Developing accreditation for community based surgery: the Irish experience

Abstract

Purpose Carrying out minor surgery procedures in the primary care setting is popular with patients, cost effective and delivers at least as good outcomes as those performed in the hospital setting. This paper aims to describe the central role of clinical leadership in developing an accreditation system for general practitioners (GPs) undertaking community-based surgery in the Irish national setting where no mandatory accreditation process currently exists. Design/methodology/approach In all, 24 GPs were recruited to the GP network. Ten pilot standards were developed addressing GPs' experience and training, clinical activity and practice supporting infrastructure and tested, using information and document review, prospective collection of clinical data and a practice inspection visit. Two additional components were incorporated into the project (patient satisfaction survey and self-audit). A multi-modal evaluation was undertaken. A majority of GPs was included at all stages of the project, in line with the principles of action learning. The steering group had a majority of GPs with relevant expertise and representation of all other actors in the minor surgery arena. The GP research network contributed to each stage of the project. The project lead was a GP with minor surgery experience. Quantitative data collected were analysed using Predictive Analytic SoftWare. Krueger's framework analysis approach was used to analyse the qualitative data. Findings A total of 9 GPs achieved all standards at initial review, 14 successfully completed corrective actions and 1 GP did not achieve the required standard. Standards were then amended to reflect findings and a supporting framework was developed. Originality/value The flexibility of the action-learning approach and the clinical leadership design allowed for the development of robust quality standards in a short timeframe.

Minor surgery in general practice in Ireland- a report of workload and safety

“…The procedures studied in this project are those commonly undertaken by GPs anywhere [2,13,14,18,19,[26][27][28][29][30][31][32]. We selected participants who had sufficient experience to demonstrate the capacity of GPs in Ireland to perform minor surgery and to have a sufficient established scope of practice to test an accreditation procedure for community surgery [17]. This was a purposefully heterogenous group of GPs with a seven fold difference between the numbers of cases managed by the busiest and least busy practices in terms of minor surgery activity.…”

“…Qualifications, infrastructure and governance are domains of high quality community surgical practice. These domains underpinned the accreditation standards, which have been reported separately [17].…”

“…Approximately 40% of Irish people are eligible for free GP care at the point of service (GMS patients); others may have private health insurance or are self-paying. The accreditation elaborated a series of standards against which the qualification, infrastructure and practice of GPs commissioned to undertake work devolved from hospitals would be measured and is described elsewhere [17].…”

Office-Based Minor Surgery: An Ever-Increasing Challenge Not Only for the Dutch General Practitioner

“…Office-based minor surgery (OBMS) has traditionally been a feature of general practice. [1][2][3][4][5][6][7][8][9][10][11] OBMS refers to all surgical procedures performed under local anesthetic, typically in the office setting. This includes a wide variety of procedures, ranging from minor excisions of dermatological imperfections and tumors, incision of abscesses, suturing wounds, and removing foreign objects, to more therapeutic procedures such as elective partial matrixectomy and thrombosed hemorrhoid treatment.…”

“…Therefore, in the Netherlands, as in some other countries, there is no official accreditation for GPs performing OBMS. 6,13 The improvement of primary care is a key issue in international comparative research. Due to the cutbacks in developed countries' health care budgets, an increase in skin disorders, and the shift in care from hospitals to general practice, there is an increasing demand for OBMS.…”