Medical Audit Advisory Groups Research Articles

Enriching Careers in General Practice: Building morale through personal development

Once general practitioners have established themselves as principals it may seem there is little else to work for. Lack of stimulation may lead to demoralisation, and it is essential that they have other ways to continue to develop their careers. Meeting other doctors to discuss cases and problems and postgraduate education often help but many doctors want to take on extra roles. The options available include undergraduate teacher, tutor for postgraduate education, and participation in medical audit advisory groups, local medical committees, or royal college faculties. Some general practitioners work part time to allow them to fit in these activities. It may also be possible to obtain extended study leave or a sabbatical to broaden experience. Others even more practice to provide new challenges.

Developing role of medical audit advisory groups.

To investigate the approaches to audit of different medical audit advisory groups (MAAGs) and to consider the implications for evaluation of their activities and their developing role in the light of new priorities for clinical audit. Qualitative study based on semistructured interviews. 15 family health services authority (FHSA) districts in two English health regions. MAAG chairpersons and support staff and FHSA general managers and medical advisors in each district, totalling 68 subjects. Structures and activities of MAAGs; perceptions of the MAAG's role and its achievements compared with the initial brief in a health circular in 1990. The approaches of different MAAGs varied considerably: some concentrated on promoting audit and others were involved in a wider range of development activities. MAAGs assessed their progress in various different ways. The importance of collaborative working was recognised, but few interface audit projects had been undertaken. MAAGs had little contact with other quality assurance activities in the FHSA, and FHSA involvement in the MAAG strategy was variable, although MAAGs were taking steps to improve communication with the FHSA. Major differences exist in the approaches taken by MAAGs and the roles they fulfil, which will make evaluation of their effectiveness a complex task. Already MAAGs are responding to changing expectations about audit and pressure for closer links with management.

Medical Audit Advisory Group, Birmingham, October 1993

Medical Audit Advisory Group, Birmingham, October 1993

MAAGs (Medical Audit Advisory Groups): the Eli Lilly National Clinical Audit Centre.

Outlines the framework for promoting audit in general practice, created as one part of the health service reforms. Medical Audit Advisory Groups (MAAGs) were set up in each district with the aim of participation in audit of all general practitioners by April 1992. The activities undertaken have included those recommended by the Department of Health; the most significant of these being the appointment of lay facilitators who are able to assist general practitioners and primary care teams co-operate over efforts to improve the quality of care, and may offer one means of introducing some of the methods of total quality management into general practice. Discusses the problems which remain: audit is not yet sufficiently systematic, interface audit with secondary care is at a very early stage, the ways to involve managers and patients in audit remain to be clarified, and there is little evidence of the consequences of audit in terms of improved care. The Eli Lilly National Clinical Audit Centre has been set up within the Department of General Practice, University of Leicester, in order to address these issues.

Medical audit advisory groups and confidentiality

Medical audit advisory groups and confidentiality

Auditing audits: the method of Oxfordshire Medical Audit Advisory Group.

To develop a systematic method for both summative and formative audit of practice audits, and to use the method to review Oxfordshire practice audits and to plan improvement. Development of a coding system for the audit cycle subsequently used prospectively to assess audits reported to medical audit advisory group coordinators on practice visits. All 85 general practices in Oxfordshire, of which 80 were visited by Oxfordshire Medical Audit Advisory Group coordinators. Satisfaction of criteria for different levels of audit (full, partial, potential, planning or no audit) according to coding scores for practice audits. 46 (58%) practices were classified as doing audit, the remainder doing no audit or only collecting data for family health services authority returns. Of audits being undertaken, 55/102 (54%) included planning care or the setting of targets. The coding system offers the prospect of formative assessment for practices to help them improve their audits, and summative assessment for the family health services authority to satisfy the needs for professional accountability. Its use in Oxfordshire disclosed considerable deficiencies in the process of practice audit. Practices in Oxfordshire should improve their audits. The advisory groups target to March 1992 is for 50% of practices to be doing full or partial and 25% potential audit and half of the remainder planning audit. Practices are encouraged to include in their audit implementing change, planning care, and agreeing criteria for further assessment.

Medical audit in general practice

Two recent books† address the subject of medical audit in general practice in very different but complimentary ways. Medical audit is one aspect of the United Kingdom Government's White Paper ‘Working for Patients’ which has received widespread support from the medical profession. The books are topical in looking at the implementation of medical audit within the new contractual arrangements for general practitioners in the National Health Service. In Managing for Quality in General Practice, Donald Irvine has written a tightly argued and structured monograph putting forward the case for improved management in general practice as the key means for improving the primary health care of individuals and practice populations. He sees the necessity of improving management skills in general practice if medical audit is to be implemented in a systematic and comprehensive fashion. The early chapters of his short book review the literature on quality assurance in health care. This is necessary and is competently done but it is the second half of the book which is stimulating and challenging. Dr Irvine discusses the changes which will need to take place in the orientation of practices, postgraduate education organizations and health authorities if improvements in health care are to be achieved. The latter chapters bear the stamp of his personal experience and enthusiasms. He writes with commitment and authority on the need to link management, medical audit and continuing medical education. He points out that in modern health care systems, the medical profession cannot remain completely autonomous. We have to be accountable to our patients and to our employers for the services which we provide. The new Medical Audit Advisory Groups will have to tread a difficult path in helping practices understand that it is in their long-term interest to audit their performance. The second book, Medical Audit and General Practice, edited by Marshall Marinker, is a multiauthor book and, as one of the contributors, I declare an interest. Its approach is completely different from Donald Irvine's monograph in that it provides a wide range of practical examples of how doctors and practices can audit performance. There are chapters on practice organization, chronic disorders, annual reports, clinical significant events and acute conditions. Practical advice is given on how to get started in medical audit and advice on how to collect and interpret different types of data. The book is liberal in its approach and in its intention. In the introductory chapter Marshall Marinker discusses the philosophy underlying medical audit. It is a means to improving patient care, not a means of placing blame. We need to learn from errors, not to hide them. This returns us to the difficulty of facing Medical Audit Advisory Groups. If they are seen by general practitioners as inquisitorial, doctors will become defensive and the potential benefits of medical audit will be lost. A successful model to learn from is the method of approving training practices in the United Kingdom. Explicit criteria, repeated visits to the training practices, peer group review and financial reward have resulted in a demonstrable rise in medical records and other elements within training practices.

Impact of medical audit advisory groups.

Impact of medical audit advisory groups.

Liverpool Medical Audit Advisory Group

Liverpool Medical Audit Advisory Group