An Coiste FeabhaisAcadúil
The Committee on Academic Quality Improvement
The Academic Quality Assurance Programme 2002 – 2003
REVIEW OF
THE DEPARTMENT OF GENERAL PRACTICE
Final Report
Department of General Practice: Review Group Report
February 2003
This report arises from a visit by a review team to the Department of General Practice
on 4th February 2003. The Department had already prepared and submitted a 'Self
Assessment Report' that, with other documentation, was made available to the review
team well in advance of the visit.
The review team consisted of: Dr Margaret Cupples, Dept. of General Practice, Queen’s
University, Belfast (Chairperson); Professor Patricia Casey, Department of Psychiatry,
Mater Misercordiae Hospital, Dublin; Professor Peter Mc Carthy, Department of
Radiology, NUI, Galway; and Ms Marilla Keating as Secretary.
The report is structured to cover the following main topics:
1.
2.
3.
4.
5.
6.
7.
1.
Aims and Objectives
Organization and Management
Programmes and Instruction
Scholarship and Research
Community Service
The Wider Context
Summary and Concluding Remarks
Aims and Objectives
The aims and objectives are clearly stated and presented in a coherent statement
outlined in the self-assessment report. The Review Group would wish to compliment
the Department on its presentation of a comprehensive Self-Assessment report.
2.
Organization and Management
It is the opinion of the Review Group that the Department of General Practice consists
of a vibrant, young, energetic, hardworking, dedicated staff, guided by a committed, fair
leader who is held in high esteem by both staff, students and the local primary care
community.
There is clear evidence of mutual support between the multi-disciplinary members of
staff who work very well together as a team. Excellent interpersonal skills, respect,
communication and relationships were displayed through all the literature presented and
discussions with the Review Group. All staff, students and Health Boards commend
Professor Murphy for the work he has done in developing such an active Department,
particularly within a very short space of time.
As the Department develops there is a clear need for additional staffing. A need for the
support of a bio-statistician and an academic with expertise in a social science was
clearly identified. Currently advice relating to these areas of resource is provided for
staff by someone who is responsible for managing one particular project and whose
availability is therefore limited. This person is employed only on a temporary contract
and the Department cannot rely on her continuing support for future research work.
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Department of General Practice: Review Group Report
The need for an expansion of the Department in order to sustain its viability has been
emphasised both in our discussions with research and teaching staff and in our
discussions with Health Board personnel. A positive development in the appointment of
an additional lecturer was recognised but it was suggested that more definitive support
and evidence of commitment from Central University Sources is needed to encourage
the continuing input of Health Boards. This is important so that medical students may
have experience of good exposure to and teaching in General Practice. Financial
resources must also be identified for adequate provision of postgraduate development in
primary care. With the current Primary Care Strategy there is a need to continue the
valued input of the Department to both undergraduate and postgraduate training, to
promote the recruitment and retention of staff to primary care and support research,
which will encourage the implementation of evidence in practice. In our discussions
appreciation of the multidisciplinary skills of the Department was expressed. Both the
Western and North Western Boards were happy to be associated with the Department in
its research activities.
The Review Group learned that there are only two members of the Department with
tenured contracts- the professor and secretary. The remaining staff have temporary
contracts ranging from 7 months to 3 years. This we believe has a major impact on
morale and limits departmental strategic planning, of both teaching and research. With
limited resources, large volumes of teaching, skeleton staffing and huge dependence on
the goodwill of the local general practitioner community we perceive a potentially
unstable situation which may jeopardise the growth of the Department.
The Review Group strongly recommends the conversion of Temporary Teaching
Assistance (TTA) contracts to permanent part-time teaching contracts. Two of the
temporary staff members are at a late stage of their postgraduate degrees and there is a
real risk that they will move to permanent posts in other institutions. For those
employed in temporary contracts there are no pension benefits, no travel support
funding, no clear career pathways and no security. All of this has a direct influence on
the Department’s strategic plans. The Head of Department carries out much of the
Department’s administrative functions as he does not believe it is appropriate to burden
temporary staff with these issues.
Recent difficulties relating to the appointment of a Senior Lecturer have been quite
devastating to staff morale and a personal blow to the professor who has made a
significant time commitment to preparations for the post. He had understood that the job
description had been clearly defined and agreed with Health Boards and relevant
University personnel and was very disturbed to discover problems within a few days of
interview. Several months have now elapsed since interview and it appears that the only
written information received by the Departmental Professor regarding this appointment
has been a letter confirming a salary appropriate to a non-clinical lecturer. It would
appear to the Review Group that a clinical Senior Lecturer, as had been expected, would
have been a more appropriate appointment to this Department which provides an
essential clinical contribution to the university’s teaching within the medical
curriculum. We believe that University personnel should consider clarification of this
situation.
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Department of General Practice: Review Group Report
Members of the Review Group are pleased to hear that an appointment of a part-time
additional secretary has been made in the week preceding this review.
Accommodation is undoubtedly unacceptable. Working conditions available to most
staff members are very cramped and poorly ventilated, with no access to natural light.
