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First GP practices receive 'outstanding' CQC ratings

The first two GP practices to be given a rating following the new CQC inspections have been rated ‘outstanding’.

Irlam Medical Practice, and Salford Health Matters, Greater Manchester, were some of the first practices to be inspected as part of the CQC’s new inspection regime which was officially rolled out on 1 October.

After an inspection, the CQC will give a practice a rating of ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’.

Both the Irlam Medical Practice, and Salford Health Matters were awarded ‘outstanding’ ratings in all areas of the CQC’s inspection criteria - including if the practice is well-led, effective, caring, safe and responsive to the people’s needs, according to the CQC.

Practices that are given a rating of ‘inadequate’ will be allowed six months to improve - but if they fail to improve the practice will be placed in special measures for a maximum of six months. However, if they are still found to be inadequate, they will have their registration with CQC cancelled and/or their contract terminated by NHS England.

Pulse recently revealed that practices that are placed in ‘special measures’ will have to pay half the costs to access a 12-month pilot support programme developed by the RCGP and NHS England, which will cost them up £5,000.


How the practices received ‘outstanding’ ratings

Salford Health Matters

  • All patients requiring an appointment with a GP are seen on the day their request is made – and requests can be made at any time of the day.
  • The practice asks for feedback from patients and sends a text message to all patients following an appointment to ask about their satisfaction.
  • Communication with staff is ‘excellent.’ Staff have weekly meetings away from the workplace and are in regular communication with the chief executive.
  • Appointment length is need-specific, with longer appointments routinely offered to some patients with a learning disability.

Irlam Medical Practice

  • The CQC identified good leadership and a strong learning culture within all staff, with quality and safety being their top priority.
  • There were examples of close working partnerships with other health and social care professionals, which included care planning and a view to avoid unplanned hospital admissions.
  • Significant events are recorded and shared with multi-professional agencies.
  • The practice reaches out to the local community, with practice nurses voluntarily carrying out an annual stroke awareness clinic at a local supermarket for the last five years. All of the staff proactively follow-up information received about vulnerable patients.

Meanwhile, according to the BBC, out of the 336 GP practices inspected as part of the new regime so far - one in six patients are ‘struggling’ to book appointments and there is also concern ‘over variations in how serious incidents were reported and investigated,’ the CQC said.

The CQC’s chief inspector of general practice, Professor Steve Field, said that he aims to ‘shine a light’ on poor care, adding that good care should be celebrated as well.

Mr Field added: ‘With our new inspection regime for general practice we are shining a spotlight on poor care and celebrating the good and the outstanding when we find it. I am very pleased that our first two ratings highlight some of the outstanding care that we know exists in general practice.

‘While we are clearly in the very early stages of ratings these services and there is a long way to go before we have inspected every general practice across the country, this should send an encouraging and inspiring message to providers and to members of the public. I congratulate the staff at these practices for their hard work in making a difference for the people using these services.’

Just before the inspection regime started in October, Professor Field claimed that 200 GP practices could be closed under the new CQC inspection regime

Related images

  • chief inspector Steve Field - online

Readers' comments (11)

  • Vinci Ho

    CQC still owes the public explanations of the actual meanings of this grading , outstanding , good , requires improvement and inadequate . Also , What is the majority ? What is the minority ?
    If it wants us to be more transparent, fine , CQC needs to be transparent as well ......

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  • If a practice is struggling to offer enough appointments this might represent poor management but is just as likely to be an indicator of gross underinvestment in primary care over the past 10 years. It should lead to a rating of 'requires improvement' to be put on the Dept of Health.

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  • Vinci Ho

    You queried the definitions being used for the ratings of GP practices. There are some explicit definitions of what constitutes each of the 4 gradings being used by the CQC already published - see Appendix C of the GP Inspection Handbook published in early October 2014. See:

    Hope this helps.

