Achieving the top rating required a concerted, year-long effort, he told GP. ‘It’s been a big effort by everybody, it’s meant everyone has looked at what we do and make sure the nuts and bolts are tight.
‘This required hard work, leadership from the front, and a single-mindedness from all partners and all the staff. We all decided this was something that we could do without it costing us an arm and a leg. We've had to put some money but it was something we had to do to say we could do it.’
‘It means having a plan. We looked at the four big areas [the CQC looks at] and decided where we might be weak. My practice manager’s office is quite literally wallpapered with Gantt charts of progress on each of the things CQC is interested in.’
But working in the way ‘that is supposed to be the best’ has come with significant downfalls, he said.
‘It’s killing us,’ he said. ‘Our days are just so bloody long. We work 11- to 12-hour days as a full working day. You are so washed out at the end of it that you've got no time for anything else.
‘My very real concern is that quality general practice requires that the practitioners are not knackered and worn out – and what we are doing now is knackering and wearing ourselves out, because the pace is too great to keep up and it’s unsustainable long-term.
‘We’ve merely proved it can be done, but it cannot continue to be done on the shoestring GPs are expected to work on both financially and in terms of work force.
‘It’s been a load more work that's not been resourced. But at least it puts me in a position where I can talk about this without anyone questioning our quality. I can turn around and say if we’re struggling, everybody else must be. There is insufficient resource to keep this running at this level.’
What made Dr Holden's practice 'outstanding'?
In its official inspection report for Dr Holden’s practice, the CQC said it saw ‘several areas of outstanding practice’, including:
- The practice had links with local schools and had provided several presentations to pupils about health issues. Pupils from a local school had designed the new logo for the practice.
- The leadership enabled staff to drive continuous improvements and carry out lead roles and innovative ways of working to meet patients’ needs. For example, the community matron regularly visited patients in their own home and local care homes in response to their needs, and held quarterly meetings with the practice manager and care home managers to review their needs.
- The practice provided medical support to a local drug misuse service, and was helping to change perceptions about people who had a drug dependency. The practice worked pro-actively with relevant services, which had enhanced their safeguarding links and holistic approach to supporting families and patients who had a drug dependency.
- The Patient Reference Group were actively involved in recruiting senior staff including the current practice manager.