What does it take to achieve an Outstanding rating in General Practice? Given that the existing quality of General Practice (GP) care in this country is high, with 5% of GP services rated as Outstanding, followed by 90% rated as Good, an Outstanding rating should be attainable. This article explores what it means to be outstanding, the work GP services do to get there and what it means for patients.
Investing in people
According to an interview given by Dr Rosie Benneyworth, CQC’s Chief Inspector of Primary Medical Services for the CQC Connect podcast, good leadership is a number one factor to achieving Outstanding. However, it is not enough to simply employ highly qualified leaders, those leaders need to care about their staff and the people they care for. Practice managers and General Practitioners are instrumental in setting out what they want the practice to achieve and should share that vision with the staff.
Staff recruitment is important – practices need to make sure they have the right teams in place to meet the needs of their patient population. Furthermore, staff need to be well trained, appropriately supervised and provided with development opportunities. GP services that are rated Outstanding tend to have a great emphasis on training, education and improvement of staff whether it be in-house training, for example training apprentices to become health care assistants or administrators, or supporting the training of those who help the delivery of primary care such as pharmacists or paramedics for example.
The culture of a practice is also considered by the CQC when rating a Provider. In Dr Benneyworth’s experience there is a link between the culture of a practice and the outcomes for patients. Structures that promote openness and teamwork tend to work better than hierarchical structures. Outstanding practices tend to be those in which staff feel valued, are included in decision making, are empowered to talk about their worries and not afraid to highlight mistakes. Regular team meetings where action points are followed through serve to make the practice team a more cohesive unit where every staff member feels involved.
“We are Outstanding and we know it”
The podcast revealed that to be Outstanding a GP service has to demonstrate characteristics above and beyond the norm and needs to demonstrate the impact of those characteristics on care. Essentially, what the practice is doing needs to be useful, effective and making a difference to its local population.
An Outstanding GP service would most likely know they are outstanding before being rated as such due to its intense focus on data collection, data analysis and audits. An Outstanding GP service would know how well they are doing, and would be measuring their performance by output as well as input, in other words, assessing the investment, initiatives and projects as well as staff satisfaction and patient outcomes.
To look inward, the practice needs to closely analyse staff and patient surveys. Surveys are a brilliant way of identifying gaps in healthcare provision. Furthermore, the practice should find ways to empower patients to be involved in decision making, not just decisions regarding their own treatment but also decisions regarding improvements that can be made within the service. As an initial step the practice can ask itself some basic questions on how things can be improved from a patient’s perspective such as – how easy is it to get into the service? what the appointment system is like? how patients communicate with the practice? It is also important to collect and learn from data, such as data on demand and capacity, asking questions such as – how many people are coming into the service? how many people are trying to get into the service but cannot get through on the phone? how much capacity is needed to deal with the demand on a day to day basis?
An Outstanding service also needs to be outward looking. It should have a good understanding of the needs of the local population it serves and how best to meet those needs. In order to meet the needs of the local population and provide joined-up care for patients, it is more than likely that the practice will need to form good relationships with pharmacies, care homes and acute trust colleagues.
A spirit of enquiry and learning is key. This can be fulfilled by seeking opportunities to work with and learn from others. As well as working with other practices, GP services can reach out to local schools and colleges, local authorities and the voluntary sector. GP services can learn from others exploring NHSE case studies and can gain support through membership with the Royal College of GPs and primary care networks. Clinical commissioning groups and local medical committees can also provide help to practices.
Becoming an outstanding service is a continual process and arguably the job is not complete when an Outstanding rating is granted. Constant evaluation is required, evaluation of the issues within a service and evaluation of the changes made to resolve the issues. Evaluation is the only way a service identifies whether the changes made are positive. In fact, achieving an Outstanding rating may not be the ultimate goal, but rather the drive for continual, positive and sustainable improvement.