Practice Business explores the latest CQC general practice inspection reports to unearth where practices frequently trip up. This time, we unpick why cervical screening and carer identification are often flagged by the CQC and how you can tackle these for a sparkling inspection
We’ve examined some of the latest CQC reports from general practice inspections and have identified two key areas that are often rated as ‘inadequate’ or ‘requires improvement’ – cervical screening and carer identification. How can you avoid these pitfalls in your practice and escape CQC dissatisfaction?
What’s the difficulty with identifying carers in primary care?
A carer is someone who provides support to a relative or loved one who could not manage alone, whether that be because of mental or physical disability, a long-term health condition, age or addiction. It is estimated that 12% of the population is undertaking a caring role at any given time.
Although a large amount of people could be classified as carers, few recognise themselves as such. This may be because carers view their ongoing support as an extension of their role as family member or friend.
It can be difficult to identify carers in general practice when the carers may not have identified themselves to be in this role. However, carers can develop mental health problems if not supported by their GPs and, more often than not, a carer relationship is only discovered by the GP once a crisis situation occurs, and the carer can no longer cope. Identifying the situation at this stage puts a huge strain on general practice time and resources.
Therefore, it is vital to identify carers, not just for the psychological wellbeing of patients, or for an improved CQC rating, but to support the wellbeing and efficiency of staff and the practice. Below we explore ways you can jump this hurdle to identify potential carers and patients that may need caring for – before the situation escalates into something less manageable.
How to identify carers in your practice
- Identify all patients with dementia, MS, stroke, Parkinson’s disease, severe mental illness or disability who may rely on family members or friends to take care of them.
- Ensure there is a question relating to carers in the new patient questionnaire required on registration. Patients may not have identified themselves as ‘carers’, so avoid the phrase by asking whether a patient is ‘helping’ to support or look after a friend, relative or loved one.
- Ask reception staff to monitor who requests repeat prescriptions, appointments and visits the practice on behalf of physically unwell, mentally ill, elderly or disabled patients. Ask them to also monitor who accompanies disabled, elderly or unwell patients to the practice on a regular basis.
- Ask clinicians to make a note of who is present at a home visit, and what relationship they have with the patient. This may be a way of identifying young carers who may not be aware of their role as carer, and may have additional needs due to their age and financial position.
- Make sure a poster about being a carer is displayed in your practice and produce or procure leaflets about carers to have in your waiting room. Ensure this leaflet is available in different languages to make it accessible to those who are not native English speakers. You can tailor the languages available to the demographics of your patient list.
The problem with smear test attendance in general practice
One in four women do not attend their cervical screening when invited and, according to Jo’s Cervical Cancer Trust, the number of women attending screening in the UK is falling – in fact, in England, attendance is currently at its lowest in 21 years.
There are many complex reasons for this. Some stem from cultural or religious barriers. Others may struggle to attend their smear tests if they are a survivor of sexual abuse. Some are scared that the simple procedure may hurt, and others are simply unaware of the test’s importance.
With much better smear test attendance, cervical cancer is almost entirely preventable. It is the responsibility of GP practice employees to raise awareness, not only for an improved CQC rating, but also to reduce the number of highly preventable cancers being diagnosed in their patients.
How to increase uptake of cervical smear tests in your practice
- Send targeted letters: it is common practice to send out letters to women eligible for smear tests. The cervical screening programme sends a standard invitation letter and a reminder letter 18 weeks later. Standard letters sent by the programme can include an additional paragraph of free text specific to a GP practice. This can be tailored towards your patient demographic, offering reassurance and incentives to attend. The GP then sends out a second reminder letter to those who failed to respond to their previous invitation. This provides an even better opportunity to emphasise that the procedure is performed by a female, often causes very little discomfort; it can urge women to get in contact with the practice if they have any questions or concerns.
- Offer pre-appointments: invite women who have their first smear test appointments coming up, or women who have had a previous negative experience, to attend a pre-appointment, where they can discuss their concerns and learn about what will happen in the test. These appointments will, hopefully, allay any concerns and improve trust between the clinician and your patient.
- Procure posters and leaflets: smear test and cervical cancer awareness posters should be displayed in your practice. Producing or procuring leaflets about smear tests that you can place in your waiting area may also help raise awareness and attendance.
- Send text reminders: there is compelling evidence to suggest that sending women who are due a smear test a text reminder increases the level of attendance. This was tested by GP practices in London, who saw uptake increase by 4.8% in 6 months. The text includes a call to action, the practice’s ‘phone number and a link to the NHS website for further information, as well as an option to opt out of being sent text reminders. Implementing a similar system in your practice could yield similarly positive results.
- Participate in awareness weeks: Cervical Screening Awareness Week takes place on 15th to 21st June this year. There are many possible ways of getting involved. You could run initiatives in your practice, such as organising a staff fundraiser for cervical cancer awareness, or you could write a short information piece to publish on your practice’s website.
- Use your practice website to direct patients towards reliable and reassuring online information about smear tests. Jo’s Cervical Cancer Trust’s website is an excellent resource for helping to educate and empower women to attend their smear tests. Zoe Sugg, or ‘Zoella’, one of the UK’s most popular Youtubers, recorded herself attending a smear test and interviewing the nurse about the procedure. It may be useful to inform your GPs about this video so they can recommend it to women who may be fearful of attending their first smear test.