4/27/2015 Improving Quality in Primary Care The role of the CQC in - - PDF document

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Improving Quality in Primary Care – The role of the CQC in England’s health service

Dr Alastair Blake EQuIP Conference Fischingen, Switzerland

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

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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

• n the side of people who use services

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Fundamental Standards

Old regulations

Care and welfare of service users Assessing and monitoring the quality

• f 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)

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

• f 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

Services

Adult Social Care

• 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

What is different about our new approach?

FROM

• Focus on Yes/No

‘compliance’

• A low and unclear bar

TO

• 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
• Specialist inspectors with teams of experts
• Focus on services, groups, pathways
• Corporate body and

registered manager held to account for quality of care

• 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

• utcomes, 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

• rganisation 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 People with poor mental health (including people with dementia) Good Good Requires improvement Good Requires improvement Overall

* * * * * * Level 2: Aggregated rating for every population group

Overall

* * * * * Level 3:

Aggregated rating for every key question Level 4: Overall rating for the practice

Overall location

*

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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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Total North South Central London Outstanding 22 10 4 7 1 Good 499 185 131 143 40 Requires Improvement 64 12 24 17 11 Inadequate 18 8 2 2 6 Total 603 Outstanding (3.5%); Good (83%); Requires Improvement (10.5%); Inadequate (3%)

Distribution of ratings for General Practices in England (1st October 2014 – mid-April 2015)

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. Safe Effective Caring Responsive Well-Led

• Conducting robust significant event analysis and sharing learning with
• ther 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
• Cultivating a strong working relationship with the Patient Participation

Group

• Offering strong personal and professional development opportunities

for staff

Examples of Outstanding practice we’ve seen so far

Examples of inadequate practise we’ve seen so far

Safe Effective Caring Responsive Well-Led

• 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

• 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
• 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

• National standards
• consistency
• Designed to inform and

empower patients

• Enforcement Powers – we

can make things happen

• Could be used to drive

integration

Cons

• Encourages inward looking

behaviour

• Gaming the system
• Barrier to innovation – makes

people risk averse

• Regulatory burden on already
• ver stretched General Practice
• Can improvement happen under

duress? Potential for creating a negative culture

Vision for the regulation of integrated care? Current situation Future vision Questions?

alastair.blake@cqc.org.uk