1. Dr John Byrne MB BCh BAO DRCOG DCH MSC MRCGP
CQC’s approach to inspection and regulation
GP Autumn Seminar
September 2015
Dr John Byrne MB BCh BAO DRCOG DCH MSC MRCGP
GP Regional Advisor
PMS Directorate
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

2. 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. 2

3. CQC approach to regulation
Inspection teams of specialist inspectors, GPs, practice nurses or practice managers.
Inspections of practices are carried out by a local inspector who will be your one point of contact.
Ratings for GP practices telling patients whether they are: Outstanding, Good, Requires improvement or Inadequate.
We gather patient views both before and during inspection.
Working closely with NHS England, our special measures approach ensures failing practices are given the support they need to improve and ensures patients are protected.
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.
The special measures approach
Our first priority is to protect the safety of people who use services
Special measures also ensures practices that need support get it
All Inadequate practices are placed in special measures following a robust quality assurance process

4. Helpful resources for practices
Make sure you’ve read our provider handbook, and understand the key lines of enquiry our inspectors will focus on
Read our mythbusters for tips and further guidance
Read our Outstanding web tool kit and consider what would make care for people who use your services Outstanding
Read our ‘What to expect from an inspection’ and case studies to understand what an inspection looks and feels like
We’ve signposted all of these resources and more in our provider toolkit
You can find our provider toolkit and all of these resources on 4

5. What happens on an inspection?
Before your inspection
You will receive a letter announcing your inspection two weeks in advance
We’ll ask you for some information in advance
For example, your statement of purpose, records of complaints, serious or adverse incidents
Your inspector will be in touch to discuss with you what will happen on the day
We will send you a set of comments cards that your patients can fill out to tell us their views in the period before we inspect
Look at your own intelligent monitoring 5

6. What happens on an inspection?
On the day of your inspection
We’ll ask you to give us a short presentation telling us what is Good about your practice and the care it delivers
We’ll want to speak to all of your staff and as many patients as are willing, in confidence (don’t forget attached staff)
We’ll want to see evidence of a variety of things and we will need a room to go through this
Maintain Business as usual
Feedback session at the end of the day.
We want your feedback too 6

7. What happens on an inspection?
After your inspection
We will give you informal feedback and identify any immediate concerns straight after an inspection
We will send you a draft version of our inspection report, so you can challenge any factual accuracies in the report
We will quality assure your report, by looking at it with other reports to ensure consistency of judgement
We will publish the report on our website, and if your report is Outstanding or Inadequate, we will send out a press release about
You can appeal your rating once it is published 7

8. Inspection feedback from practices
“My staff told me they found it a positive experience, as they don’t always get a chance to reflect on what we are doing.”
“I was very impressed with the professionalism of the inspection team.”
“I would like to thank you on behalf of the team for making in the inspection day as pleasant as possible and for all your efforts in producing your report.”
“They worked very hard to ensure that the day was as stress free as possible whilst getting the information they needed.” 8

9. Our inspection programme 2014/15
We have published 1,534 inspection reports since we launched our approach to inspecting GP practices in October 2014
What have we found?
4% outstanding
81% good
11% requires improvement
4% inadequate
85% of GP practices we have inspected are providing a good standard of care
Please note – check with James Smith in Provider Engagement for the latest numbers before using this slide 9

10. What makes an Outstanding practice?
Effective leadership
Strong, shared vision amongst practice staff
Effective staff training and support
Positive, patient centred culture
Effective working with multi-professional colleagues, including from other organisations
Additional clinical services empowering patients to self-manage long-term conditions (not always commissioned)
Strong PPG involvement 10

11. What makes an Outstanding practice?
Support for patients and carers with their emotional needs (e.g coordinating support groups)
Close working with the community to raise awareness of health conditions
Contribute to community wellbeing programmes (e.g walking groups and social enterprise programmes) 11

12. What can lead to Inadequate care?
Weak leadership and a chaotic and disorganised environment
A lack of vision for the organisation and clarity around individuals’ roles and responsibilities
A poor culture of safety and learning (e.g lack of significant event analysis or learning from complaints)
Poor systems for quality improvement (including quality audit)
Limited examples of assurance of clinical care 12

13. What can lead to Inadequate care?
Disregard for HR processes (e.g DBS checks)
Unsafe medicines management (Vaccines storage)
Limited access to appointments during core hours
Urgent Care Planning (O2 ,Defibrilators, Medicines) 13

14. Examples of Inadequate care
“There was no mechanism for the practice to seek patient feedback about services, and complaints had not been used to improve the service.”
“The locum GP was not sure who they should report incidents or concerns to; they had not received an induction and had not seen policies regarding incident reporting.”
“We found no evidence of criminal record checks for the two practice nurses, or any of the non-clinical staff.
There was no system in place to monitor the professional registration status of the practice nurses to ensure they maintained their registration.” 14

15. Issues by key question Safe
Up to the end of May 2015:
69% rated Good or Outstanding
Most practices discuss/share learning from Significant Event Analysis (SEAs)
We expect to see significant improvement in number of incidents being reported using National Learning Reporting System (already 100 practices using it)
However, safety remains our main concern:
Of the 977 services rated:
25% Required Improvement
6% were Inadequate
Safety issues often relate to poor systems and processes 15

16. Issues by key question Effective
We’ve found many examples of good, effective clinical practice, meeting the needs of local populations, e.g:
Quality improvement programmes
Coordinated referral processes
Joined up care with other healthcare providers
Joined up models of working, benefits observed include:
Appointments outside normal working hours
Wider range of services 16

17. Issues by key question Caring
Outstanding practices were able to demonstrate, for example:
Specific support for individual population groups
Innovative programmes for certain health conditions and flexible access to services 17

18. Issues by key question Responsive
Typically practices rated as outstanding had considered the needs of its population and subsequently implemented change. For example:
Guaranteed same-day appointments
Extended practice opening hours
Language support for non-English speaking patients
Innovation in how primary care is provided is developing rapidly:
Recently registered new GP care model using technology to provide consultation
Social enterprises are leading the way in care provision models
Demonstrate a clear vision to improve health of vulnerable and excluded groups
Work closely with services across their locality 18

19. Issues by key question Well-led
Our inspection findings show good leadership is the foundation of an Outstanding organisation. Examples include:
Culture the practice leaders create
Excellent staff development and support
Patients are at the centre of their developments 19

20. Population groups
GPs typically provide good services to their population group
Common examples of where GPs had done more to adapt their services to specific needs include:
Population group
Example
Working age people
Offering appointments outside of usual working hours (8am ) and at weekends.
People with long-term conditions
Educating patients to self-manage their long-term conditions more effectively.
People whose circumstances may make them vulnerable
Being flexible in their approach to vulnerable people by offering longer appointments and allowing homeless patients to register their home address at the practice.
People experiencing poor mental health
Maintaining strong links with local counselling services and improving access to psychological therapies.
Older people
Providing continuity with a named GP for people aged over 75.
Families, children and young people
Offering information in age appropriate formats for young people and ensuring staff were well trained on local safeguarding processes. 20

21. Across all our sectors:
Looking to the future
CQC strategy
Across all our sectors:
Focusing on a future vision of quality regulation
Considering the role of regulation versus other drivers of quality.
Public consultation January 2016
PMS inspections after Sept 2016
Co-producing any continuing improvements 21

22. Find information on all of the above at: www.cqc.org.uk/GPProvider
Find out more
Read the monthly e-bulletin
Sent to all providers and registered managers, or sign up through our website
Join our online community
Read our provider toolkit
Find information on all of the above at:

23. Thank you 23