The Foundation programme represents a collection of legislative, regulatory and clinical requirements for all general practices in Aotearoa New Zealand. It represents a nationally consistent benchmark by which a practice can measure its current quality of care and progress toward health equity outcomes.
To meet PHO Service Agreement Amendment Protocol (PSAAP) requirements and qualify for capitation funding, practices will need to complete the College’s revamped Foundation programme.
This standalone programme provides a baseline standard expected of a general practice. It is a requirement for the Cornerstone Bronze, Silver and Gold tiers.
Pinnacle will provide assessors to assess you against the standard which will be at no cost to your practice. This is one of the membership benefits of Pinnacle. You are still welcome to find your own assessor through the College website, but fees associated with the assessment process will be at your own cost.
Practices that are due to be assessed in 2024 will have received letters with potential dates for assessment. This ensures practices have ample time for planning as a team and can put processes in place early to meet the standard. Please ensure you have signed those letters and sent them back to firstname.lastname@example.org. Pinnacle supply the assessors free of charge so it is important that these assessments are booked as soon as possible.
The RNZCGP website has good information to support practices to meet the standard. In particular the quality programmes resources tab on the left hand side has some good resources on it.
The Pinnacle team are available to answer any questions you may have around the standard. Your first point of contact is the practice systems support team. The Pinnacle nursing team are available if you have any questions regarding criteria affecting nursing. Common areas that require nursing input are standing orders.
We have set up monthly Zoom sessions where practices can ask any questions of other practices or Pinnacle staff.
If there are trends occurring through the assessment process, we will ensure these are shared with practices through our website.
If you would like a Pinnacle staff member to meet with your team for an initial start up meeting, please contact Michelle Bayley to arrange a time. It is important that you have a representative from each area of your team at that meeting to help ease the load of one person trying to complete all areas of the standard.
It is important practices set up processes to ensure that when assessment date comes, it is not a big piece of work. Products such as GP Docs are useful to manage the process within the practice. If you do not have a product such as GP Docs, it is important as a team you are consistently using staff meetings and clinical governance meetings to update a few policies each month.
Any recent changes to legislation or requirements within the standard are captured on the RNZCGP changes within each criteria or under Foundation Standard recent updates.
Despite the increase in immunisation providers outside general practice since COVID-19, general practice continues to be the service that facilitates the majority of childhood immunisations. A good process that identifies roles and responsibilities, timing and method of inviting (recalling) whānau for immunisation can improve coverage for the practice, with the ultimate health gain of fewer vaccine-preventable illnesses in patients and whānau.
As part of Foundation Standard criteria 7.2, practices are required to have a documented process on how recalls are undertaken in general practice. The areas that need to be covered in the standard are outlined in this process. Pinnacle has put together a process for practices to use/amend that covers those areas (see the files section below). Your nurse leads and child immunisation improvement nurse are always available if you have any questions about immunisation or practice recall process email@example.com
All practices in Aotearoa New Zealand need to meet Foundation Standard, a standard set by RNZCGP. Pinnacle has trained assessors and as part of Pinnacle membership we provide practices with free assessment.
Pinnacle provide support in a variety of ways. Contact the practice systems support team, nurse leads or Michelle Bayley if you have any clinical questions. Join the monthly Zoom for updates on trends we are seeing during practice assessments and answers to any questions you might have. These are advertised through our newsletters and on the events page of our website.
We recommend that once practices have met the standard, they put in place a regular way of reviewing policies for the future and divide that up so that it doesn’t become the burden of one staff member.
Key themes from practice assessments
All practices must comply with the PHO enrolment requirements when enrolling patients. These are summarised on our website, including a useful video for practices presented by Te Whatu Ora.
Through Foundation Standard assessments and discussions with Te Whatu Ora Health Payments Integrity Unit, the following points may be of interest.
Through the foundation standard assessment process a few gaps have been noted around the management of hazardous substances within practices.
Under section 13.2 practices are required to show evidence of:
Consideration should also be given to eliminating the risk where it is reasonably practicable to do so.
Where it is not reasonably practicable, then a plan on how to minimise the risk could include:
Procedures in your Emergency Management Plan and/or your Health Emergency Policy are reviewed and updated on a regular basis with consideration being given to relevant legislation and practice standards.
Worksafe has produced a practical guide on working safely with hazardous substances. This includes instructions for filling out inventories, a hazardous substances calculator and other resources. It is highly recommended that practices use this website to record their hazardous substances. This site will also help practices determine what substances in their practices are hazardous including those that don’t meet the threshold such as medical detergents, bleach and the mercury in a sphygmomanometer.
