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

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 1 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 3 1

4/27/2015 Fundamental Standards Care and welfare of service users Person-centred care Assessing and monitoring the quality Dignity and respect of service provision (April 2015 onwards) Need for consent New Regulations Safeguarding service users from Safe care and treatment Old regulations abuse Cleanliness and infection control Safeguarding service users from abuse Management of medicines Meeting nutritional needs Meeting nutritional needs Cleanliness, safety and suitability Safety and suitability of premises of premises and equipment Safety and suitability of equipment Receiving and acting on complaints Respecting and involving service users Good governance Consent to care and treatment Staffing Complaints Fit and proper persons employed Records and Requirements relating to workers Fit and proper persons requirement Staffing for directors Supporting workers Duty of candour Cooperating with other providers 4 4 Who do we inspect? Acute Hospitals Primary Medical Adult Social Care Services • Acute Trusts • GP Practices • Care homes • Community Trusts • GP Out of Hours • Domiciliary Care • Mental Health Trusts • Urgent care/ walk-in services centres • Hospices • NHS 111 • Dentists 5 5 What is different about our new approach? TO FROM • Professional, intelligence-based judgements • Focus on Yes/No ‘compliance’ • Ratings - clear reports about safe, effective, caring, well-led and responsive care • A low and unclear bar • Five key questions (with Key Lines of • 28 regulations,16 outcomes Enquiry) • CQC expects all providers to • CQC enforces continuously improve improvement to level of compliance • 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 • Individuals at Board level also held to account for quality of care account for the quality of care 2

4/27/2015 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. 7 Our new approach 8 Registration 9 3

4/27/2015 Intelligent Monitoring 10 Expert Inspections 11 Making judgements and publishing ratings 12 4

4/27/2015 Ratings grid Level 1: Every Level 2: Safe Effective Caring Responsive Well-led Overall key question Aggregated for every rating for population every Older people Good Outstanding Good Outstanding Good * group population group People with long Good Inadequate Good Inadequate Good * term conditions Families, children Requires Requires Good Good Good * and young people improvement improvement Working age people (including those Good Good Outstanding Good Outstanding * recently retired and students) People whose circumstances may Requires * Good Outstanding Good Good make them improvement vulnerable People with poor mental health Requires Requires * Good Good Good (including people improvement improvement with dementia) Level 4: Level 3: Overall * * * * * Aggregated Overall location Overall rating for rating for every * the practice key question 13 13 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 14 Enforcement Action 15 5

4/27/2015 Our enforcement powers Not an escalator – more than one power can be used 16 Distribution of ratings for General Practices in England (1 st October 2014 – mid-April 2015) Total North South Central London Outstanding 22 10 4 7 1 Good 499 185 131 143 40 Requires 64 12 24 17 11 Improvement Inadequate 18 8 2 2 6 Total 603 Outstanding (3.5%); Good (83%); Requires Improvement (10.5%); Inadequate (3%) Overall rating by domain 18 6

4/27/2015 Overall ratings As at 9 th 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. 19 Examples of Outstanding practice we’ve seen so far • Conducting robust significant event analysis and sharing learning with Safe 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 Effective 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 Caring dying homeless man to visit the beach • Providing a service which proactively reaches out to meet the needs of Responsive people in vulnerable situations. • Offering flexible, longer, or guaranteed same-day appointments • Cultivating a strong working relationship with the Patient Participation Well-Led Group • Offering strong personal and professional development opportunities for staff Examples of inadequate practise we’ve seen so far • Not undertaking any analysis of significant events Safe • 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 Effective • 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 Caring • 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 Responsive • 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 Well-Led responsibilities for day-to-day running of the practice • Poor visibility of leaders and lack of whole practice meetings 7

4/27/2015 Pros and Cons of this approach to improving quality in general practice Pros Cons • National standards � � • Encourages inward looking � � behaviour consistency • Gaming the system • Designed to inform and • Barrier to innovation – makes empower patients people risk averse • Enforcement Powers – we • Regulatory burden on already can make things happen over stretched General Practice • Could be used to drive • Can improvement happen under integration duress? Potential for creating a negative culture Vision for the regulation of integrated care? Current Future situation vision Questions? alastair.blake@cqc.org.uk 8