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CQC’s new approach to inspecting and regulating GP and OOH providers

January 2015

WelcomeAmanda Reynolds

Inspection manager (acting)

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Our purpose and role

Our purposeWe make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

Our roleWe 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.

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Developing the changes

We co-produced the changes by working closely with our partners, providers, key stakeholders, the public and people who use services:

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Our new approach

What are we doing differently?

• Inspection teams of specialist inspectors, GPs, practice nurses or practice managers.

• Inspections of a number of practices carried out in a CCG area over a 2-4 week period.

• Introductions of ratings for GP practices telling patients whether they are: outstanding, good or whether they require improvement or are inadequate.

• Strengthening our Intelligent Monitoring of providers using nationally held data and local intelligence.

• New ways of gathering patient views both before and during inspection.

• Develop a clear approach to responding to failing practices, working with NHS England.

Our key questions

Is the quality of care:•Safe? people are protected from abuse and avoidable harm.

•Effective? people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.

•Caring? staff involve and treat people with compassion, kindness, dignity and respect.

•Responsive? services are organised so that they meet people’s needs.

•Well-led? the leadership, management and governance of the organisation assures the delivery of high-quality care, supports learning and innovation, and promotes an open and fair culture.

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Intelligent monitoring

• Intelligent Monitoring is a tool to help our inspectors understand the areas of care that need to be followed up.

• Looks at set of indicators including patient experience and statistical measures of performance.

• The indicators relate to the five questions we ask all services.

• The indicators will be used to raise questions, not make judgements – our ratings do that.

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Key lines of enquiry

• For each of the five key questions there are between three to five key lines of enquiry (KLOEs).

• For each KLOE we have identified characteristics of good.

• They support consistency and ensure we focus on areas that matter most.

• KLOEs are supported by guidance on key things to consider; these are called prompts.

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Key lines of enquiry continued…

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Ratings: 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

Severe harm has or is likely to occur, shortfalls in practice, ineffective or no action taken to put things right or improve

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How do we decide a rating?

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Ratings grid

Level 1: Every key question for every population group

Safe Effective Caring Responsive Well-led

Older people Good Outstanding Good Outstanding Good

People with long term conditions

Good Inadequate Good Inadequate Good

Families, children and young people

Good GoodRequires

improvementGood

Requires improvement

Working age people (including those recently retired and students)

Good Good Outstanding Good Outstanding

People whose circumstances may make them vulnerable

Good Outstanding GoodRequires

improvementGood

People with poor mental health (including people with dementia)

Good GoodRequires

improvementGood

Requires improvement

Overall

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Level 2: Aggregated rating for every population group

Overall * * * * *Level 3: Aggregated rating for every key question

Level 4: Overall rating for the practice

Overall location

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Population groups

Inspectors will judge how well services meet the needs of six different population groups:

•Older people

•People with long-term conditions

•Families, children and young people

•Working-age people, including those recently retired and students

•People whose circumstances may make them vulnerable

•People experiencing poor mental health (including people with dementia).

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What to expect from an inspection

• We will send you a letter two weeks before we inspect (unless we are responding to concerns) and our inspector will call you.

• On the day, we will ask you to tell us (and give us evidence) about the good care you give, and we will want to talk to staff and patients to find out more.

• At the end of the inspection, we will tell you our initial thoughts.

• We will write up our report and send it to you to check for factual accuracy before we publish it on our website.

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Timelines

Published signposting document setting out high level proposalsDec 2013

First wave of GP out-of-hours providers (approximately 30 providers)

Jan – Mar 2014

Public consultation on draft inspection handbook and Wave 1 of testing (200 practices in 12 CCG areas)

April – June 2014

Wave 2 of inspections ongoing testing and refining of our revised approach

July – Sept 2014

Oct 2014 New approach fully implemented. Ratings awarded

By April 2016

Every NHS GP practice and NHS GP out-of-hours service inspected and awarded ratings

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Find out more

• Website:www.cqc.org.uk

• Twitter:@CQCforGPs

• Join our provider onlinecommunity: https://communities.cqc.org.uk/provider

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Thank you