Camden CCG Survey of GP Views Surrounding CMC

March 2014

Introduction

• CMC IT system out to procurement – relaunchAugust 2014

• Survey Monkey questionnaire – November 2013• 10 questions• Emailed to all Practice Managers after promotion

in monthly meeting for distribution to GPs• Advertised on Camden GP website for 2 weeks

Background

• CMC went live in Camden in March 2013

• Camden population ~244,000

• Camden CCG EOLC LCS payment of £40 per record created, £10 per “closure” of record

Monthly Additions

March April May June July August September

October

November

December

January

February

12 13 31 17 22 6 19 18 14 24 30 26

• 242 total records created (as of 10th March 2014)

• 16.5% of expected EOL population (0.59% of

244,000)

Actual Place of Death – recorded

51

3

15

14

Home

Care Home

Hospice

Acute

Camden GP Activity

• 45 records originated or approved by GPs in Camden (18.6% of total)

• Only 11 Camden practices engaging (out

of 39)

Survey Results

• 19 responses (at time of survey, only 16 GPs actively using CMC)

• Open-ended survey

Q1: Are you involved in the care of dying patients?

1

5

8

5

0 2 4 6 8 10

No never

Yes rarely (once or twice a year)

Yes sometimes (most months)

Yes frequently (weekly)

Number of responses

Q2: Have you heard about CMC?

18

1

Number of responses

Yes

No

Q3: Have you ever completed a CMC record for a patient?

6

13

Number of responses

Yes

No

Q4: Do you feel any of the following statements are barriers to you using CMC? Tick all that apply

Patient refusal (0)Not interested (0)

Not part of my job/role (1)Not had an appropriate patient (1)Not heard about it (1)Can’t be bothered (1)

Started a record, but never finished it (2)

Not received log-in details to use it (4)Not had any training to use it (4)Better done by specialist palliative teams (4)

Not confident in using the system (8)

Don’t like the computer system (10)

Lack of time (12)

Lack of interoperability with GP computer systems (15)

Q4: Comments

“No training but have worked my way through”

“It is extremely annoying that it fails to integrate with any existing systems, and that it requires a

separate log on.

Faxing a form to OOH takes me 3 minutes. Filling this in takes 45. Obvious why I don't use it!”

“Whole practice staff waiting months for log ins after

training”

“Main issue is we have so many logins already, and CMC login has to be reset frequently (every few months I believe), and with the frequency we make palliative care referrals (around once every few months for a

typical GP), our login does not work by the time we get to it.

Our feeling is that it is much better if we stick with our palliative care referral forms, and the local palliative

care team fills it in.”

Q5: Any suggestions for how we can change CMC to make you more likely to use it? – 16 responses

“Pull data from our GP system to save workload and

repetition”

“Integrate with EMIS - even a simple link to their log-in page would make it much more

user friendly. Nobody wants to use a completely separate system for the relatively few contacts we have with palliative patients”

“Much shorter and easier to use”

“Needs to be much quicker eg link with

Emis system”

“Needs to link with EMIS Web.

Medication screen could be made much more simple.

Should automatically move people who have died off workflow tray.

Who on earth designed the website name!!!! If you want this to be used

CHANGE IT”

“Link it to our EPR”

“Roll out learning about the system and using the system to GP trainees as it's a good stage to begin using it”

“Less issues with passwords, integrated with EMIS and current systems”

“Integrate it with EMIS Web, then almost all GPs would use it straight away”

“Easier access. Interface with EMIS Web”

“Get it integrated with primary care systems. Avoid having to have a separate password”

“Data from EMIS Web to be captured onto CMC system to avoid repetition of inputting data”

“Make it much briefer. Too cumbersome and time consuming to use in real world General Practice”

“I found it very difficult to set up an encounter and navigate round the site”

“Integrate it with EMIS web so it can be autopopulated, anything with a changing password system is doomed to not be used if used infrequently and to my knowledge I have never received a password that I am aware of”

“Not intuitive, not a user friendly interface, no interoperability, time consuming - would the time be better spent talking to the patient.

I do think it is a good, indeed crucial idea, but am tempted to wait before using it, until the interface is improved”

Q6: Are you aware of the financial incentives for using CMC included in the EOLC LCS?

10

9

Number of responses

Yes

No

Q7: How confident are you in identifying CANCER patients approaching the last year of their life?

0

0

12

6

0 5 10 15

Not at all

A bit

Mostly

Very

Number of responses (1 skipped)

Number of responses

Q8: How confident are you in identifying NON-CANCER patients approaching the last year of their life?

1

5

11

1

0 5 10 15

Not at all

A bit

Mostly

Very

Number of responses (1 skipped)

Number of responses

Q9: How confident are you in discussing advanced care plans (including resuscitation status) with patients?

1

5

10

2

0 5 10 15

Not at all

A bit

Mostly

Very

Number of responses (1 skipped)

Number of responses

Q6: Which methods of teaching would help you develop your competence in the care of people at the EOL? Tick all that apply

5

7

9

11

5

Number of responses (1 skipped)E-learning

Formal teaching sessions

Group clinical supervision

Spending time with the local palliative teamsWorkshops

Conclusions

• Poor GP engagement with CMC

• Commonest reason INTEROPERABILITY

• Camden CCG EOLC study day March 19th

• The Design Council to review current CMC system

Areas to Focus Upon

1. USABILITY-navigation-terminology -passwords-website address-condense -user interface

2. INTEROPERABILITY-with GP system (EMIS web)-flagging

3. CMC LOGISTICS-too many IG forms -timely release of log-ins-system training