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Working with Patient Participation Groups in Primary Care Inspections

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Title: Working with Patient Participation Groups in Primary Care Inspections


1
  • Working with Patient Participation Groups in
    Primary Care Inspections

2
CQC purpose and role
Our purpose 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
3
CQC approach to regulation
4
Inspection feedback from practices
My staff told me they found it a positive
experience, as they dont always get a chance to
reflect on what we are doing.
For the first time in our lives, we feel that
our work has been recognised and appreciated.
They worked very hard to ensure that the day was
as stress free as possible whilst getting the
information they needed.
We appreciate you making the process less
stressful than we expected it to be!
4
5
Our inspection programme
  • We have published 3,159 inspection reports since
    we launched our approach to inspecting GP
    practices in October 2014 (as of 18 March 2016)
  • What have we found?

83.7 of GP practices we have inspected are
providing a good or outstanding standard of care
5
6
Overall rating by domain
GP Practices
(Information correct as of 18 March 2016)
7
Ratings by region
The graph below breaks the ratings down by
region. Outstanding Good RI
Inadequate
North 1039
North 1039 41 885 80 33
North 1039 3.9 85.2 7.7 3.2
Central 934
Central 934 44 720 118 52
Central 934 4.7 77.1 12.6 5.6
London 411
London 411 9 296 78 28
London 411 2.2 72 19 6.8
South 775
South 775 35 615 97 28
South 775 4.5 79.4 12.5 3.6
(Information correct as of 18 March 2016)
8
Key themes from our inspections
  • Most GP practices provide good care
  • However, weve found a small number of extremely
    concerning cases of poor care
  • Weve found a strong link between good leadership
    and good care
  • Likewise, weve found a strong link between poor
    leadership and poor care

8
9
Key themes from our inspections
  • Safety culture is an area where we found room for
    improvement for GP practices
  • We often found poor incident reporting, lack of
    learning from significant events, poor medicines
    management
  • Practices deliver better care when they share
    learning through multi-professional networks
  • Professional isolation (common in single handed
    practices) can lead to lack of communication and
    engagement with staff and patients and lack of
    transparency

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
  • Support for patients and carers with emotional
    needs

10
11
Working with Patient Participation Groups (PPGs)
  • We put peoples views and experiences at the
    heart of what we do
  • PPGs represent patient and community views at a
    practice level
  • In 2013 CQC developed an approach to working with
    PPGs in partnership with PPGs with National
    Association of Patient Participation
  • The published Guide will be updated in 2016

11
11
12
Working with PPGs on an inspection
  • When we contact a GP practice about an
    inspection, we ask the practice manager for the
    contact details of two members of the PPG, if
    there is one
  • We ask that you pass on any information about how
    patients view the practice which may be
    appropriate including
  • Comments or views on standards of quality and
    safety at the practice
  • Recent activity surveys, meetings or complaints
    analysis
  • Any other work being carried out at the practice
    to gather patient views
  • PPG Chairs and members are often interviewed
    during the inspection and may be present when it
    happens

13
Reports
  • If your PPG contributed to our judgement we try
    to refer to this in the final report of our
    inspection
  • You can receive an alert as soon as the final
    report is published see our website to register
    to receive alerts

 
14
Listening to patients
  • On our inspections we also
  • Use comments cards
  • Spend time talking to patients and staff
  • Work with experts by experience people who use
    services
  • We also also have regular contact with Local
    Healthwatch, Overview and scrutiny committees and
    CCGs who tell us about local views and
    experiences of care

15
Outstanding case study Holsworthy Doctors
Holsworthy doctors in Devon has the largest
catchment area of any practice in England. The
practice was rated outstanding in April 2015
Some patients live far away from the practice So
they enabled patients to request prescriptions
and appointments online
The practice has a comprehensive business plan in
place Progress is regularly discussed with staff
and Patient Participation Group members
The practice holds monthly multidisciplinary
meetings, including with specialists from the
local hospitals palliative care team
The nearest hospital is 29 miles away So the
practice hosts a series of specialist clinics,
such as diabetic retinal screening
The practice facilitated a virtual PPG, to enable
them to receive a wider range of feedback and
more opportunities for finding improvement
The nearest hospice is 25 miles away So the
practice helped build a satellite day hospice
15
16
What can lead to inadequate care?
  • Weak leadership and a chaotic and disorganised
    environment
  • Isolated working not working closely with other
    local providers to share learning
  • A lack of vision for the organisation and clarity
    around individuals roles and responsibilities
  • A poor culture of safety and learning (for
    example, lack of significant event analysis or
    learning from complaints)

16
17
What can lead to inadequate care?
  • Poor systems for quality improvement (including
    quality audit)
  • Limited examples of assurance of clinical care
  • Disregard for HR processes (for example, DBS
    checks)
  • Unsafe medicines management
  • Limited access to advice and treatment
  • Lack of practice nurses or very low numbers of
    practice nurse sessions

17
18
Examples of inadequate care
We identified one locum staff member who had
treated patients but couldnt provide evidence
that they were medically qualified to do so.
We found no evidence of criminal record checks
for the two practice nurses, or any of the
non-clinical staff.
Medicines were found to be out-of-date, and
requests for prescriptions had not been processed
in a timely manner to ensure patients had access
to their medicines.
There was no mechanism for the practice to seek
patient feedback about services, and complaints
had not been used to improve the service.
18
19
Support for poor performing practices
  • What happens when a practice enters special
    measures?
  • We will inform the NHS clinical commissioning
    group, and NHS area team
  • The Royal College of GPs provides peer support to
    practices, using a local turnaround team. They
    help practices identify and deliver an
    improvement plan

19
20
Further information
  • The CQC PPG Guide for Working Together can be
    found at www.cqc.org.uk/PPGs
  • For all CQC reports and to sign up to our alerts
    go to
  • www.cqc.org.uk
  • ADD ANY OTHER CONTACT DETALS
  • ANY QUESTIONS
  • ?
  •  

20
20
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