CQC’s new approach to inspecting and regulating GP and OOH providers January 2015 Welcome Housekeeping: Tea and coffee is available throughout Presenter: check with your communications lead re: fire alarms/toilets etc Today’s event won’t cover everything we’re consulting on but is focusing on key areas - visit our website for full details on everything we’re consulting on and how to give us your feedback. Note – today’s event won’t be covering every aspect of consultation – people should still read our consultation documents 1 1

Welcome Amanda Reynolds Inspection manager (acting)

Our purpose and role Our purpose Our role We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve. Our role We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care. We will be a strong, independent, expert inspectorate that is always on the side of people who use services. 3

Developing the changes We co-produced the changes by working closely with our partners, providers, key stakeholders, the public and people who use services: A new start consultation – June 2013 Primary medical services signposting document – Dec 2013 GP and GP OOH advisory and reference groups *** Public steering groups/focus groups Provider and public online communities GP co-production/population groups GP and OOH provider handbook consultation – April 2014 4

Our new approach Model shows the different stages: Registration Surveillance Standards Expert inspection Judgement and publication – ratings Action where needed This high level model applies to all the services we regulate. What differs is the detail within each of those stages, so for example the data we collect and monitor for adult social care is different to primary care, the questions we ask at registration and the expertise of our teams are different for social care than primary care.

What are we doing differently? Inspection teams of specialist inspectors, GPs, practice nurses or practice managers. Inspections of a number of practices carried out in a CCG area over a 2-4 week period. Introductions of ratings for GP practices telling patients whether they are: outstanding, good or whether they require improvement or are inadequate. Strengthening our Intelligent Monitoring of providers using nationally held data and local intelligence. New ways of gathering patient views both before and during inspection. Develop a clear approach to responding to failing practices, working with NHS England.

Our key questions Is the quality of care: Safe? people are protected from abuse and avoidable harm. Effective? people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence. Caring? staff involve and treat people with compassion, kindness, dignity and respect. Responsive? services are organised so that they meet people’s needs. Well-led? the leadership, management and governance of the organisation assures the delivery of high-quality care, supports learning and innovation, and promotes an open and fair culture. 7

Intelligent monitoring Intelligent Monitoring is a tool to help our inspectors understand the areas of care that need to be followed up. Looks at set of indicators including patient experience and statistical measures of performance. The indicators relate to the five questions we ask all services. The indicators will be used to raise questions, not make judgements – our ratings do that. 8

Key lines of enquiry For each of the five key questions there are between three to five key lines of enquiry (KLOEs). For each KLOE we have identified characteristics of good. They support consistency and ensure we focus on areas that matter most. KLOEs are supported by guidance on key things to consider; these are called prompts. 9

Key lines of enquiry continued… Inspection teams will use the above four main sources of evidence to answer the KLOEs

Ratings: four point scale High level characteristics of each rating level Innovative, creative, constantly striving to improve, open and transparent Consistent level of service people have a right to expect, robust arrangements in place for when things do go wrong May have elements of good practice but inconsistent, potential or actual risk, inconsistent responses when things go wrong Severe harm has or is likely to occur, shortfalls in practice, ineffective or no action taken to put things right or improve Following each inspection, we will judge whether services are outstanding, good, requires improvement or are inadequate. We have developed characteristics to describe what each of these ratings looks like (which we’ll take a closer look at in our next table session). 11

How do we decide a rating? This is how we rate in relation to each of the key questions, i.e is a service safe, effective, responsive, and well-led Our inspection teams will review the evidence gathered throughout the inspection process against the KLOEs and use the guidance supplied to decide on a rating The inspection team will answer the following questions: Does the evidence demontrate we can rate the service as good? If yes – does it exceed the standard of good and could it be outstanding? If no – does it reflect the characteristics of requires improvement or inadequate? Services rated as ‘inadequate’ (and some that ‘requires improvement’) will usually be in breach of one or more regulations – we’ll follow enforcement processes in those circumstances - there will be a separate consultation about those regulations and enforcement policy in the summer. 12

Ratings grid Level 1: Every key question for every population group Level 2: Aggregated rating for every population group Level 3: Aggregated rating for every key question Level 4: Overall rating for the practice This is how we rate in relation to each of the key questions, i.e is a service safe, effective, responsive, and well-led Our inspection teams will review the evidence gathered throughout the inspection process against the KLOEs and use the guidance supplied to decide on a rating The inspection team will answer the following questions: Does the evidence demontrate we can rate the service as good? If yes – does it exceed the standard of good and could it be outstanding? If no – does it reflect the characteristics of requires improvement or inadequate? Services rated as ‘inadequate’ (and some that ‘requires improvement’) will usually be in breach of one or more regulations – we’ll follow enforcement processes in those circumstances - there will be a separate consultation about those regulations and enforcement policy in the summer. 13

Population groups Inspectors will judge how well services meet the needs of six different population groups: Older people People with long-term conditions Families, children and young people Working-age people, including those recently retired and students People whose circumstances may make them vulnerable People experiencing poor mental health (including people with dementia).

What to expect from an inspection We will send you a letter two weeks before we inspect (unless we are responding to concerns) and our inspector will call you. On the day, we will ask you to tell us (and give us evidence) about the good care you give, and we will want to talk to staff and patients to find out more. At the end of the inspection, we will tell you our initial thoughts. We will write up our report and send it to you to check for factual accuracy before we publish it on our website. 15

Timelines Dec 2013 Published signposting document setting out high level proposals Jan – Mar 2014 First wave of GP out-of-hours providers (approximately 30 providers) April – June 2014 Public consultation on draft inspection handbook and Wave 1 of testing (200 practices in 12 CCG areas) July – Sept 2014 Wave 2 of inspections ongoing testing and refining of our revised approach Oct 2014 New approach fully implemented. Ratings awarded By April 2016 Every NHS GP practice and NHS GP out-of- hours service inspected and awarded ratings

Find out more Website: www.cqc.org.uk Twitter: @CQCforGPs Join our provider online community: https://communities.cqc.org.uk/provider

Thank you 18