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Lessons from the top: key trends from the latest Outstanding inspections

by in CQC, GP Practice Management

While talk of CQC inspections has undoubtedly decreased over the last few months, in part due to the fact that most practices are onto second (and even third in some cases) visits or calls, inspections still remain a critical part of practice evaluation. That means, whether good, bad or downright ugly, inspection reports remain an interesting source of information and advice on how to run a practice well.

Take the latest outstanding GP practice report for example. Cadbury Heath Healthcare in Bristol rated outstanding in four of the five inspected areas, and across all of the checks on specific services. For practice managers everywhere, there should be something to learn from this report – which can be found here.

To save you trawling through the last reports, here are the key messages across the various different inspection areas, pulled from the last ten outstanding reports, that can help shape your service delivery and preparation for inspections:

Are services safe?

Outstanding practices tended to have:

  • Clear systems to assess, monitor and manage risk so that safety incidents were less likely to happen.
  • When incidents did happen, practices recognised where systems and processes had worked well and improved their processes where appropriate – this was well documented too.
  • An open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • A clear vision which had quality and safety as its top priority. A strategy to deliver this vision that was produced with stakeholders and was regularly reviewed and discussed with staff, as well as an effective approach to succession planning.
  • Systems to safeguard children and vulnerable adults from abuse.
  • Monthly safeguarding meetings with health professionals including midwives and health visitors. Some practices had a safeguarding lead and staff that knew how to identify and report concerns, with learnings from safeguarding incidents made available to staff.
  • Staff who acted as chaperones and who were trained for their role and had received a Disclosure and Barring Service (DBS) check.
  • Staff who took steps, including working with other agencies, to protect patients from abuse, neglect, discrimination and breaches of their dignity and respect.
  • Arrangements to ensure that facilities and equipment were safe and in good working order.

Are services effective?

Outstanding practices tended to:

  • Deliver effective care and treatment to patients that supported the achievement of better outcomes than comparable services and promoted a good quality of life.
  • Undertake a wide range of quality improvement projects, across all areas of the service. These drove continued improvement to the care offered. For example, an End of Life care Quality Improvement Programme was undertaken to ensure patients had the knowledge and support needed to make informed choices regarding end of life plans.
  • Have an ethos of recognising potential and developing staff into roles that met staff development needs and aligned these with the business needs of the practice.
  • Ensure staff were committed to working collaboratively with allied health professionals to ensure patients with complex needs received coordinated care
  • Have Quality Outcome Framework (QOF) attainment rates higher than local and national averages achieved by doing all they could to encourage patients to attend long term condition reviews.
  • Innovate through examples such as the introduction of the ‘Year of Care’ approach to caring for and reviewing patients with musculoskeletal (MSK) conditions such as osteoarthritis, osteoporosis, inflammatory arthropathies, fibromyalgia, connective tissue disorders and gout as well as coeliac disease and on-diabetic hyperglycaemia.
  • Offer e-consultations.

Are services caring?

Outstanding practices tended to perform better by

  • Proactively identifying supporting carers in the roles they fulfilled.
  • Delivering a strong person-centred culture put people’s needs first.
  • Placing a significant importance on community engagement and collaborative working to make the area a better place to live for local residents.
  • Ensuring practice websites were easy to navigate and online services as easy to use as possible.
  • Helped patients to be involved in decisions about care and treatment and ensuring they were aware of helpful programmes such as the Accessible Information Standard (a requirement to make sure that patients and their carers can access and understand the information that they are given.)
  • Ensuring staff communicated with people in a way that they could understand, for example, through communication aids and easy to read materials
  • Helping patients and their carers find further information and access community and advocacy services, while also helping them ask questions about their care and treatment.
  • Hosting monthly clinics with local carers’ group, who offered additional support.

Are services responsive?

Outstanding practices tended to ensure:

  • Patients could access care and treatment in a timely way.
  • Services were tailored to meet the needs of individual people and collaboration with the local community was integral to how services were developed.
  • Community links initiatives were implemented to strengthen links between the practice and the local community. These included support for those living within deprived areas.
  • In one practice, a volunteer driver service was set up by the practice to ensure patients who were vulnerable through isolation and disability were able to get to the practice and other community services they may have been referred and signposted to.
  • The patient participation group (PPG) were an integral part to the practice ensuring care was delivered in a way that met people’s needs.
  • There were innovative approaches to providing integrated person-centred care.
  • Areas were identified where there were gaps in provision locally and had taken steps to address them. For example, one practice had a fibro scanner and were able to screen patients for fatty liver of those at high risk of cirrhosis.

Are services well-led?

Outstanding practices tended to have a leadership team who focused on:

  • Ensuring the leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care.
  • Governance and performance management arrangements were regularly reviewed and reflected best practice.
  • The practice, where possible, looked at external organisations for help. For example, some outstanding practices were members of the Clinical Research Network and an accredited Royal College of General Practitioner Research Ready Practice which gave ongoing opportunities for developing and improving patient care.
  • Working closely with locality practices to provide opportunities for sharing learning from incidents and complaints.
  • Ensuring the strategy and business plan had been developed by the practice team, and staff were empowered to deliver against objectives.
  • High levels of staff satisfaction, resulting in consistently high levels of staff engagement.
  • Ensuring collaboration and support across all staff groups which engendered an ethos of openness and a common focus on improving quality of care, patient and staff experiences.
  • Delivering a proactive approach to working with other organisations and strong links had been developed with local community groups and schools to improve care and tackle health inequalities.
  • Boosting a stable leadership team where leaders communicated well with each other and with the team.
  • Being knowledgeable about issues and priorities relating to the quality and future of services and participated in external groups to ensure they understood the local changes and challenges.
  • Setting the practice strategy, so it was in line with health and social care priorities nationally and across the local area.

We hope the above points, which consistently came up in the outstanding reports, will help you achieve top marks in your next inspection. It’s also worth taking time to remind yourself of the latest KLOEs, which can all be found here. For [PLUS] members you can also find the CQC checklist,  CQC guidance and a guide to the CQC annual regulatory review process in the resources area.

What other tips can you share with your fellow practice managers? What made you an outstanding practice? Share your thoughts below or in the Practice Index Forum.

Topics trending in the forum:
Do we have to give names?
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