    Richard Banyard (CQCassist)

    PS Don't forget that the CQC have sought to mirror the OFSTED categories in their ratings system, which does of course now apply to ALL providers of health and social care in England.

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  • Publishing this could make some sense. However it is only relevant if there is a breakdown of the age demographics of the practice and the full practice income. This needs to be £ per patient per year, regardless of the contract (GMS, PMS, APMS) and including extras like payment from nursing homes, number / hrs of GP Registrars etc. Without this there is no comparison

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  • Vinci Ho

    People are protected by a strong comprehensive safety system, and a focus on openness, transparency and learning when things go wrong.
    There is a genuinely open culture in which all safety concerns raised by staff and people who use services are highly valued as integral to learning and improvement.
    All staff are open and transparent and fully committed to reporting incidents and near misses. The level and quality of incident reporting shows the levels of harm and near misses, which ensures a robust picture of safety.
    Learning is based on a thorough analysis and investigation of things that go wrong. All staff are encouraged to participate in learning and to improve safety as much as possible. Opportunities to learn from external safety events are identified.
    There are comprehensive systems to keep people safe, which take account of current best practice. The whole team is engaged in reviewing and improving safety and safeguarding systems. Innovation is encouraged to achieve sustained improvements in safety and continual reductions in harm.
    A proactive approach to anticipating and managing risks to people who use services is embedded and is recognised as the responsibility of all staff.
    People are protected from avoidable harm and abuse.
    When something goes wrong, people receive a sincere and timely apology and are told about any actions taken to improve processes to prevent the same thing happening again.
    Openness and transparency about safety is encouraged. Staff understand and fulfil their responsibilities to raise concerns and report incidents and near misses; they are fully supported when they do so. Monitoring and reviewing activity enables staff to understand risks and gives a clear, accurate and current picture of safety.
    How CQC regulates: NHS GP practices and GP out-of-hours services 24
    appendices to the provider handbook
    Performance shows a good track record and steady improvements in safety. When something goes wrong, there is an appropriate, thorough review or investigation that involves all relevant staff and people who use services. Lessons are learned and communicated to support improvement. Improvements to safety are made and the resulting changes are monitored.
    There are clearly defined and embedded systems, processes and practices to keep people safe and safeguarded from abuse. These:
    • Are reliable and minimise the potential for error.
    • Reflect national, professional guidance and legislation.
    • Are appropriate for the care setting.
    • Are understood by all staff and implemented consistently.
    • Are reviewed regularly and improved when needed.
    Staff have received up-to-date training in systems, processes and practices.
    Safeguarding vulnerable adults, children and young people is given sufficient priority. Staff take a proactive approach to safeguarding and focus on early identification. They take steps to prevent abuse from occurring, respond appropriately to any signs or allegations of abuse and work effectively with others to implement protection plans. There is active and appropriate engagement in local safeguarding procedures and effective work with other relevant organisations.
    Staffing levels and skill mix are planned, implemented and reviewed to keep people safe at all times. Any staff shortages are responded to quickly and adequately.
    Staff recognise and respond appropriately to signs of deteriorating health and medical emergencies.
    Risks to safety from service developments, anticipated changes in demand and disruption are assessed, planned for and managed effectively. Plans are in place to respond to emergencies and major situations. All relevant parties understand their role, and the plans are tested and reviewed.
    Requires improvement
    There is an increased risk that people are harmed or there is limited assurance about safety.
    People do not always receive a timely apology when something goes wrong and are not consistently told about any actions taken to improve processes to prevent the same happening again.
    How CQC regulates: NHS GP practices and GP out-of-hours services 25
    appendices to the provider handbook
    Safety concerns are not consistently identified or addressed quickly enough.
    There is limited use of systems to record and report safety concerns, incidents and near misses. Some staff are not clear how to raise concerns or are wary about doing so.
    When things go wrong, reviews and investigations are not always sufficiently thorough or do not include all relevant people. Necessary improvements are not always made when things go wrong.
    Systems, processes and practices are not always reliable or appropriate to keep people safe. Monitoring whether safety systems are implemented is not robust. There are some concerns about the consistency of understanding and the number of staff who are aware of them.
    Safeguarding is not given sufficient priority at all times. Systems are not fully embedded, staff do not always respond quickly enough or there are gaps in the system of engaging with local safeguarding processes.
    There are periods of understaffing or inappropriate skill mix, which are not addressed quickly. The way that agency, bank and locum staff are used does not ensure that people’s safety is always protected.
    There is a risk that staff may not recognise or respond appropriately to signs of deteriorating health and medical emergencies.
    The risks associated with anticipated events and emergency situations are not fully recognised, assessed or managed.
    People are unsafe or at high risk of avoidable harm or abuse.
    When something goes wrong, people are not always told and do not receive an apology. Staff are defensive and are not compassionate.
    Safety is not a sufficient priority. There is limited monitoring of safety. There are unacceptable levels of serious incidents or significant events.
    Staff do not recognise concerns, incidents or near misses. Staff are afraid of, or are discouraged from, raising concerns and there is a culture of blame. When concerns are raised or things go wrong, the approach to reviewing and investigating causes is insufficient or too slow. There is little evidence of learning from events or action taken to improve safety.
    How CQC regulates: NHS GP practices and GP out-of-hours services 26
    appendices to the provider handbook
    Systems, processes and practices do not keep people safe. There is wilful or routine disregard of standard operating or safety procedures.
    Care premises, equipment and facilities are unsafe.
    There is insufficient attention to safeguarding children and adults. Staff do not recognise or respond appropriately to abuse.
    Substantial or frequent staff shortages or poor management of agency or locum staff increases risks to people who use services.
    Staff do not assess, monitor or manage risks to people who use the services. Opportunities to prevent or minimise harm are missed.
    Changes are made to services without due regard for the impact on people’s safety. There are inadequate plans in place to assess and manage risks associated with anticipated future events or emergency situations.

