Grace,
>Clinical governance appears to mean quality control
It sounds a little like imposed quality control.
>How can a GP tell a colleague what to do?
I'll pass on that<BG>
>And even *more* how can a non-GP??
I usually start by raising a subject, giving advance notice and then getting
the GPs to tell me what they think they should be doing. Then go through the
records and draw attention to those occasions when they haven't.
I don't do anything a GP couldn't do if the GP had the time.
>Still, there are probably basic areas of quality that could be tackled with
>protocols etc agreed as a group
To which end I act as a catalyst.
>Re prescribing indicators, I don't think cardiovascular spend is
>an easy one.
I'm not sure any of them are.
>We have a low cardiovascular spend
>A mid-range (for our PCG) figure for ASTRO-PU in practice population
>A mid range spend on lipid lowering drugs and ACE inhibitors
>We just use lots of bendrofluazide and atenolol for high BP
I wonder what proportion GPs know that the BNF recommends 50mg as the
maintenance dose of atenolol. It isn't apparent from what I dispense (and it
was fairly new news to me!)
Can a practice then justify (or be obliged to justify) having more scripts
for 100mg than for 50mg?
>As far as I know our patients' blood pressures are no worse than
>average !
>(How can you tell?)
Pooling of data at PCG level?
>Does that make me a poor quality prescriber?
>I hope not, but it might look that way :-(
I have problems with the application of prescribing indicators. They are not
great measures of prescribing quality. They are however the best (only?)
measures that we have, they are transparent, open to criticism and open to
change. Like any other evidence, it might not be perfect or give us all the
answers but until someone comes up with something better it's the best
measure that is available.
Regards
Jeff Green
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Community Locum and Prescribing Support Pharmacist
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