The right steps to an improved CQC rating

What does it take to manage a GP practice? Those who are on the frontline know how much of a challenge it can be to keep up with health and safety and ensure that your practice is working efficiently for staff and patients. We caught up with The Practice Group (TPG) for a look at best practice care

At a time when primary care services are facing challenges with staffing, funding and meeting demand, it is no mean feat to take a surgery or service which is struggling to meet standards and drastically improve the quality of care it delivers.

The Care Quality Commission (CQC) – England’s independent regulator of health and social care – rate GP practices in individual areas such as safety, care and responsiveness using four rating levels. The lowest rating is ‘inadequate’, which means the service is performing poorly and standards are not being met, and therefore requires another inspection within six months to ensure improvements have been made. The next rating is ‘requires improvement’, followed by ‘good’ and ‘outstanding’.

When surgeries are rated ‘inadequate’ or ‘requires improvement’ changes must be quickly made to avoid closures.

Leadership and governance

In 2016 a GP surgery in Hertfordshire, led by two GP partners, received an overall rating of ‘inadequate’ from the CQC. With approximately 5,500 patients on its books, the surgery had been struggling to recruit any permanent doctors and had been forced to reduce the number of nurses and administrative staff, relying on locum GPs to support the service. In the report, the surgery was found to be lacking the systems and processes to ensure clinical leadership and strong governance.

Shortly after the team running the surgery stepped down, and following a failed procurement process, TPG was approached by NHS England to discuss the possibility of taking over the management of the surgery from January 2017. TPG’s patient-centric values and desire to improve local surgeries through their approach of combining local care with centralised support meant that they were able to step in and begin to improve the safety and quality of the service.

Review, review, review

TPG’s operational and clinical teams reviewed the surgery data to create an action plan for improvement in the surgery and after a swift two-week mobilisation – which took place over the festive period, TPG’s service went live on January 2, 2017.

TPG employed an additional four sessional GPs and a practice nurse to join the existing surgery team. By increasing the team members they were able to increase the number of appointments for the patients, as well as bringing some much-needed stability to the surgery team and continuity of care for patients. To add a further layer of governance to the surgery, TPG employed a clinical lead to conduct regular clinical meetings on site and provide leadership and support for all clinicians working within the surgery.

Having reviewed the CQC report and conducting their own risk assessment in the surgery, TPG found that there were some good initiatives and work being done within the surgery but more work was needed to further support the different population groups at the surgery.

Monitoring medicines

One category flagged by the CQC as an area for concern; was the system for checking the monitoring of high-risk medicines, which was not evident upon inspection. Electronic patient records showed that some patients had not received appropriate blood monitoring, and the surgery was instructed to establish a clear process for this so that patients taking high-risk medicines received this vital aspect of care. To improve this aspect of the service, TPG implemented a new standard operating procedure (SOP) and employee training to the surgery, which has worked within other TPG surgeries to ensure appropriate blood monitoring takes place. TPG also implemented a rolling programme of audits of patients who are prescribed high-risk medicines, led by the clinical lead.

Specific surgery policies

Another cause for concern was the surgery’s policies – although these were accessible to staff, the policies in place were not practice-specific in crucial areas such as safeguarding. Making sure employees were informed of a surgery’s policies and that they were specific to the needs of the surgery and patients was of utmost importance to TPG.

As TPG has a centralised support centre with a number of departments dedicated to support their GP surgeries, their quality assurance team stepped in to embed TPG’s wider policies and localising SOPs within the surgery. They ensured correct training and procedures were in place to help prevent and manage incidents. Safety policies including child and adult safeguarding were reviewed regularly and the appropriate training (which includes refresher courses) were made more accessible to staff.

A patient-centered practice

TPG believe that a patient’s involvement in the decisions made about their care is hugely important to their wellbeing. That’s why they developed an active patient participation group (PPG) who they engage with to obtain thoughts and concerns that patients have about the care they receive. This not only enabled TPG to make improvements but gives patients an open forum to share their thoughts.

From special measures to good

The latest CQC report (conducted in March 2018) saw the surgery taken out of special measures and awarded with a ‘good’ rating across all areas including leadership, safety and care. This shows the vast improvements that have been made to provide effective safety measures and leadership initiatives within the surgery.

The surgery and the patients faced some real challenges. What was needed, was a strong, dedicated team and more refined protocols to ensure the day-to-day operations of the practice run smoothly.

Patients’ satisfaction with the quality of care they receive is of huge priority to TPG, and they continue to make improvements, not only here but in their other surgeries across the country, to make sure patients are receiving high quality, safe and responsive primary care.

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