It is a legal requirement for team members handling hazardous substances to be able to manage these safely and have had training that is documented. Team members can do inhouse training using the data sheets. The RNZCGP has provided a data sheet training template to assist practices with this.
Liquid phenol kept in a bottle is considered a class 6.1 substance and requires certified handler training. Practices using phenol for toenail surgery can purchase phenol swabs which does not require certified handler training. Whitely Allcare supply phenol swabs but only supply these to pharmacies. RNZCGP are currently looking for a supplier directly to practices. In the interim, practices are advised to prescribe the swabs ensuring they are aware of which pharmacies in their area carry these.
Some further clarifications on the AS/NZS 3003:2018 and AS/NZS 2500:202 standards. Practices that have portable RCDs need these to be 10mA which can still be purchased. These are required for Medical electrical equipment that is fastened to the patient in a manner such that contact resistance is lowered and easy disconnection is not possible ie electrodes or transducers attached to the patient, and parts that are in electrical contact with conducting liquids which in turn enter the patient. Examples of these types of electrical equipment include ECGs (plugged into direct current), diathermy, speculum with lighting (plugged into direct current). Electirc beds in a consult room would not need a portable RCD, however in a treatment room where a patient may be having an ECG on an electric bed, and there is a possibility of static electricity or liquid on the bed, then a portable RCD would be safest.
If a practices is new and/or has done alternations after 2018, they will need to be compliant with AS/NZS 3003:2018 and patient areas will need to have a body protected electrical area which includes socket outlet RCDs.
To meet this indicator (9.3), practices need:
Medicines reconciliation is about obtaining the most accurate list possible of patient medicines, allergies and adverse drug reactions by using two different sources of information. Sources of information could include a discharge summary, community pharmacy records, the patient or whānau, your practice management system. Reconciling medications reduces the risk of medication errors and confusion that may occur during patient transfer of care. The RNZCGP have some good guidance around this based on the Health Quality and Safety Commission Medicine Reconciliation Standard. Most practices find that by starting with patients who have been discharged from hospital, it makes this a tangible group of patients to start the process with. Also we know that the interface between primary and secondary care is the area where most errors can occur so this is a good group of patients to use this process.
The RNZCGP have a general policy that practices can use as a template.
Ensure you cover:
Every practice needs to audit regularly against their process in the policy. The college have a good template that you can use on their site (medicines reconciliation paper form in the guidance). This template on its own is not enough to meet the standard. Ensure you include in the narrative the way you audited your patients. Acknowledgement to Lakes Surgery for their example below.
To meet this indicator (9.1), practices need:
All practices are required to have a repeat prescribing policy. There is some good guidance on the RNZCGP website.
The documented policy for repeat prescribing needs to outline a reliable, safe and consistent approach to repeat prescribing. The policy needs to be clear on who generates, takes responsibility for, and the process for generating repeat prescriptions and the audit process.
New additions since last policy renewal
There is a requirement for the practice to audit against the process in the policy including a view on prescribing to Māori vs non Māori. Look at a previous day or week to audit of all the repeat prescriptions generated by the practice.
The audit needs to reflect checks that show alignment with your policy. A good way to do this is to print out your policy and mark points you want to monitor. Depending on what is in your policy you could audit:
Include in your evidence:
17 August 2022
Ngā Paerewa, the Health and Disability Services Standard has been updated. This relates to Foundation Standard indicator 14 of the 2020 standard.
This may mean some significant changes to what your practice is currently doing, or a re-alignment to your current policies.
The most significant ones, as a starter for you to be aware of, include the following.
- It fosters continuous quality improvement (CQI) and is considered best practice for primary care. In order for the practice to document how team members are going to manage infection prevention and antimicrobial stewardship.
- Antimicrobial stewardship is about avoiding the unnecessary use of antimicrobials, for example, antibiotics, and making sure that whenever they are used, they are used with care to minimise the risk of antimicrobial resistance. Patients, doctors, nurses and pharmacists all play an important part in antimicrobial stewardship. Note as primary care does not have a national antimicrobial stewardship programme, practices are exempt from 5.3, 5.4, 5.5.4 and 5.5.5. More information is found on the foundation standard page.
Enjoy a deep dive into the updated standards! They are very readable and practical. The nursing lead team is always available for kōrero on this subject.