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CQC outstanding practice: Is your practice responsive?

Key learning points for GP practices from the CQC's examples of outstanding practice.

Engaging with children and young people

Welbeck Road Health Centre in Derbyshire had an outstanding approach to the care of children and young people. It actively promoted the ‘You’re Welcome’ initiative - a DH quality initiative to ensure health services are young people friendly.

The practice had leaflets displaying the services offered and how to access them in appropriate formats for young people. It also had an explicit policy and information on confidentiality and consent relating to young people. The practice also ran its own young person’s (13 to 19 year old) questionnaire. The results of this showed that all participants would recommend the practice to others, felt staff were welcoming and friendly, and felt able to ask questions. Improvements were made to increase the response rate, improve the explanation of confidentiality for young people, and to clarify who young people could bring to consultations. Facebook and Twitter accounts were actively promoted by the practice to maximise interaction with young people about their health and medicines.

Learning points:

  • What has your practice done to make itself ‘young person friendly’?
  • Is there anything you can learn from the You’re Welcome initiative?
  • Do you have a policy on confidentiality and consent for young people? And, if so, do all staff understand this and how it applies in practical situations?
  • Do you take steps to get feedback on your practice from children and young people?

Working with your PPG

Case study 1: The PPG at Aspull Surgery in Wigan, Greater Manchester has worked with a specialist activities instructor to establish weekly health walks, and has trained two patients as walk leaders. The weekly walks attract 10 to 12 people. The chair of the PPG reported that the practice staff go the extra mile to support the PPG and patients

Case study 2: Streatham High Surgery in south London has been supporting its patient participation group (PPG) to organise and provide Saturday drop in sessions. These sessions were health promotion events, and the topics were selected by PPG members, responding to issues that mattered to patients.

Learning points:

  • Have you got minutes of all your PPG meetings or emails if a virtual group and can you demonstrate active patient participation?
  • Can you show how patient feedback is helping you improve the service that you are offering?
  • Can you show any new initiatives that have been set up as a result of patient feedback?
  • Is your PPG helping you with health promotion events and other health promotion initiatives?

Improving access to care

Case study 1: Concord Medical Centre in Bristol had invested in a DEXA scanner for patients with suspected osteoporosis. It offered a free assessment for its own patients and a private service for those from other practices. The service meant local patients received their diagnosis far quicker and without needing to attend hospital. In one year the practice had provided 213 patient scans, including 136 scans for the local hospital to help reduce patient waiting times.

Case study 2: Concord Medical Centre had also developed a joint service with Bristol Oncology Centre to provide in-house oncology treatment for their own patients and patients from other practices in the community. The practice has the facilities to see up to 20 patients per day and offer a specialist treatment suite and community garden to support emotional wellbeing. The treatment provided at the practice includes chemotherapy, osteoporosis infusion treatment, biological monoclonal antibodies, blood tests, PICC line care, electrolyte replacement, venesections for polycythaemia and immunoglobulin infusions.

Case study 3: Dalefield Surgery in Bolton, Lancashire is part of a group of practices that has secured funding to support the needs of non-English speaking patients who make up approximately 9% of the practice population. The funding has enabled them to employ workers to support their patients and other practices in the Bolton area. Appointments for patients were 20 minutes and interpreters were available through a telephone service. The practice made referrals for new non-English speaking patients to a worker who provided comprehensive interventions for patients and their families.

Case study 4: Shere Surgery in Guildford, Surrey identified that its patients had poor access to local mental health services and therefore approached a charitable trust for funding to provide an on-site service for patients. The trust funded clinical psychology, counselling and CBT services, which are provided at the practice on weekdays and weekends.

Case study 5: Heaton Road Surgery in Newcastle had twice as many patients with learning disabilities in comparison with other local practices. To address the needs of these patients, staff had undergone training in learning disabilities. The practice arranged to be inspected by North East Health Checkers who use experts by experience with learning disabilities to carry out a quality check of the practice to assess its responsiveness to patients with learning disabilities. The report was very positive, areas for improvement were highlighted and the practice was working towards them. The practice sent letters to patients with learning disabilities inviting them to take up the offer of a health check. These letters were followed up with a personal telephone call to ensure the patients knew why they had been invited to attend if they hadn't taken up the offer.

Case study 6: Cuckoo Lane Practice in west London worked hard to improve the coordination of care for older people. An Age UK support worker attended the practice three days a week to support older patients who live alone. The practice also provided transport to improve access for those patients who are house bound or find it difficult to get to the surgery. This had improved socialisation and reduced the number of home visits by 20 during its first month.

Learning points:

  • Can you describe your patient population (age, sex, ethnicity, deprivation)?
  • Can you describe how you tailor your services to your population?
  • Can all of your staff describe all of the services that you offer?
  • Are you confident in how your patients are communicated with about services?
  • Is your website up to date, does it detail your services and how to access services?
  • Do you have any links with your local hospital and have you identified ways in which you can provide more services closer to home?

Using new technology to improve access

The nurse practitioner at Newton Surgery in Norfolk offered open access by mobile phone to teenagers who were insulin dependent diabetics. They were able to text their blood test results if they had any concerns about managing their diabetes and the nurse practitioner would respond.

Learning points:

  • Are you signed up to Patient Online?
  • How is this advertised and promoted to patients?
  • How will you increase uptake of these services?
  • Can you give examples of how you use technology to improve access for patients?

Fionnuala O'Donnell is a practice manager in Ealing, West London, and a CCG board member

CQC definition of a practice rated as outstanding for ‘Responsive’

Services are tailored to meet the needs of individual people and are delivered in a way to ensure flexibility, choice and continuity of care.

People’s individual needs and preferences are central to the planning and delivery of tailored services. The services are flexible, provide choice and ensure continuity of care.

The involvement of other organisations and the local community is integral to how services are planned and ensures that services meet people’s needs. There are innovative approaches to providing integrated person-centred pathways of care that involve other service providers, particularly for people with multiple and complex needs.

There is a proactive approach to understanding the needs of different groups of people and to deliver care in a way that meets these needs and promotes equality. This includes people who are in vulnerable circumstances or who have complex needs.

People can access appointments and services in a way and at a time that suits them.

There is active review of complaints and how they are managed and responded to, and improvements are made as a result. People who use services are involved in the review.

Outstanding practice examples for other key questions

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