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  • Vinci Ho

    Not the easiest appendix for the public to find on line .Generic and dogmatic definitions.

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  • God help those poor outstanding practices who will be overwhelmed by patients beating at their door....don't be surprised if they are found to be inadequate soon....

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  • A third practice was also given an 'outstanding' rating.......

    Yorkshire Health Incorporated

    All registered patients are visited daily 365 days a year to make sure they are well and have no outstanding needs of any sort. Practice nurses are available for any domestic duties that the patient(s) may require eg. cleaning, dish-washing, shopping, collecting children from school etc. They were especially praised by the CQC for voluntarily operating the TV remote controls for some patients to avoid them having to get out of their chairs to change TV channels.

    Practice hours have been extended to 24 hours 7 days a week to improve access.

    Clinicians meet with all staff on an hourly basis to ensure communication remains of paramount importance. Practice meetings with all staff are held daily at midnight which all staff attend willingly and voluntarily.

    Appointment times and duration are entirely at the patients discretion.

    The CQC have confirmed an excellent learning culture with all staff taking OU courses in Public Relations, Practice Management, Porcine Auricular Refashioning and Lithohaematogenesis.

    Practice nurses are available at all local supermarkets to assist with bagging patients shopping and transporting it to their cars if necessary.

    Other planned community outreach projects under consideration which attracted CQC praise are street cleaning, emptying household domestic waste bins weekly to prevent the spread of infection and disease and providing a torch shining service to escort late night revellers home after the street lights have been switched off to prevent minor accidents.

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  • Are we comparing like with like? For example - the best hospital in England has 125 consultants per 100 beds [ St Thomas], among the worst failing hospitals in Nottingham has 48/100. So, one can work almost 3 times as hard and still be failing.
    Funding per patient in London is about £550 as opposed to £168 in Lancashire.
    Its apples and oranges, nay, these are at least fruit, it is tigers and lemmings.

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  • clearly outstanding is a measure of political correctness not medical standards...what a surprise.

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