With GP practices now rated as Outstanding, Good, Requires Improvement or Inadequate following CQC inspections – and having to publicly display their rating from April – the pressure on achieving top marks is arguably greater than ever. So what is the CQC looking for during inspections and how can practices ensure they score highly?

The questions asked

New style inspections of GP practices really focus on five questions, namely:

• Are services safe?
• Are services responsive to people’s needs?
• Are services caring?
• Are services effective?
• Are services well-led?

Inspectors delve deeply into each of these areas and practices that have already been inspected suggest practice managers should prepare examples of how the practice is ensuring excellence in each area. This could include examples of initiatives entered into, partnerships formed with other local healthcare providers and the work being done to look after specific patient groups, which include:

• Older people
• People with long-term conditions
• Families, children and young people
• Working age people (including those recently retired and students)
• People whose circumstances may make them vulnerable
• People experiencing poor mental health (including people with dementia)

Handily, the CQC has published a handbook that sets out clearly how GPs will be assessed and rated. The handbook helps providers understand exactly what inspectors will be looking for – and importantly how inspectors will determine the rating following an inspection.

Achieving greatness

One of the best ways to find out what the CQC is looking for is to take a look at the inspection reports of practices that have already achieved an Outstanding rating (these are published on the CQC website). One such practice is Irlam Medical Practice in Salford, which inspectors found was providing an innovative, caring, effective, responsive and well-led service that meets the needs of the population it serves.

The report on the Irlam Medical Practice highlights a number of areas of outstanding practice including:

• Staff proactively follow up information received about vulnerable patients. Inspectors saw examples where clinical and reception staff had used their initiative to raise a concern or pass on information which led to a positive outcome for the patient.
• Inspectors saw excellent examples of close working partnerships with other health and social care professionals, including care planning and with a view to avoiding unplanned hospital admissions.
• The practice reaches out to the local community, with nurses voluntarily carrying out an annual stroke awareness clinic at a local supermarket, where they provided health and blood pressure checks, and identification of any underlying health issues.

Professor Steve Field, Chief Inspector of General Practice said: “While care for all groups of patients is good, we found that care for older people, for people who are vulnerable and for those with long-term conditions to be outstanding. Staff showed us they were able to recognise signs of abuse in older people, they contacted patients with known memory or confusion issues by phone to remind them of appointments and they arranged home visits for flu vaccinations and health checks for people who struggled to attend the surgery.

“The practice had excellent clinical leadership and teamwork and worked closely with other local practices, agencies and the local hospital, Salford Royal, to improve the quality of care provided for local people. All of this hard work pays off in making a real difference for their patients – which is why we found this practice to be Outstanding.”

Strong learning culture

Meanwhile, the report on Dr M.R Spencer & Partners in Bolsover, Derbyshire, highlighted a number of areas of outstanding practice:

• A strong learning culture and commitment to continued quality improvement. This culture was embodied by all staff across the service.
• The practice promotes work with young people and schools as part of the national “You’re Welcome” initiative. This includes engaging students in competitions and promoting healthy eating and alcohol awareness campaigns.
• The practice is involved with initiatives to promote physical and mental health wellbeing. For example, the service encourages adult literacy for patients with mental health needs and works alongside a local gym, which provides chair-based exercise classes and runs a falls prevention group.
• A monthly singing group takes place, comprised of older patients who have chronic illnesses such as Alzheimer’s and memory problems. This activity is aimed at improving the mental wellbeing of older patients.
• The practice works proactively with the community matron to support end of life care planning and hospital admission prevention.

Practices can learn a lot from each other, especially when it comes to inspections. The CQC inspection reports provide a superb insight into what’s working (and what’s not, of course) at practices up and down the country. An hour or two spent trawling through the reports could well provide the ideas and information that elevate an inspection from Good to Outstanding.

Next week we’ll look at how practice managers can prepare for an inspection and provide an idea of what a typical inspection day will be like.

A thread has been created on the forum with what questions other practices have been asked by the CQC. See them all by clicking here.