Quality Review – Aiming for Excellence and CORNERSTONE®

Today the College is announcing a review of our quality standard Aiming for Excellence, and our quality improvement programme, CORNERSTONE®.

Aiming for Excellence and CORNERSTONE® have been in place for about 20 years. While they have evolved during that time, change in the sector, and in New Zealand as a whole, has happened faster, and things are now out of kilter.

There are major changes happening in general practice and primary care, and we have a Government committed to having more services delivered in primary care, and to training more GPs.

We need a fit-for-purpose, modern, quality improvement programme for general practice that creates the right environment for these changes to be successful.

College members, practice teams and Primary Health Organisations have told us they want quality standards that support environments where more care can be delivered safely and equitably. Our own research, which we are releasing today, confirms this.

 

College members, practice teams and Primary Health Organisations have told us they want quality standards that support environments where more care can be delivered safely and equitably. Our own research, which we are releasing today, confirms this.

Our plan is to completely revamp Aiming for Excellence and the CORNERSTONE® programme. The following principles will be followed in the review process:

  • a mandatory, minimum quality standard that all general practices must meet – currently the Foundation Standard should continue;
  • the new programme should focus on quality indicators and measures that enable care to be delivered safely and equitably;
  • there should be non-financial incentives for practices to undertake quality improvement activities that improve patient outcomes for enrolled populations;
  • there should be a recognition system to acknowledge practices that consistently perform well against the standard;
  • compliance costs should be reduced through initiatives such as developing a framework to cross-credit activities done for continuing professional development, and other assessment and certification purposes with CORNERSTONE® requirements and vice versa;
  • as much assessment as possible done online to reduce time spent in practices; and
  • there are tie-ins with other credentialing assessments, eg: day surgery requirements.

We won’t know all of the details until we’ve done further work, including consulting extensively with the sector (PHOs, practices, College members, PMAANZ, the Ministry of Health and other stakeholders).

We have set ourselves a target of having a new programme agreed by 1 December 2018, for practices to start implementing from 1 April 2019.

We know that there are many CORNERSTONE® accredited practices who are due for an in-practice assessment during 2018. The information below outlines the options for affected practices.

The College is committed to working with members, practices and important stakeholders to develop the new CORNERSTONE® programme.

If you would like more information or would like to be involved in the review, please call the College on 0800 433 733.


Cornerstone Review Q &As


Why are we making changes?

Our core quality programme, the Aiming for Excellence standard and CORNERSTONE® quality accreditation programme have been in place for about 20 years. While they have evolved during that time, change in the sector, and in New Zealand as a whole, has happened faster, and things are now out of kilter.

The College Board has decided it’s time for a complete revamp of both Aiming for Excellence standard and CORNERSTONE®. The aim is to work with the sector to develop a quality improvement programme that is fit-for-purpose for the wide variety of general practices and Primary Health Organisations (PHOs) in New Zealand today. A one-size programme no longer fits all our practices and the needs of their patients.

The areas we need to focus on were highlighted in independent research commissioned by the College in April this year where practice members, including practice managers and GPs, told us the programme needed to change to stay relevant and appropriate for them. A big part of that request was to reduce the compliance burden on practices and re-focus on meaningful requirements.

The Foundation Standard has been a compulsory PSAAP contractual requirement for all practices not in the CORNERSTONE® programme, since 1 July 2017.

When is the review and how long will it go for?

The review was approved at the College Board meeting on 20 June 2018.

A new programme will be approved by the Board by 1 December 2018.

We expect to implement the new programme from 1 April 2019.

What will happen to practices on the CORNERSTONE® programme?

Practices coming up for an in-practice reaccreditation visit will have the choice of proceeding with the assessment, or extending their accreditation period until the new programme takes effect. There will be no additional cost or financial disadvantage for practices selecting this option.

We know that practices put a lot of work into preparing for the assessments and they may like the assessment visit to go ahead. We are very happy to arrange that for them.

Practices on the annual programme should continue with their self-assessment as this work is likely to make the change to the revamped system easier.

