whilst an advocate of CQC initially, my recent experience with them to change practice registration and problems I have had with DBR, have completely changed my views of the ability of this organisation to hold others to account. I found then invisible, unapproachable, internal structures completely fragmented, no mechanism internally to address concerns other then the complaints process, and no mechanism for us to question any aspect of their work. They appear to be a law onto themselves and will not allow any aspect of their work to be questioned. They are not well led, they are not responsive to need, their approach to working with us is authoritarian (command and control), about as far removed from partnership with providers as one could get. They will not meet face to face is problems arise, and will only allow access through their customer services. Any change to this way of working with providers would be a welcome improvement. I do not feel at all confident in their ability to hold my practice to account at the moment.
Well done, General Practice needs to start thinking out of the box and do things differently. We have taken very similar approaches in my practice and get very good patient feedback. We need to move away from traditional models and develop services that meet population need, which means a transformed practice team. My only concern is that we are moving into a crisis with nurse practitioners and practice nurses, many of them are coming to retirement age (not sure what age yours are) all three of mine are in their late 50s, and succession planning for them is challenging. My belief is that nurses with the right skills will make a massive contribution to both the LTC and frailty tsunami we are heading into. This is exactly the direction we need to be travelling in with GPs providing leadership. The next step would be to have community services wrapped around practice populations to facilitate and enable integrated working.
The senior nurse is an advanced nurse practitioner trained and remunerated appropriately. Our whole team receive clinical supervision and actively involved in leadership and decision making. there is a structured process for support and education. The team are stimulated motivated and thriving. All the savings were ploughed back into front line services that supported transformation of our whole team
These are some very interesting views, my concern is for compassion, personal care and human kindness. As our populations grow older and they lose family and communities around them, they become more isolated and lonely. My worry is that we then develop more remote applications to manage their care with no/or limited human contact. Telehealth is a typical example, we might record a persons vital signs through machines from a distance, but we can't reassure them when they are breathless and anxious. I truly believe that technology has its place, but this should not be at the expense of human contact, particularly for the more frail, vulnerable and isolated in our communities. many of the patients who come to my practice to see their GP because they are lonely and isolated , have not been proactively supported to manage their long term conditions. We are fully supportive of new technology and this will have a high profile in the future, but for now we are engaging with our communities, supporting them with self care (this includes exposure to new technology) and mobilising the assets in and around our practice population to manage demand and provide high quality, patient centred care. What is the point of being kept alive until you are 120 if you have no quality of life and no human contact. Just a thought!!!
It is absolutely appalling to even suggest that a practice manager is individually at fault for missing/ submitting a claim for an enhanced service or any other contracted service. Inadequate or failing corporate and financial governance would be the underlying reason for this type of organisational failure. There should be robust monthly monitoring of all practice income and achievement of contracted activity. there should be strong clinical leadership for clinical functions, with the admin team providing sound foundations to ensure that all the money that is due to come into the practice is coming into the practice. A simple spread sheet would be wholly inadequate. Organisational wide implementation, monitoring, claiming and clinical care delivery need to be in place to ensure that patients are getting high quality clinical care that this is appropriately coded by clinicians and claimed through sound administration processes. Leadership from partners and the support of specialist medical accountants is essential in ensuring the practices maximises its contracted income and delivers excellent outcomes for patients as part of the process.