On a heath and safety issue we would be concerned about these working conditions.
Space is obviously is at a premium – inadequate for current staff and restricting
expansion of staff numbers. There is a possibility of alternative accommodation in
another location (Distillery Road) but we believe that it would be disastrous to the
development of the Department. One of the strengths of the Department is the close
proximity of staff members to each other, with excellent communication opportunities,
which enhance co-operation.
The Review Group were very disappointed that the Department has no online access to
their accounts as the accounting package Agresso is not fully functional. This is
causing distress and concern to staff who have responsibility for major budgets and
requires urgent attention.
With respect to staff development and training, all staff are encouraged to partake in
continuing personal development. We are pleased to note that Professor Murphy has
been willing, despite his limited secretarial support, to allow the current secretary to
attend professional development courses.
The Department relies heavily on the good will of the GP tutors when students are on
attachment. The importance of maintaining this good relationship is recognised by the
Review Group, taking into account the potential difficulties in placing students,
including facilitating changes at short notice.
3.
Programmes and Instruction
There is clear evidence of student involvement in programme review. There are plans
for involving student involved in a core curriculum committee and the Review Group
would encourage this.
The Review Group would compliment the Department on its innovative programme of
postgraduate training in primary care.
Higher Diploma and Masters in Primary Care
The Review Group conducted teleconference interviews with two students who had
completed the Higher Diploma course. Both commented very positively – one
described the course as “ a joy to do- the course was perfectly done, the handouts and
lecture quality was excellent, staff were approachable and helpful.” This view was
seconded by the other student. The course co-ordinator has clearly put a lot of
dedicated effort into revising the programme in the light of feedback and is to be
complimented. One postgraduate student reflected on the value of having had
multidisciplinary involvement in learning. This has broadened their understanding of
other professionals’ work and continues to benefit them in their everyday work.
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Department of General Practice: Review Group Report
Access to St Angela’s library in Sligo is limited. Students are not permitted to borrow
books. The Review Group would suggest that steps should be taken to address this issue
to allow regular access to these students, some of whom travel considerable distances to
this university resource.
A need was also identified in respect of provision of appropriate support for students to
access library information from their own computers.
Problems have occurred in respect of time taken in the process of student registration.
H-Dip and Masters students must register alongside all other postgraduate students.
Time is precious to these students who seek to register during their summer school
programme, which entails a week of intensive time-tabled study. We understand this
difficulty will be remedied in the incoming year with on-line registration becoming
available.
Under Graduate Programme: 5th Year Medical Programme -General Practice
Students spoke positively about their time in General Practice and about the quality of
information in the handbook and handouts provided during the course. They appreciated
the enthusiasm of their GP tutors in the practice attachment. The students specifically
appreciate the Department’s involvement in teaching basic clinical shills such as taking
blood and performing intimate examinations. However they describe a steep learning
curve in that this large volume of material was delivered very close to the OSCE. The
Review Group believes that these basic clinical skills should be taught much earlier in
the curriculum.
The students would like the Department to consider their access to the use of a car when
allocating practice attachments. Students spoke of the expense involved in paying for
accommodation if attached to practices located within the Western Health Board
(WHB) area. Unlike the North Western Health Board, the WHB does not reimburse
students for travel or accommodation expenses. Dr Hynes from the WHB does not
recall this issue ever having been raised with them. Following feedback of this
information the Review Group has been informed that the professor had, prior to Dr
Hynes’ appointment, written twice to a member of the WHB Primary Care Unit
requesting such support. This matter should be followed further.
Early Patient Contact Programme (2nd Year pilot )
This pilot programme was very favourably reviewed by students. It is an innovative
programme with immediate relevance. Unfortunately staff resources within the
Department currently are insufficient to sustain its delivery. The Review Group suggest
consideration should be given to identify resources to allow students to develop their
understanding of the management of illness within the community at this early stage of
their training.
4. Scholarship and Research
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Department of General Practice: Review Group Report
The Review Group were impressed by the amount of research output from this small
department, driven in the first instance by the Head of Department and filtering into the
wider general practice community. We would like to congratulate the Department in
developing its research ethos with lunchtime seminars and regular research meetings
despite the previously mentioned constraints in resources and staffing.
This comprehensive research programme, which has gained international recognition,
will be hampered with the absence of a medical statistical adviser. This issue may be
accommodated from within Faculty resources.
Financial Research support appears to be only available to permanent full time staff. It
appears that health services research is excluded from PRTLI. The Dean of research has
agreed to look into possible funding for TTA’s, such as travel support. The Dean is also
willing to consider a mechanism on how research methodology teaching would be made
available at Faculty or Departmental level. The need for GPs to improve their
background research skills before undertaking postgraduate degrees in research was
identified.
The Dean would welcome contact from staff with an interest in research. He wishes to
be kept up to date with current research projects and would wish to be helpful in trying
to identify sources of support.