Practices who want to change from the Foundation Standard quality assurance programme to the CORNERSTONE® programme will still have the option of making this change.

Teaching practices who are currently working towards CORNERSTONE® accreditation need to continue with this work because the Board has reconfirmed that all teaching practices with GPEP 1 registrars will have to be accredited by 1 December 2019.

Those with registrars who are in GPEP 2 and not yet Fellows will need to have CORNERSTONE® accreditation by 1 December 2019 using either the current, or the revamped, system.

What is going to change?

We’ve outlined the immediate changes above.

Our plan is to completely revamp Aiming for Excellence and the CORNERSTONE® programme. The following principles will be followed in the review process:

  • a mandatory, minimum quality standard that all general practices must meet – currently the Foundation Standard - should continue;
  • the new programme should focus on quality indicators and measures that enable care to be delivered safely and equitably.
  • there should be non-financial incentives for practices to undertake quality improvement activities that improve patient outcomes for enrolled populations;
  • there should be a recognition system to acknowledge practices that consistently perform well against the standard;
  • compliance costs should be reduced through initiatives such as developing a framework to cross-credit activities done for continuing professional development, and other assessment and certification purposes with CORNERSTONE® requirements and vice versa;
  • as much assessment as possible done online to reduce time spent in practices; and
  • there are tie-ins with other credentialing assessments, eg: day surgery requirements.

     

    We won’t know all of the details until we’ve done further work, including consulting extensively with the sector (PHOs, practices, College members, PMAANZ, the Ministry of Health and other stakeholders).

     

What is going to stay the same?

All practices that are CORNERSTONE® accredited now will remain CORNERSTONE® accredited. We will be asking PHOs and others who have set CORNERSTONE® accreditation as a prerequisite for their own purposes to continue recognising practices’ CORNERSTONE® status while the review is being done.

While the review is happening, Aiming for Excellence and the CORNERSTONE® programme (and its criteria and indicators) will stay the same. Practices on the annual programme should keep working on their annual requirements, because it’s likely that work can be used as evidence in the new programme.

What is happening to the Foundation Standard?

While the focus on this review is on Aiming for Excellence and the CORNERSTONE® programme, it’s possible that this may result in some changes to the Foundation Standard.

If there are changes, they won’t take effect until at least 1 April 2019 when we are planning to launch the revamped quality standard and programme for general practice.

In the meantime, the Foundation Standard will remain the same.

Will teaching practices be affected?

The Board has reconfirmed the College policy that all teaching practices must be CORNERSTONE® accredited. In the past, teaching practices could receive an exemption to this policy if they were working towards CORNERSTONE® accreditation.

Teaching practices who are currently working towards CORNERSTONE® accreditation need to continue with this work because the Board has reconfirmed that all teaching practices with GPEP 1 registrars will have to be accredited by 1 December 2019.

Teaching practices with registrars who are in GPEP 2 and not yet Fellows will also need to have CORNERSTONE® accreditation by 1 December 2019, unless the College Chief Executive gives a formal extension for a specified period.

Why has the College Board imposed deadlines on teaching practices to become CORNERSTONE® accredited?

The Board strongly believes that in order for registrars to practise at a level expected of Fellows of this College, they need to be taught and supported in practice environments that have integrated quality improvement principles into how they care for their patients and strive to improve patient outcomes.

I'm working towards CORNERSTONE® and now it's changing. Have I wasted that work?

If you are doing the process for the first time, please continue and make the transition using the existing standard and accreditation process, especially if you are, or want to be, a teaching practice.

What do we need to know or do while the review takes place?

Practices that already have CORNERSTONE® accreditation won’t have to do anything differently until the review and revamp has been completed.

We will contact practices working towards their accreditation to help them develop a plan for achieving this goal.

Once the new quality standard and programme has been developed, we will provide information and training to ensure a smooth transition from the current programme to the new one.

Where can I get more information, or provide feedback, on how this affects my practice?

There is a lot of information in this set of questions and answers. Other ways of finding out more include: