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4/27/2015
Improving Quality in Primary Care – The
role of the CQC in England’s health
service
Dr Alastair Blake
EQuIP Conference
Fischingen, Switzerland
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Agenda
• What is the Care Quality Commission?
• How do we regulate General Practice in England?
• What have we found so far?
• Pros and Cons of this approach to Quality in General
Practice
Our 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
We will be a strong, independent, expert inspectorate that is always
on the side of people who use services
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Care and welfare of service users
Assessing and monitoring the quality
of service provision
Safeguarding service users from
abuse
Cleanliness and infection control
Management of medicines
Meeting nutritional needs
Safety and suitability of premises
Safety and suitability of equipment
Respecting and involving service
users
Consent to care and treatment
Complaints
Records
Requirements relating to workers
Staffing
Supporting workers
Cooperating with other providers
New Regulations
(April 2015 onwards)
Old regulations
Fundamental Standards
Person-centred care
Dignity and respect
Need for consent
Safe care and treatment
Safeguarding service users from
abuse
Meeting nutritional needs
Cleanliness, safety and suitability
of premises and equipment
Receiving and acting on complaints
Good governance
Staffing
Fit and proper persons employed
and
Fit and proper persons requirement
for directors
Duty of candour
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Who do we inspect?
Acute Hospitals
Primary Medical
Adult Social Care
Services
•
•
•
Acute Trusts
Community Trusts
Mental Health Trusts
•
•
•
•
•
GP Practices
GP Out of Hours
Urgent care/ walk-in
centres
NHS 111
Dentists
•
•
•
Care homes
Domiciliary Care
services
Hospices
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What is different about our new
approach?
FROM
TO
• Focus on Yes/No
‘compliance’
• A low and unclear bar
• Professional, intelligence-based judgements
• Ratings - clear reports about safe, effective,
caring, well-led and responsive care
• 28 regulations, 16 outcomes
• Five key questions (with Key Lines of
Enquiry)
• CQC enforces
improvement to level of
compliance
• CQC expects all providers to
continuously improve
• Providers and commissioners clearly
responsible for improvement
• Generalist inspectors
• Corporate body and
registered manager held to
account for quality of care
• Specialist inspectors with teams of experts
• Focus on services, groups, pathways
• Individuals at Board level also held to
account for the quality of care
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Key questions in ALL Inspections
Our focus is on five key questions that ask whether a provider is:
1. Safe? – people are protected from abuse and avoidable harm
2. Effective? – people’s care, treatment and support achieves good
outcomes, promotes a good quality of life and is based on the best
available evidence
3. Caring? – staff involve and treat people with compassion, kindness,
dignity and respect.
4. Responsive? – services are organised so that they meet people’s
needs
5. Well-led? – the leadership, management and governance of the
organisation assure the delivery of high-quality care, supports
learning and innovation, and promotes an open and fair culture.
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Our new approach
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Registration
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Intelligent Monitoring
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Expert Inspections
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Making judgements and publishing
ratings
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Ratings grid
Level 1: Every
key question
for every
population
group
Safe
Effective
Caring
Responsive
Well-led
Older people
Good
Outstanding
Good
Outstanding
Good
People with long
term conditions
Good
Inadequate
Good
Inadequate
Good
Families, children
and young people
Good
Good
Requires
improvement
Good
Requires
improvement
*
Working age people
(including those
recently retired and
students)
Good
Good
Outstanding
Good
Outstanding
*
People whose
circumstances may
make them
vulnerable
Good
Outstanding
Good
Requires
improvement
Good
*
Good
Good
Requires
improvement
Good
Requires
improvement
*
*
*
*
*
*
People with poor
mental health
(including people
with dementia)
Level 3:
Aggregated
rating for every
key question
Overall
Overall
*
Level 2:
Aggregated
rating for
every
population
group
*
Overall
location
*
Level 4:
Overall
rating for
the practice
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Rating 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
Significant harm has or is likely to occur, shortfalls
in practice, ineffective or no action taken to put
things right or improve
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Enforcement Action
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Our enforcement powers
Not an
escalator –
more than one
power can be
used
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Distribution of ratings for General
Practices in England (1st October 2014 –
mid-April 2015)
Total
North
South
Central
London
Outstanding
22
10
4
7
1
Good
499
185
131
143
40
Requires
Improvement
Inadequate
64
12
24
17
11
18
8
2
2
6
Total
603
Outstanding (3.5%); Good (83%);
Requires Improvement (10.5%); Inadequate (3%)
Overall rating by domain
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Overall ratings
As at 9th April 2015, there have been 603 PMS ratings published. Overall; 83%
were rated as good, 10.5% as requires improvement, 3.5% as outstanding and
3% as inadequate.
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Examples of Outstanding practice
we’ve seen so far
•
Safe
•
Effective
Conducting robust significant event analysis and sharing learning with
other practices, the CCG and other external bodies
Having a strong safety culture in the whole MDT
•
Offering additional training to staff so that they can deliver extra
services for patients close to home – e.g. complex leg ulcer management
•
Providing a range of compassionate additional services to support
patients and carers emotional needs e.g. Inclusion Healthcare paying for a
dying homeless man to visit the beach
•
Providing a service which proactively reaches out to meet the needs of
people in vulnerable situations.
Offering flexible, longer, or guaranteed same-day appointments
Caring
Responsive
•
•
Well-Led
•
Cultivating a strong working relationship with the Patient Participation
Group
Offering strong personal and professional development opportunities
for staff
Examples of inadequate practise
we’ve seen so far
Safe
•
•
•
Not undertaking any analysis of significant events
Storing medicines and vaccines in an unsafe way (e.g. not refrigerated)
Not ensuring that staff have been properly screened in the recruitment
process
Effective
•
•
Not undertaking any clinical audits or evaluation of the service
Not using up-to-date best practice in patient care
•
Little concern for privacy and dignity for patients at the reception desk
and waiting area
Not holding lists of people at the end of life or sharing their information
with OOH services
Poor availability of appointments at times which suit patients
Difficult to contact the practice via telephone
No provision of same-sex clinicians
Caring
•
Responsive
•
•
•
•
Well-Led
•
Absence of vision for the organisation and lack of clarity in roles and
responsibilities for day-to-day running of the practice
Poor visibility of leaders and lack of whole practice meetings
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Pros and Cons of this approach to
improving quality in general practice
Pros
Cons
• National standards consistency
• Encourages inward looking
behaviour
• Gaming the system
• Barrier to innovation – makes
people risk averse
• Regulatory burden on already
over stretched General Practice
• Designed to inform and
empower patients
• Enforcement Powers – we
can make things happen
• Could be used to drive
integration
• Can improvement happen under
duress? Potential for creating a
negative culture
Vision for the regulation of integrated
care?
Current
situation
Future
vision
Questions?
[email protected]
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