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By Alan Gillies;Bev Ellis;Nick Lowe

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Some of the issues around integrating the current local CHD programme into the requirements of the NSF are discussed later. The principles developed can hopefully be applied to future NSF implementations that are imminent. The requirements of clinical governance, increased accountability and the wish to continuously improve the quality of care are important motivators for most primary care managers. Doctors and nurses are keen to demonstrate that they are providing a high quality service. As ever there is a danger that audit and data collection start to be seen as the main drivers of clinical activity rather than the real drivers, which are about patients and their problems.

Unpublished report supported by the US Air Force Office of Scientific Research (Contract F49620-79-C-0063), University of California at Berkeley. Managing the process of change • 35 In this way, a training needs matrix may be defined for each GPIMM level: Role GP Competency 1 Competency 2 Competency 3 Competency 4 Competency 5 Required Required Required Required Required level level level level level Required Required Required Required Required Administrator Manager Nurse level level level level level Required Required Required Required Required level level level level level Required Required Required Required Required level level level level level The skills of the staff may then be audited against that required for the current or target GPIMM level.

This has in turn led to the adoption of a very limited computer-based solution, which has specific risks attached to it. The dependency upon the FHSA has major risks associated with it in terms of data integrity. The problems with access and training increases risks due to ignorance and highlights many opportunity risks which are normally associated with paper-based systems, there are risks of information not being available for health promotion, management and monitoring. A linked practice: One doctor, 1200 patients The practice This practice had a well established computer system and the doctor and his practice manager were very comfortable with the technology.

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