CQC reveals qualities of outstanding and most-improved GP practices

The CQC has revealed what top-performing practices did to secure their 'outstanding' ratings and how special measures practices managed to turn around care and improve services.

The very best GP practices ‘tend to have a detailed understanding of the communities they serve’ and ‘demonstrate their responsiveness to people’s needs’ in term of the services they offer within and outside the practice, according to the CQC.

The findings are presented in the CQC’s annual State of Care report, which compiles the watchdog’s findings during inspections over the 2015/16 year.

It details how the practices rated outstanding managed to do it and what practices that initially struggled did to pull themselves out of special measures.

Practices have impressed inspectors by offering telephone consultations in response to patient feedback, establishing a ‘child’s hour’ before and after school for same-day appointments and considering emotional and social needs as important as medical ones.

The report also showed that other, more immutable factors can impact on a practice’s rating, with those with larger list sizes tending to perform better in inspections.

Qualities of outstanding practice

  • Staff engagement – Inspectors described a practice where each GP partner ‘led’ on a particular area, for example care homes or schools. This ‘built expertise and rapport on specific issues and with particular groups’.
  • Especially responsive – Outstanding practices identify and react to the potential unmet needs of specific population groups in their areas. They gather information from patients and use it to plan facilities and services accordingly.
  • Opening hours – Practices with better ratings tend to be open outside of core hours, with 24% of outstanding opening on a Saturday.
  • Learning culture – A common characteristic of outstanding practices is that they have a ‘no blame’ culture among staff, where ‘everyone is aware of their own role and feels important in supporting and promoting change’.

Two fifths (41%) of inadequate practices to have been re-inspected so far have managed to improve to good, the report shows.

The CQC said practices were most likely to do this when they ‘improved communication between staff’ and ‘introduced systems to enable learning’, such as violent incident reporting.

A third (34%) also improved to a requires improvement rating, while a quarter (25%) remained inadequate.

Map: Which areas have the most outstanding GP practices?

Most practices rated requires improvement also improved following a second visit from inspectors, with 76% going up to good and 17% remaining the same. A further 7% dropped to inadequate.

‘Inspectors usually remark that a positive change is more likely in services that have an open culture where continuous improvement is encouraged,’ the report said.

‘Governance and governance frameworks are important areas of improvement identified in inspection reports – for example, introducing a new electronic management workflow system to provide an automatic audit trail for all documents that were read and reviewed by staff.

‘Other factors behind good ratings included evidence of fostering an organisational culture of continuous learning, improvement and innovation – and having a clear vision, strategy and values.’

It identified professional isolation as a ‘major barrier’ to improvement. ‘GPs who work with other GPs, or practices that work with one another, can share knowledge and good practice, and collaborate to improve,’ it said.

The attitude of practices to the CQC is reportedly another ‘major factor in whether providers are likely to improve from ratings of inadequate or requires improvement’.

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