This article relates to the CQC key question: Is your practice well-led?
One of the five key questions the CQC looks at on our inspections is how well-led GP practices are.
The ‘well-led’ key question and the key lines of enquiry (KLOE) were developed in partnership with the Kings Fund. To make a judgement about how well-led GP practices are, our inspection teams look specifically at the vision and strategy that underpins how a GP practice operates.
There is substantial evidence around the role that culture – ‘the way we do things around here’ - and leadership can play in supporting organisations to deliver high-quality compassionate care for patients. We cannot form a judgment on a GP practice, therefore, without looking at its leadership team and how the organisation is managed.
We know from research evidence that there are pre-conditions for a healthy organisation, which can be thought of as building blocks:
- a clear vision and strategy that is enacted in practice
- a well thought-through governance framework
- a developing leadership strategy
- a culture that supports learning and innovation
- team-based working
- high levels of staff engagement
- patient and carer engagement.
Our ‘well-led’ key question focuses on how the leadership, management and governance of an organisation assures high-quality person-centred care delivery, supports learning and innovation and promotes an open and fair culture.
Well-led practices make the work of general practice easier, creating both a happier working environment for GPs and their staff, and better service to patients.
We have also found that in practices where there is poor leadership, there is more likely to be issues across the practice, for example in safety, effectiveness, responsiveness and how caring the service is.
Well-led key line of enquiry 1: vision and strategy
To direct the focus of GP inspections, our inspection teams will use a standard set of key lines of enquiry (KLOEs) that directly relate to the five key questions.
The KLOEs are set out in Appendix B to the NHS GP practices and GP out-of-hours services provider handbook.
The ‘well-led’ key question has five key lines of enquiry to ensure our inspection teams focus on those areas that matter most. The first KLOE asks:
- Is there a clear vision and strategy to deliver high-quality care and promote good outcomes for people?
Looking at the vision and values of a GP practice is important as it highlights the organisation’s strategic objectives and on what the practice places value. These have a powerful influence on the behaviour of staff at all levels. The leaders within a GP practice are the key determinants of whether the vision and values are achieved, so it is crucial that GP practices have a clear strategy that is shared by all staff.
When collecting evidence against this KLOE inspection teams will be looking at whether:
- there are well-defined vision and values, driven by quality and safety, which reflect compassion, dignity, respect and equality
- there is a clear, robust and realistic strategy which is monitored and regularly reviewed
- staff, and people who use the service, were involved in the development of the vision, values and strategy
- staff know and understand the vision, values and strategy.
We have developed characteristics to describe what outstanding, good, requires improvement and inadequate care looks like in relation to the ‘well-led’ key question. These characteristics are in Appendix C to the NHS GP practices and GP out-of-hours services provider handbook.
The Kings Fund has published advice on ‘well-led’ organisations:
- What does a ‘well-led’ organisation look like?
- Exploring the CQC’s Well-led domain: how can boards ensure a positive organisational culture?
Professor Nigel Sparrow is senior national GP advisor and responsible officer at the CQC
More CQC resources
- View the full CQC Essentials series on Medeconomics
- CQC's recommended reading to help practices meet regulations and prepare for an inspection