Is your practice well-led?

The Care Quality Commission (CQC) has recently published more of its popular mythbuster fact sheets. The latest round of mythbusting notes, written by Nigel Sparrow, Senior National GP Advisor and Responsible Officer at the CQC, aim to share the facts about such diverse topics as GP locums, consent for minor surgery in GP surgeries and the role of registered managers.

Well-led practices

Perhaps one of the most relevant fact sheets for practice managers is the one recently released about well-led practices.

As those who have already been inspected know all too well, when the CQC inspectors call they are extremely interested in the leadership standards at practices. It is, indeed, one of the five key questions that are asked. As a result, it is handy to know more about the well-led question and the key lines of enquiry (KLOE) that will be pursued – namely vision and strategy.

Commenting in his mythbuster fact sheet, Nigel Sparrow says: “There is substantial evidence around the role that culture – ‘the way we do things around here’ – and leadership can play in supporting organisations to deliver high-quality compassionate care for patients. We cannot form a judgment on a GP practice, therefore, without looking at its leadership team and how the organisation is managed.”

When it comes to leadership, GP practices are similar to most other organisations (despite the additional pressures and bureaucracy), which means inspectors will be looking for:

• a clear vision and strategy that is enacted in practice
• a well thought-through governance framework
• a developing leadership strategy
• a culture that supports learning and innovation
• team-based working
• high levels of staff engagement
• patient and carer engagement.

Nigel adds: “Our ‘well-led’ key question focuses on how the leadership, management and governance of an organisation assures high-quality, person-centred care delivery, supports learning and innovation and promotes an open and fair culture.

“Well-led practices make the work of general practice easier, creating both a happier working environment for GPs and their staff, and better service for patients. We have also found that in practices where there is poor leadership, there is more likely to be issues across the practice, for example in safety, effectiveness, responsiveness and how caring the service is.”

Vision and strategy

Happily for practice managers, preparation can be done ahead of an inspection because inspectors use a standard set of KLOEs, which are:

1. Is there a clear vision and strategy to deliver high-quality care and promote good outcomes for people?
2. Do the governance arrangements ensure that responsibilities are clear and that quality, performance and risks are identified, understood and managed?
3. How does the leadership and culture reflect the vision and values, encourage openness and transparency and promote good quality care?
4. How are people who use the service, the public and staff engaged and involved?
5. How are services continuously improved and sustainability ensured?

Further prompts in relation to each question can be found in Appendix B to the NHS GP practices and GP out-of-hours services provider handbook.

Real-world examples

A number of practices have been praised (and rated outstanding) for their leadership by the CQC. Here are some examples:

1. A suburban practice with 10,000 registered patients

The practice had outstanding services for people with a learning disability and performed better than other practices nationally for QOF indicators relating to learning disability.

It had taken the lead role in influencing the care provided by neighbouring practices, by working with the local CCG as well as other CCGs in the area. One of the GPs had developed a ‘ready reckoner’ for common conditions associated with learning disability. The template was used by the CCG and there were easy-read leaflets on the website. The practice had also looked at this group of patients to determine the number of ‘do not attend’ appointments. The learning disability register was cross-checked in order to help people with a learning disability through the health care system.

The lead partner also helped other practices by giving advice about setting up their own services.

This is outstanding because the GPs at the practice are showing strong leadership by championing the care of people in their area who have a learning disability.

2. An urban practice with 15,500 registered patients

The practice had an active patient participation group (PPG), Carer Support Group and ‘Friends’ Group. These groups of volunteers were co-ordinated by a member of staff at the practice. They influenced changes and improved services for patients at the practice by offering services to all patients or carers – especially those who were lonely or isolated.

For example, the Carers Support and Friends groups offered lunch clubs for housebound patients, a telephone support service, sitting and befriending services, weekly social events and support for carers. The Friends of the practice group was also involved in raising funds for the practice. They were able to buy an Entonox gas cylinder, which patients could use for pain relief during complex wound dressings, and they paid for transport and other maintenance at the practice.

This is outstanding because it is an example of a practice that has worked hard to engage its patient participation group, who as a result, provide an innovative range of services.

3. A suburban practice with 12,700 registered patients

The practice set up an apprentice scheme in 2008, which involves a two-year apprenticeship to gain a non-vocational qualification (NVQ) level 2 in business administration; apprentices also have the option of gaining a level 3 NVQ. The scheme has led to 100% employment for apprentices, either in this practice or other local practices. We saw that one apprentice had developed over a number of years and had successfully achieved a supervisory role at the practice.

This is outstanding because the practice has an innovative approach to the development of staff.

Further examples can be found in the CQC inspection reports, which can be found here.

What examples could you use to show how well-led your practice is? What great examples have you seen elsewhere? Let us know by commenting below or take it to the Practice Index Forum here.