?) I have today published several policies reflecting our need to comply with the requirements of the Care Quality Commission.
Doctors should be familiar with the policies, but as a minimum need to know where to find them when working (they are in the policies folder). Thank you for your co-operation in this.

New information on opioids and memo

I would like to bring your attention to the new guidelines on prescribing opioids, particularly in palliative care. These can be found in the medication section of the site.
We have just published a memo to all duty doctors covering some issues which we would like all duty doctors to be aware of. It can me found in the memos section.