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CQC’s approach to inspection and regulation

GP Autumn Seminar

September 2015

Dr John Byrne MB BCh BAO DRCOG DCH MSC MRCGP

GP Regional Advisor

PMS Directorate

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Our purpose and role

Our purposeWe make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

Our roleWe monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care.

We will be a strong, independent, expert inspectorate that is always on the side of people who use services.

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CQC approach to regulation

Helpful resources for practices

• Make sure you’ve read our provider handbook, and understand the key lines of enquiry our inspectors will focus on

• Read our mythbusters for tips and further guidance

• Read our Outstanding web tool kit and consider what would make care for people who use your services Outstanding

• Read our ‘What to expect from an inspection’ and case studies to understand what an inspection looks and feels like

• We’ve signposted all of these resources and more in our provider toolkit

You can find our provider toolkit and all of these resources on www.cqc.org.uk/GPProvider

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What happens on an inspection?

Before your inspection

•You will receive a letter announcing your inspection two weeks in advance

•We’ll ask you for some information in advance

• For example, your statement of purpose, records of complaints, serious or adverse incidents

•Your inspector will be in touch to discuss with you what will happen on the day

•We will send you a set of comments cards that your patients can fill out to tell us their views in the period before we inspect

•Look at your own intelligent monitoring

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What happens on an inspection?

On the day of your inspection

•We’ll ask you to give us a short presentation telling us what is Good about your practice and the care it delivers

•We’ll want to speak to all of your staff and as many patients as are willing, in confidence (don’t forget attached staff)

•We’ll want to see evidence of a variety of things and we will need a room to go through this

•Maintain Business as usual

•Feedback session at the end of the day.

•We want your feedback too

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What happens on an inspection?

After your inspection

•We will give you informal feedback and identify any immediate concerns straight after an inspection

•We will send you a draft version of our inspection report, so you can challenge any factual accuracies in the report

•We will quality assure your report, by looking at it with other reports to ensure consistency of judgement

•We will publish the report on our website, and if your report is Outstanding or Inadequate, we will send out a press release about

•You can appeal your rating once it is published

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Inspection feedback from practices

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“My staff told me they found it a positive experience, as they don’t always get a chance to reflect on what we are doing.”

“I would like to thank you on behalf of the team for making in the inspection day as pleasant as possible and for all your efforts in producing your report.”

“I was very impressed with the professionalism of the inspection team.”

“They worked very hard to ensure that the day was as stress free as possible whilst getting the information they needed.”

Our inspection programme 2014/15

• We have published 1,534 inspection reports since we launched our approach to inspecting GP practices in October 2014

• What have we found?

• 4% outstanding

• 81% good

• 11% requires improvement

• 4% inadequate

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85% of GP practices we have inspected are providing a good standard of care

What makes an Outstanding practice?

• Effective leadership

• Strong, shared vision amongst practice staff

• Effective staff training and support

• Positive, patient centred culture

• Effective working with multi-professional colleagues, including from other organisations

• Additional clinical services empowering patients to self-manage long-term conditions (not always commissioned)

• Strong PPG involvement

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What makes an Outstanding practice?

• Support for patients and carers with their emotional needs (e.g coordinating support groups)

• Close working with the community to raise awareness of health conditions

• Contribute to community wellbeing programmes (e.g walking groups and social enterprise programmes)

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What can lead to Inadequate care?

• Weak leadership and a chaotic and disorganised environment

• A lack of vision for the organisation and clarity around individuals’ roles and responsibilities

• A poor culture of safety and learning (e.g lack of significant event analysis or learning from complaints)

• Poor systems for quality improvement (including quality audit)

• Limited examples of assurance of clinical care

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What can lead to Inadequate care?

• Disregard for HR processes (e.g DBS checks)

• Unsafe medicines management (Vaccines storage)

• Limited access to appointments during core hours

• Urgent Care Planning (O2 ,Defibrilators, Medicines)

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Examples of Inadequate care

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“There was no mechanism for the practice to seek patient feedback about services, and complaints had not been used to improve the service.”

“The locum GP was not sure who they should report incidents or concerns to; they had not received an induction and had not seen policies regarding incident reporting.”

“We found no evidence of criminal record checks for the two practice nurses, or any of the non-clinical staff.

There was no system in place to monitor the professional registration status of the practice nurses to ensure they maintained their registration.”

Issues by key questionSafe

Up to the end of May 2015:

• 69% rated Good or Outstanding

• Most practices discuss/share learning from Significant Event Analysis (SEAs)

• We expect to see significant improvement in number of incidents being reported using National Learning Reporting System (already 100 practices using it)

However, safety remains our main concern:

• Of the 977 services rated:

• 25% Required Improvement

• 6% were Inadequate

• Safety issues often relate to poor systems and processes

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Issues by key questionEffective

• We’ve found many examples of good, effective clinical practice, meeting the needs of local populations, e.g:

• Quality improvement programmes

• Coordinated referral processes

• Joined up care with other healthcare providers

• Joined up models of working, benefits observed include:

• Appointments outside normal working hours

• Wider range of services

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Issues by key questionCaring

• Outstanding practices were able to demonstrate, for example:

• Specific support for individual population groups

• Innovative programmes for certain health conditions and flexible access to services

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Issues by key questionResponsive

• Typically practices rated as outstanding had considered the needs of its population and subsequently implemented change. For example:

• Guaranteed same-day appointments

• Extended practice opening hours

• Language support for non-English speaking patients

• Innovation in how primary care is provided is developing rapidly:

• Recently registered new GP care model using technology to provide consultation

• Social enterprises are leading the way in care provision models

• Demonstrate a clear vision to improve health of vulnerable and excluded groups

• Work closely with services across their locality 18

Issues by key questionWell-led

• Our inspection findings show good leadership is the foundation of an Outstanding organisation. Examples include:

• Culture the practice leaders create

• Excellent staff development and support

• Patients are at the centre of their developments

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Population groups

• GPs typically provide good services to their population group

• Common examples of where GPs had done more to adapt their services to specific needs include:

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Population group ExampleWorking age people

Offering appointments outside of usual working hours (8am-6.30) and at weekends.

People with long-term conditions

Educating patients to self-manage their long-term conditions more effectively.

People whose circumstances may make them vulnerable

Being flexible in their approach to vulnerable people by offering longer appointments and allowing homeless patients to register their home address at the practice.

People experiencing poor mental health

Maintaining strong links with local counselling services and improving access to psychological therapies.

Older people Providing continuity with a named GP for people aged over 75.

Families, children and young people

Offering information in age appropriate formats for young people and ensuring staff were well trained on local safeguarding processes.

Looking to the future

CQC strategy 2016-21

•Across all our sectors:

• Focusing on a future vision of quality regulation

• Considering the role of regulation versus other drivers of quality.

• Public consultation January 2016

PMS inspections after Sept 2016

• Co-producing any continuing improvements

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Find out more

• Read the monthly e-bulletin

• Sent to all providers and registered managers, or sign up through our website

• Join our online community

• Read our provider toolkit

Find information on all of the above at: www.cqc.org.uk/GPProvider

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Thank you