The Care Quality Commission has recently published a further tranche of reports on the quality of care provided by GP practices that have been inspected under its new approach. Following recent inspections by specialist teams, one has been rated Outstanding, 38 practices have been rated as Good, nine have been rated as Requires Improvement and, significantly, two have been rated Inadequate.

In previous Practice Index blog posts we’ve looked at what makes outstanding practices stand out from the crowd, so this week we thought we would look at the other end of the scale and find out what practices can do to avoid receiving a poor rating, especially as it seems it’s the small, relatively simple procedures that make a difference to scores.

10 common failures…

1. Systems were not in place to ensure patients received a safe service through the management of risks.
2. Staff were not clear about reporting incidents, near misses and concerns.
3. There was limited evidence of learning and communication with staff when things went wrong.
4. There was insufficient assurance to demonstrate people received effective care and treatment. For example, the absence of completed clinical audits to demonstrate that patient outcomes were in line with national and local guidance which resulted in continuous improvements.
5. Systems in place to ensure adequate GP cover when the provider GP was on leave were inadequate.
6. Insufficient leadership capacity and limited formal governance arrangements meant there was no guarantee the practices could assess and monitor the quality of the service they provided and could identify, assess and manage risks to patients, staff and others.
7. Requirements relating to workers and management of medicines were lacking.
8. Patients were at risk of harm because systems and processes were not sufficiently robust to keep them safe. For example, appropriate recruitment checks on staff had not been undertaken prior to their employment. The risks of unforeseen circumstances which might impact on the running of the service had not been identified and appropriately managed.
9. Some safety information was recorded but action and learning from these was not always evident.
10. There was insufficient assurance to demonstrate people received effective care and treatment. For example, patient involvement in care and treatment decisions was not evident.

…and the CQC’s 10 ways to remedy them

1. A robust system must be in place to ensure that documentation has been obtained before people start working at the practice to ensure they are suitable to work with patients.
2. Suitable arrangements must be implemented to support staff with development and appraisals so they can deliver care and treatment safely and to an appropriate standard.
3. Effective systems must be in place to identify, assess and manage risks in order to protect people from inappropriate or unsafe care. For example; implementing robust risk assessments in respect of fire safety, ensuring there is sufficient GP cover to meet patient demand, the introduction of an effective infection control system and undertaking audits to ensure good and improving patient outcomes.
4. Effective and robust systems must be in place for assessing and monitoring the quality of services provided through effective governance and patient feedback.
5. Robust systems must be implemented to respond to any identified risks from pre-employment checks.
6. Robust systems must be in place to follow up patients on repeat prescriptions, particularly those on high risk medicines.
7. Care should be appropriately planned involving patients who may require additional support to ensure their physical and emotional needs are met. This includes those with complex needs, in vulnerable circumstances, carers and those who have suffered recent bereavement.
8. Effective systems must be in place to protect patients against the risks of inappropriate or unsafe care or treatment by identifying, assessing and managing risks.
9. Ensure document checks that are being carried out on medicines and emergency equipment.
10. Appropriate procedures should be in place to ensure all staff members are recording the temperature of the vaccine fridge consistently and according to guidance.

What advice can you share with your fellow Practice Managers ahead of a CQC inspection? Please comment below or on the Practice Index Forum.

To see a list of the CQC inspection questions that have been asked to Practice Index members this year, click here.