The latest round of CQC inspection results has been released. Overall the performance of GP practices has been positive, with 85 practices out of the 109 inspected rated good. Two practices received outstanding ratings while, more worryingly, eight were rated inadequate.

From the most recent inspections, what did the inspectors love and what did they dislike?

The good

Inspectors praised outstanding practices for the following:

• Offering a wide range of extended opening times, early in the morning, the early evening and on Saturday mornings. The practice operated a walk in surgery each morning which meant that patients who attended between 8.30am and 10.30am were seen. Patients particularly valued this walk-in service.
• Health care assistants working as key members of the practice team and speaking a range of languages, including those spoken by many of the practice’s population group. This supported good communication and patients’ involvement in understanding and managing their care.
• The practice had a very good skill mix which included two nurse clinicians and a nurse practitioner who were able to see a broader range of patients than the practice nurses. In addition the practice had four practice nurses and a health care assistant which allowed for greater capacity for monitoring and reviewing patients’ health.
• Offering health checks for 40–75 year olds. Despite already meeting its target to complete 300 of these for the year 2015–2016, one of the outstanding practices decided to continue with these checks so that patients’ health and well-being could be monitored.
• A practice offered smoking cessation clinics in different languages to meet the needs of its patients, many of whom did not have English as their first language. These clinics had been successful in helping 70% of those who had attended to give up smoking (56 patients in total).
• One practice provided excellent facilities for patients. There was a resource room containing a range of health information for patients; a prayer room for use by both staff and patients; a room for mothers to breastfeed their babies in private and two sound-proof rooms where staff could telephone patients confidentially and without distraction.
• A local councillor told us that the practice was very engaged with local schools, inviting school parties to visit and talking to children about the work of doctors and nurses.
• One practice had signed up for the Safe in Town scheme and provided a safe haven for vulnerable people (vulnerable people were able to come to the practice and the person’s carers would be contacted). In 2014 the practice was awarded a grant to develop a community garden at the practice. Patients worked to create the garden which provided exercise and reduced social isolation.
• Longer appointments were made available for people with a learning disability and Saturday morning clinics were offered to patients with a learning disability to encourage attendance.
• The practice referred patients to Wellbeing Enterprise Services, a social enterprise to support people to achieve happier, healthier and longer lives. Patients could be referred for support with a number of issues, including debt management, housing and social isolation. A report from this service showed that patients who were referred by the practice benefitted from the interventions provided.

The bad

Negative findings and suggested improvements noted by inspectors included:

• Staff were not clear about reporting incidents, near misses and concerns; and there was limited evidence of learning and communication with staff.
• Formal governance arrangements were limited and we noted confusion regarding roles and responsibilities.
• There was evidence of division and a lack of communication between clinical and non-clinical staff which hindered progress on improving patient outcomes.
• Staff hadn’t received training in infection control, with the practice told they must introduce and undertake a comprehensive infection control audit.
• Practices must ensure that all electrical equipment testing is up to date.
• Recruitment arrangements must include all necessary employment checks for all staff.
• Governance arrangements should include systems and processes to audit and monitor the quality and safety of the services provided, including systems to demonstrate and provide assurance of how patients’ health care needs are managed, supported and met.
• Governance arrangements must also include audits to monitor staff training, infection control, and keeping the business continuity plan updated.
• Practices should deploy sufficient numbers of suitably qualified, competent, skilled and experienced staff to effectively support and meet the needs of patients, including all clinical and administrative tasks.
• A detailed locum induction pack should be available to ensure all locums have adequate information to carry out their roles safely.
• Practices should seek and act on feedback from patients, for the purposes of continually evaluating and improving services.

The ugly

Some of the most concerning findings included:

• Patients were at risk of harm because systems and processes were not in place to keep them safe. Concerns were identified regarding the arrangements for managing vaccines.
• Patients were at risk of harm because inadequate systems were in place to keep patients safe including those for incident reporting, safeguarding and medicine management.
• There was insufficient clinical staff to keep patients safe and inadequate clinical leadership.

Thanks to the detailed reports provided by the CQC, inspections provide practices with a handy guide to what’s needed and what to avoid when seeking to achieve a good or outstanding rating. Head along to www.cqc.org.uk to read through all reports.

What initiatives have you been praised for in inspections? Let everyone know either by commenting below or in the Practice Index Forum. You can find the forum topic here. 

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