600+ on-site assessments and counting – A/Prof Harry Jacobs, AGPAL GP Surveyor

“It is a privilege to be welcomed into a fellow GP’s realm, to be invited to inspect all aspects of the practice and to be given respect when delivering feedback.”

Associate Professor Harry Jacobs is an AGPAL GP Surveyor who has completed over 600 on-site assessments since taking on the role in 1999.

With plenty of stand-out memories and as an AGPAL Surveyor bound to be recognised by many practice teams, Harry reflects on his AGPAL journey and the enjoyment he has received from undertaking his surveyor role.

“What a difference general practice accreditation has made to the delivery of primary care in Australia (since 1999)!

Who remembers the days of medical records on six by four cards, illegible handwritten notes, water boilers to ‘sterilise’ instruments, and clinical performance stationary at about the standard which was current at the time of junior doctor hospital experience?

The early days

As an AGPAL Surveyor since the inception of accreditation, I recall the early days of initial training for surveyors and the first rounds of on-site accreditation assessments. These were incredibly long and onerous visits as surveyors and general practice teams became familiar with the process and learned to trust the feedback mechanism.

To this day I thoroughly enjoy visiting practices on subsequent accreditation cycles to observe the pride these teams display in their practice improvements, the widespread commitment to continuous quality improvement, the greater sense of teamwork, the increasing commitment to chronic disease management including provision of allied health services and the extraordinary commitment of those working in rural and remote practices. Visiting rural and remote practices as an AGPAL Surveyor can involve challenging amounts of travel and logistics but it is always a rewarding adventure and the customary hospitable welcome from teams out in the country is legendary.

Common themes in areas for improvement

Having personally performed over 600 on-site assessments, you might ask me if there are common themes in the work that I do? What could be an area of focus for improvement for practice teams?

After all my years surveying there is one area I observe a casual regard for and this is in regards to the importance of appropriate documentation in many general practices.

This relates to medical records, especially detailed documentation of handover of care (between GP’s, GP to specialist/hospital/other health care provider), and dealing with test results (documentation of informed consent, tracking if tests are completed and clearly documenting discussion of test results).

Other aspects of medical care of considerable risk to GP’s and requiring detailed documentation are recording informed consent including details of discussion of risks and benefits and the prescription, monitoring and management of the use of S8 drugs. Documentation is also needed for business management purposes including staff HR, tax and regulation compliance.

Although this is one common area I find to be of improvement, there are many initiatives I discover in practices which go above and beyond the accreditation requirements. Accreditation can be seen as a risk management exercise and can support practices to set minimum benchmarks to support them with aiming higher to ensure they are operating at an optimum level.

Most general practices have embraced the continuous quality improvement mindset so the process of accreditation no longer carries the sense of fear and intimidation I certainly felt all those years ago.”