1. Act on colleagues' comments in your multi-source feedback (MSF) if they suggest you could enhance patient safety or quality of care. Discuss this later with your appraiser.
2. Audit a patient pathway or practice protocol. Are all team members adhering to the agreed pathway? Help those who are 'doing their own thing' to conform to practice policy.
3. Learn from a significant event audit. Include the whole team in finding out what went wrong and what might help prevent a recurrence. Once implemented, check that any changes made have worked.
4. Set up systems for the team to minimise the frequency and effects of mistakes.
5. Take the lead in your practice team or in a local group of professionals in relation to a clinical field or a particular aspect of GP work.
6. Make the most of continuity of care. Ask patients to come back for further review if you are uncertain about their care and/or refer them onto others in the team for a second opinion. Record such examples of teamwork in your portfolio.
7. Define your part in any clinical or organisational audit done at your practice. For example, audit the care you provided versus that of colleagues.
8. Describe how you and/or the team involve patients in planning and delivering services and how patients' feedback is considered and acted on.
9. Describe how the practice's patient participation group (set up one if no such group) is supported and briefed and how its voice is heard.
10. Demonstrate your support for patients' self care. Do you/the practice provide self-management plans - for example, information sheets for asthma patients? Reflect on how self care works out in real life.
11. Reflect on your latest patient survey and consider what changes you should make after discussing it with the practice team. Demonstrate your support for patients' self care: for example, with information leaflets in various languages or by auditing patient literature quality.
12. Discuss the results of your patient survey outside the practice team - with the patient participation group or your appraiser.Demonstrate your support for patients' self care: for example, by matching their preferred mode of communication - email, text, telephone consultations.
13. Audit whether outcomes are as good with patient self management as with doctor/nurse led care.
14. Audit whether you and others record the pat-ient's occupation as a norm. Do you take it into account in clinical management or dec-iding if a patient is fit to return to work, for example if their job involves lifting and they have a back problem?
15. Keep good, comprehensive medical records: include warnings to patients about potential side-effects and action to take.
16. Capture all remarks, good and bad, from patients (from the receptionist log, suggestion box or website comments, say); and feed back to all the team and to GP locums.
17. Keep asking questions. Find out what you need to know from your primary care organisation (PCO), practice manager, the BMA, allied health professionals, and so on.
18. Put time, effort and resources into building and sustaining your team. Plan for an effective skill mix with training needs assessments, protected time for learning, recognition of enhanced skills and contributions to the team.
19. Ensure all team members know their role in any emergency, for eample, if a patient is unconscious or fitting, or is a threat to security. Log team protocols, training and any significant events.
20. Get data about your and your practice's performance from your PCO. Look at whether you are at an extreme of the range for, say, referrals and prescribing and make changes as appropriate. Log all this in your portfolio.
- Professor Chambers is honorary professor at Staffordshire University and a GP in Stoke-on-Trent