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What makes a CQC 'outstanding' practice?

Under the CQC's new inspection regime, practices in England will be rated as 'outstanding', 'good', 'requires improvement' or 'inadequate'. What can other practices learn from the first two practices rated as outstanding?

Both practices had a clear vision, with quality and safety as their top priority (Picture: iStock)
Both practices had a clear vision, with quality and safety as their top priority (Picture: iStock)

The first two practices to be rated under the CQC’s new inspection regime were awarded an ‘outstanding’ rating. Irlam Medical Practice in Greater Manchester and Salford Health Matters in Eccles were both rated outstanding against all five of the CQC’s key questions: Are services safe, effective, caring, responsive to people’s needs and well-led?

So, what made these practices outstanding and what can other practices learn from the CQC’s reports on the two organisations?

Chief executive of Salford Health Matters Neil Turton says the inspection team’s focus was relentlessly on important areas.

‘They did not look at anything that would not be considered important by a practice with a quality improvement agenda. Everything they looked at were things that we were working on already,’ he explains.

‘They looked at the culture of the organisation and teamwork, but the approach to staffing is really important. How are you meant to work well without a well-supported, motivated, and dare I say it, happy workforce?’

How ratings work

A practice’s overall rating is based on the ratings to each of the CQC’s five questions. Where a practice is rated ‘outstanding’ on two or more of the questions and ‘good’ on the remainder, it will usually be awarded an overall outstanding rating.

What makes a practice outstanding?

In terms of the two practices that were awarded the outstanding ratings, a number of common themes can be found in the reports relating to the five key questions.

Safe

  • Both practices had robust systems in place for monitoring safety, dealing with significant events and learning from incidents. Most importantly, all staff were aware of these systems and understood their responsibilities within this.

Effective

  • Both practices were able to demonstrate that they were up to date with both NICE and other locally agreed guidelines and were able to show how these guidelines were helping them to improve practice and outcomes for their patients.
  • Clinical audits were undertaken regularly and used to improve learning within the practice or the quality of services provided.
  • Staff had the right skills and experience for the roles they were undertaking – and the practice could demonstrate this through its records.

Caring

  • Feedback from patients about their care and treatment during the inspections was consistently positive.
  • Inspectors found many positive examples of staff delivering excellent care and staff understood the importance of involving patients in their care and providing the information patients needed to make informed choices.

Responsive

  • Both practices had initiated positive improvements for their patients that were over and above their contractual obligations.
  • The practices had implemented changes and improvements based on the need of their patients.
  • Patients reported good access, with urgent appointments available on the same day.
  • There was a clear and accessible complaints system and evidence that the practices responded quickly to issues raised. There was also evidence of shared learning from complaints with staff and other organisations.

Well-led

  • Both practices had a clear vision, which had quality and safety as their top priority.
  • There was a high level of staff engagement and staff satisfaction in both practices. The report for Irlam Medical Centre mentions that staff felt valued and rewarded and were encouraged and trained to improve their skills.
  • There was clear evidence of effective team working.

Six population groups

Practices are also rated on the quality of care that they provide to six population groups. Salford Health Matters in Eccles was rated outstanding in each of these groups. Below are some key points from the report that explain why.

Older people

  • There was a register of all patients over 75 and they had a named GP.
  • Patients at risk of hospital admission ad a care plan in place.
  • Housebound patients were routinely visited.
  • An appointment system that enabled patients to speak to a clinician on the day they called the practice worked well for this patient group.
  • The practice worked well as part of a multidisciplinary team to take a holistic approach to caring for over-65s.

People with long-term conditions

  • Patients had an annual review of their condition, when their medication needs were checked.
  • Longer appointments and home visits were available if needed.
  • Patients at risk of hospital admission had a care plan in place, which was regularly reviewed by a GP.

Families, children and young people

  • Systems were in place for identifying and following up children at risk.
  • Childhood immunisation rates were monitored and take-up was good.
  • Appointments were available outside school hours.
  • The premises were suitable for children and babies.
  • There was evidence of good joint working with midwives and health visitors.

Working age people

  • Appointments were routinely offered until 6.30pm, with appointments until 8pm one night a week and the practice was open one Saturday a month. Patients could also attend another practice within the same group that had different late night or Saturday opening times.
  • NHS Health Checks were offered to all patients between 40 and 74 and the practice was trialling different ways of engaging this group to increase uptake.

Vulnerable patients

  • There was a register of people living in vulnerable circumstances, including those who were homeless, travellers and those with learning disabilities.
  • Homeless patients could see a GP at a drop-in centre three times a week without an appointment.
  • There were longer appointments for people with learning disabilities.
  • Staff knew how to recognise signs of abuse in vulnerable children and adults and they were aware of their responsibilities regarding information sharing.

Patients experiencing poor mental health

  • All staff at the practice were ‘dementia friends’.
  • A primary care mental health worker regularly attended the practice so patients could see someone in a place they were familiar with.
  • The practice sign-posted support groups and were proactive in helping patients address issues such as smoking to help them improve their overall health.

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