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CQC outstanding practice: Is your practice well-led?

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

Staff development

Case study 1: St Paul’s Way Medical Centre in east London demonstrate a strong commitment for staff to develop their skills, competence and knowledge through weekly mentoring and an annual learning programme. Clinicians have weekly protected time for mentoring and use the sessions to discuss referrals, results and prescribing, and reflect on opportunities for personal development and career progression.

Staff are encouraged and supported by the practice to acquire new skills. For example, administrative staff were trained in customer service skills and nurses had attended a diabetes care certificate training course. The HCA had undertaken flu vaccination training and was being supported to study for an assistant practitioner qualification

Case study 2: Dr Munro and Partners in Greater Manchester set up an apprentice scheme in 2008, which involves a two-year apprenticeship to gain a non-vocational qualification (NVQ) level 2 in business administration. Apprentices also have the option of gaining a level 3 NVQ. The scheme has led to 100% employment for apprentices, either in this practice or other local practices.

Learning points:

  • Are you confident about your HR? (recruitment and selection, induction, training, appraisal) Do you have all the documentation to support this?
  • Do you have regular meetings with staff and are these minuted?
  • How do you encourage ongoing learning and development in the practice? Do you have regular education meetings?
  • How are staff views listened to and acted on?

Working closely with the patient participation group

Case study: St Thomas Medical Group in Exeter, Devon had an active patient participation group (PPG), Carer Support Group and Friends of St Thomas Health Centre Group. These groups of volunteers were co-ordinated by a member of staff at the practice. They influenced changes and improved services for patients - especially those who were lonely or isolated. For example, the groups offered lunch clubs for housebound patients, a telephone support service, sitting and befriending services, weekly social events and supported carers.

The Friends of the practice group was also involved in raising funds for the practice. They were able to buy an Entonox gas cylinder, which patients could use for pain relief during complex wound dressings, and they paid for transport and other maintenance at the practice.

Learning points:

  • Are you making the most of your PPG?
  • Will someone from the PPG be available to talk to the CQC during your inspection?
  • Consider what sorts of questions the PPG member will be expected to answer

More information on making the most of your PPG can be found here.

Showing leadership across the local region

Lofthouse Surgery in West Yorkshire had outstanding services for people with a learning disability and performed better than other practices nationally for QOF indicators relating to learning disability. It had taken the lead role in influencing the care provided by neighbouring practices, by working with the local CCG as well as other CCGs in the area.

One of the GPs had developed a ‘ready reckoner’ for common conditions associated with learning disability. The template was used by the CCG and there were easy read leaflets on the website. The practice had also looked at this group of patients to determine the number of ‘do not attend’ appointments. The learning disability register was cross-checked in order to help people with a learning disability through the health care system.

The lead partner also helped other practices by giving advice about setting up their own services.

Learning points:

  • Where does the practice excel, can you provide examples of what you have done and how it has added value?
  • Do any of your GPs or other staff have leadership roles outside of the practice? Has this helped the practice improve services and if so, how?
  • Are there any examples of your practice supporting other practices in the area to improve the services they provide?

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 ‘well-led’

The leadership, governance and culture are used to drive and improve the delivery of high-quality person-centred care.

The strategy and supporting objectives are stretching, challenging and innovative, while remaining achievable.

A systematic approach is taken to working with other organisations to improve care outcomes, tackle health inequalities and obtain best value for money.

Governance and performance management arrangements are proactively reviewed and reflect best practice.

Leaders have an inspiring shared purpose, strive to deliver and motivate staff to succeed.  

There are high levels of staff satisfaction. Staff are proud of the organisation as a place to work and speak highly of the culture. There are consistently high levels of constructive staff engagement. Staff at all levels are actively encouraged to raise concerns.

There is strong collaboration and support across all staff and a common focus on improving quality of care and people’s experiences.

Innovative approaches are used to gather feedback from people who use services and the public, including people in different equality groups.

Rigorous and constructive challenge from people who use services, the public and stakeholders is welcomed and seen as a vital way of holding services to account.

The leadership drives continuous improvement and staff are accountable for delivering  change. Safe innovation is celebrated. There is a clear proactive approach to seeking out and embedding new ways of providing care and treatment.

Outstanding practice examples for other key questions

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