Health Boards:
Funding from the Western Health Board was raised during the Review Group’s
telephone call. Unless radical changes are made in the growth / expansion of the
Department the group had some concerns that the current funding may not be sustained.
However, the NWHB were very supportive. Both Health Boards stated that it was
crucial at this current time to have a strong Department of General Practice in view of
the developing primary care strategy. The need for good exposure to teaching in general
practice was highlighted, since 50% of undergraduate medical students become GPs.
The Review Group was pleased to see the library faculties that were available, which
are very user-friendly in layout with a very helpful librarian who provides useful
handouts and helpful information on data bases which are currently updated regularly.
5.
Community Service
The Department acknowledges that it has focused on in-house development rather than
on making commitments to organisations within the wider community. However, they
do have positive plans to extend their community involvement both nationally and
internationally with the acquisition of more tenured staff. Nevertheless we would
comment that the research work in which the Department is engaged is of immediate
relevance to the wider community locally and nationally.
6.
The Wider Context
This Department is involved in clinical teaching, of paramount importance to
undergraduate medical students, but its influence extends beyond the confines of the
university. Involvement with various statutory and voluntary sources of provision of
health care within the city and region provides support to these organisations and the
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Department of General Practice: Review Group Report
individuals participating in their work. The Department currently has a leading role in
the professional and personal development of those who work within primary care. It
has been creative in developing new educational courses for both undergraduates and
postgraduates. Its ongoing research studies will provide important information for the
development of public policy, both regional and national, regarding health care
delivery. Involvement of Departmental staff in the postgraduate activities of the local
primary care community must continue in order to promote effective use of resources
and efficient delivery of health care. The opinion of the Review Group is that the
Department makes a huge contribution in all these areas, particularly in view of its
limited resources.
7.
Summary and Concluding Remarks
1. Staffing:
This Department’s teaching, research and clinical commitments are such that we would
recommend the university should consider immediate ways of securing continued high
standards in the delivery of these. The Department’s full potential may be realised by
reviewing the two temporary contracts which exist currently (the undergraduate tutor
and the co-ordinator in Primary Care), making these tenured and increasing the numbers
of staff employed. Failure to attend to these considerations may mean that the delivery
of the Department’s commitments becomes less than adequate.
2. Accommodation:
There is urgent need for creative thinking regarding the provision of adequate
accommodation to provide proper space allocation, ventilation and lighting for current
staff and for prospective additional personnel.
3. Central University Support:
Access to current information about financial accounts for which staff have
responsibility must be provided. Attention should be given to identifying financial
resources to support students in their practice attachments, adequately re-imburse GP
tutors for their time spent in teaching, support research within the Department and
involvement in postgraduate education and research.
The Review Group considers that this Department has an excellent record of
achievement since its relatively recent beginning. We have highlighted
recommendations, which we feel are crucial to its continued viability. Recognition of its
needs by the University and provision for these will undoubtedly allow the Department
to gain further national and international acclaim.
Suggested specific recommendations:
1. The University must consider the potential instability of a clinical teaching
department in which no-one except the professor holds a full time tenured contract.
2. More staff with tenured contracts should be appointed to allow the department to
realise its full potential, continue delivering high quality undergraduate and
postgraduate teaching and plan strategic development.
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Department of General Practice: Review Group Report
3
There should be written communications between the university and the professor
regarding difficulties attendant in the current process of appointment of the Senior
Lecturer.
4 A source of medical statistical support must be identified to support ongoing
research and the submission of high quality research proposals for funding
opportunities.
5 Appointment of a staff member with social science expertise would enhance
research activity and facilitate teaching.
6 Alternative arrangements for staff accommodation must be made urgently: it is
recommended that the solution should not result in the dispersal of staff to different
locations.
7 A facility to allow staff with responsibility for budgets to have immediate access to
information regarding these finances must be provided.
8 The university should consider ways of supporting departmental research activity,
recognising that several potential sources of funding available to other university
department s are not applicable to general practice.
9 Consideration should be given to identifying additional financial resources to
support teaching, recognising inequalities regarding reimbursement of student
expenses and of GP tutors’ time.
10 Postgraduate students should have access to St Angela’s library with similar
privileges to those enjoyed by other NUIG students.
11 Adequate support for students to access central university library facilities using
their own computers should be ensured.
Comments on The Methodology of the Review Process
All contacts of the University administration personnel with the Review Group prior to
and during the review process were extremely courteous and accurate. The process of
the review was very efficiently managed throughout.
The Review Group members wish to thank the Department of General Practice, NUI,
Galway, for their diligent preparation and presentation of their work. We would hope
that the process of this review has clarified the current strengths and weaknesses of the
Department and will provide a sound focus for further development.
The Review Group:
Dr Margaret Cupples, Dept. of General Practice, Queen’s University Belfast (chair).
Professor Patricia Casey, Dept. of Psychiatry, Mater Misercordiae Hospital, Dublin.
Professor Peter Mc Carthy, Dept. of Radiology, NUI, Galway.
Ms Marilla Keating (Secretary).
February 2003
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