The Care Quality Commission has published another batch of reports on the quality of care provided by GP practices that have been inspected under its new approach.
Always interesting reading, the reports provide practice managers with plenty of insight regarding what’s working well at practices – and what’s not so good of course! Practice Index has trawled through the latest reports to find examples of what the inspectors particularly liked at the ‘outstanding’ practices.
CQC inspectors like to see examples of collaborative working. One practice was praised for its innovative approach to working with other agencies to improve outcomes for patients. Significant challenges were overcome by the practice, which facilitated well co-ordinated safeguarding and management of patients with complex care needs.
Social services were able to use the practice facilities for safeguarding strategy meetings, which had further enhanced working relationships and patients – particularly women experiencing domestic violence – were able to access discreet, face to face social care support at the practice once a week.
The same practice held monthly multidisciplinary meetings, which included hospital specialists from the palliative care team. The practice knew that it was difficult for patients needing palliative care support to travel to the local hospice approximately 25 miles away, so had facilitated the building of a satellite day hospice on land owned by the practice.
Excellent ongoing care
Another initiative that scored highly was a practice policy of follow-up calls to patients leaving hospital. Being able to demonstrate that 100% of all patients newly discharged from hospital following an emergency admission were contacted within 24 hours by GPs from the practice, to ensure they had received appropriate care, treatment and support, helped an outstanding mark to be achieved.
A recent inspection praised a practice for significantly improving access to support for patients living with long-term conditions and their carers. The Memory Matters programme run by the Alzheimer’s society was hosted at the practice, enabling carers and patients to attend when they would otherwise be unable to travel the relatively long distance to the local towns.
Continuing the above theme, CQC inspectors look for evidence that practice procedures are adapted to meet the needs of the patient list – it’s all about understanding patients.
One rural practice was praised for hosting specialist clinics at the practice for procedures normally offered at the main hospital (29 miles away). These include diabetic retinal screening (held 3-4 times a year) and regular specialist hospital nurse appointments for patients with complex diabetes and leg ulcer treatment. Access for working patients is facilitated through early morning appointments and the hosting of weekend clinics for flu vaccination throughout the winter months. Patients were able to request repeat prescriptions and appointments online and text messaging was used for appointment reminders and blood test results.
Continuity of care
According to the CQC, practices can benefit from providing evidence that their patient list is managed in a way that avoids barriers. One recently inspected practice was praised for allowing patients who move out of the surgery catchment area to remain registered with the practice for continuity of care and treatment.
Additional engagement and participation
Participation in local healthcare services/studies and the offering of additional services is never far from the top of any inspector’s agenda.
In addition to the specialist clinics mentioned above, another outstanding practice was praised for the introduction of a children’s immunisation and vaccination programme. Yet another practice proactively engaged in research and clinical studies to inform good practice and look at new ways to improve outcomes for patients. An example quoted showed how a practice involved in lung and asthma studies had been able to better help patients and reduce episodes of acute exacerbation.
Another GP provided a free acupuncture clinic for patients with various conditions such as muscular-skeletal conditions, migraine, fibromyalgia and chronic fatigue syndrome. Audits showed a 70% response rates with reduced referral rates to secondary care and a reduction in prescribing costs.
Making the most of in-house expertise
One successful practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, they offered dedicated services for substance misuse. The lead GP has a clinical interest in this area – he is a research associate in substance misuse at a local university – and this expertise was used to operate two clinics a week.
Inspectors look closely at in-house policies and procedures that ensure practices are running smoothly with knowledgeable and efficient staff. Safety is also high on the agenda and one practice was praised for its clear vision that had quality and safety as its top priority. A business plan was in place, which was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.
Elsewhere, all staff received 360 degree feedback every year as part of the appraisal process. 360 degree feedback is a system or process in which employees receive confidential, anonymous feedback from the people who work around them. This shows the practice used innovative approaches to gather feedback from staff.
Finally, the good old topic of patient participation, which we’ll discuss in a forthcoming blog. Inspectors did however highlight how one surgery was innovative in their attempts to engage with patients and made use of social media to do this. For example, they had introduced a Facebook page and twitter account in recent months to engage with patients, who could also sign up to receive the practice newsletter by email.
All of the CQC reports can be viewed online at http://www.cqc.org.uk and make for interesting reading.
Do you have any examples of great practice management that the CQC inspectors loved? If so please do comment below and if you have any CQC inspection questions feel free to take them to the Practice Index forum where other PMs will be able to offer their help and advice.