Compulsory PCS: What do GPs really think?

Sampling included GPs from four ICGP faculties (two rural/two urban). The study was conducted with agreement of faculty secretaries. ICGP members were identified from their listing on the ICGP website. Sample size was 362 doctors, equivalent to 14.3% of ICGP membership of 2,515.³ A questionnaire was developed and piloted to establish the uptake, experiences and acceptability of the ICGP CPD Scheme to GPs. It was sent in two mailings (December 2011 and March 2012) to coincide with the end of the first year of the scheme.

A response rate of 71% (257/362) was achieved; 76% (196/257) of respondents worked in urban areas, 74% (190/257) were in a practice with two or more doctors, 93% (238/257) are enrolled in the new scheme and 87% (222/257) were doing an audit.

Fifty-six per cent (145/257) of respondents found the PCS fee of €267 unacceptably high. A minority, 34% (133/257) found the system of credits awarded by the scheme clear, 47% (121/257) indicated they believed it would improve the care they deliver, while 38% felt it had increased workload significantly. The results will provide insight into GPs’ experience of the Professional Competence Scheme, and will be relevant to ICGP scheme administrators, as well as reflecting the experience of GPs.

Methods

A postal questionnaire was devised with a view to establishing basic demographic profile, to ascertain uptake of the ICGP administered Professional Competence Scheme and GPs’ opinions of the scheme. Mailing lists were obtained from the ICGP website (December 2011). Four areas were selected; Kerry, Cavan/Monaghan, Dublin South, and Dublin North. The study was discussed and agreed with the relevant faculty secretaries. The questionnaire was piloted (n = 20) for ease of use and clarity, and minimally modified. Pilot data was not included in results.

Mailings were sent out in December 2011 and March 2012. A stamped addressed envelope was enclosed, together with a cover letter explaining the study. Given the survey solicited confidential feedback from GPs only, with no direct patient involvement, no ethical issues were identified.

Results

Profile of respondents and practices

The response rate was 71%, (257 of 362 GPs surveyed), with 76% of responders working in urban areas. Most GPs worked with at least one other doctor (74%). The average reported ratio of medical card patients to private was 56:44. A majority of responding GPs were male (67%), and were aged over 50 years (62%).

In South and North Dublin the response rate was 66.8% (115/172) and 70.5% (79/112) respectively. In Kerry the rate was 80.9% (34/42) and in Cavan/Monaghan it was 80% (29/36).

GPs’ experience with the Professional Competence Scheme

Ninety-three per cent of GPs responding indicated they had enrolled in the scheme, and 87% indicated they were doing an audit. Asked to rate the clarity of the scheme’s system of awarding credits, only 37% indicated it was ‘clear,’ 34% indicated it was ‘unclear,’ with the remainder ‘undecided.’ Just over half (54%) indicated it was likely that GPs would uniformly comply with the scheme. Asked if participation in the scheme would improve the care they provide to their patients, 47% indicated that it would, and 27% indicated it was unlikely to. Most (89%) of responders had logged onto the ICGP website for the purposes of the PCS, but only 46% indicated that it was ‘easy’ to use.

Asked how the scheme has impacted on workload, 48% indicated it had increased workload ‘somewhat’ and 37% felt it had increased workload ‘significantly.’ When asked about the fee of €267, a majority (56%) indicated it to be ‘unacceptably high.’ 

Eighty-seven per cent of respondents indicated they were doing an audit (data collection completed March 2012).

Discussion

There is a well developed literature in relation to factors thought to be relevant in GPs’ engagement with their own professional development.⁴

The profile of respondents studies here indicates this sample to be comprised of predominantly older male GPs, and results should be interpreted accordingly.

There is a high degree of self-reported enrolment and participation with the scheme. This may reflect negative drivers of behaviour (eg. concern to maintain registration on the medical register), or positive drivers, including a well developed process of support for audit by the ICGP,⁵ and long established small group learning networks.⁶

A majority of GPs have logged on and used the ICGP website for PCS, although just under half reported it to be easy to use. This impression may reflect the extent to which older GPs feel at ease with online activities.

There remains a lack of clarity surrounding the system for awarding credits, with only 37% finding it clear. The com- ments section particularly revealed confusion surrounding internal and external accreditation. Engagement with the audit requirement is good, with 87% auditing or intending to audit within the year.

The commonest areas of audit given were diabetes (24), vaccination (24), thyroid disease (12), methadone (8), pre- scribing (16) and COPD (10). Given the extent to which certain important disease areas (COPD/depression), known to be of significance as leading causes of premature morbidity and mortality, are not the subject of managed care initiatives7 by individual GPs, thought might be given to formally encouraging or directing GPs to audit these areas of care in future audit cycles.

Markedly increased levels of GPs are now carrying out audits in this sample (87%), relative to that previously reported (25%) among Irish GPs.⁷ The majority of GPs feel the scheme has impacted on workload, and more than half report the current fee to be unacceptable.

GPs were asked to identify the single most important area of continuing professional development, with most indicating CME small group meetings (85), external (35), reading (14), internal (9) and faculty meetings (5). The high level of importance given to small group meetings may again reflect the sustained and long term development of faculty based small group learning undertaken by the ICGP and its members over several years.^8,9

Given this level of importance attaching to tutor-led small group work in Irish general practice, the continued reduction in tutor availability is of particular concern.

The cohort of GPs used in this study was compiled using the ICGP website’s ‘Find a GP’ listing. It should be noted that not all enrollees on the ICGP PCS would be included in the ‘Find a GP’ listing. This should be taken into account when interpreting results.

Overall, most GPs are engaging well with the scheme. A large proportion believe it will improve patient care, although most disapprove of the fee and feel the PCS has increased their workload. There remains confusion and a lack of clarity surrounding the scheme’s system for awarding credits. CME small group meetings remain the most popular form of continuing professional development.

Most respondents are intending on auditing this year and, given the scheme’s requirements, there may be a trend towards new areas of professional development in the coming years.

Data from this study will be useful as a baseline against which to measure future engagement with and development of the professional competence scheme.

Acknowledgements: Participating GPs and ICGP faculty secretaries

References

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