A principled approach
The design team has set three principles to guide quality for general practice in New Zealand.
- All practices should actively work to improve patient outcomes in their enrolled population;
- All practices must actively work towards reducing health inequalities in its enrolled population, with a focus on tangata whenua; and
- The simplified Aiming for Excellence standard for general practice is sufficiently robust to be accepted by other providers/organisations for their credentialing purposes.
The concepts being proposed
Based on the principles, the team is proposing these concepts for a simplified quality system:
Foundation Standard remains compulsory for all general practices (as it is now) and comprises of core compliance requirements only.
Because Foundation Standard is compulsory for all practices, the definition of ‘core compliance’ (what every practice must do) becomes an important discussion. Is ‘core’ only the legal requirements, or does ‘core’ also encompass requirements to ensure that no harm is done to patients?
These are two options the team considered – which one do you think all practices should be required to do to be Foundation Standard certified?
- Compliance with minimum legislation and regulation, or
- Compliance with minimum legislation and regulation, equity requirements and a small number of clinical improvement activity, eg: test result audits.
The CORNERSTONE® programme becomes a series of modules to be accredited against, instead of a one-size-fits-all programme.
General practice has changed significantly since CORNERSTONE® was created, and a one-size-fits-all programme doesn’t necessarily suit all practices. Different models of care, and different services, means that the current CORNERSTONE® programme may not be quite right for some practices.
One option is to create a CORNERSTONE® programme that allows practices to choose a number of different modules they would like to be accredited for. Potential modules include: quality improvement; advanced procedures/minor surgery; advanced diagnostics; nurse-led clinics; teaching practices; integrated care teams; sustainability and environmental systems; and digital or technology enabled care.
Each module could be assigned a credit value, and accreditation could be achieved by choosing modules and accumulating a defined number of credits, eg: 100 credits.
Alternatively, the modules do not have a credit value, and practices would be accredited for each of the modules they have selected, eg: CORNERSTONE® accredited, with endorsement for quality improvement, nurse-led clinics, integrated care and sustainability.
- Would a module system make accreditation simple for you to achieve and maintain?
- Would a credit system for modules, or an endorsement for modules be a simple system?
The CORNERSTONE® Annual Programme and mandatory indicators are retired.
The Annual Programme was originally introduced to provide a way for practices to spread CORNERSTONE® requirements evenly over the four-year accreditation period.
Recognising the amount of work needed to keep up to date with the annual programme and mandatory requirements, the team wondered whether the annual programme is still valuable or useful for practices.
- Would it be simpler for you to continue with the annual programme because its familiar and it keeps you on track?
- Would it be simpler for you if the annual programme was retired?
Tell us what you think
The simple way – answer 4 poll questions here
The longer way – email firstname.lastname@example.org
If you would like more information, please call the College on 0800 433 733.
Mihi and acknowledgements
Thanks to our colleagues from practices and PHOs with expertise in developing and assessing quality systems, and also Dr Melanie Wi Repa, chair of Te Akoranga a Māui for her invaluable guidance during our discussions about Māori health and health equity.