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| What makes a GP practice outstanding? | What makes a GP practice outstanding? |
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| The scene is inner-city Leicester – a GP practice faced with a young homeless man dying without ever having seen the sea, dips into its own charity’s funds to pay for the man’s last wish, with a nurse to accompany him. | The scene is inner-city Leicester – a GP practice faced with a young homeless man dying without ever having seen the sea, dips into its own charity’s funds to pay for the man’s last wish, with a nurse to accompany him. |
| Inclusion healthcare social enterprise community interest company, whose patient list is made up of street dwellers in Leicester’s city centre, has been rated outstanding for the way it looks after its troubled patient list by the Care Quality Commission (CQC) as part of its first-ever – and controversial – quality assessment of all the UK’s 8,000 GP surgeries. | Inclusion healthcare social enterprise community interest company, whose patient list is made up of street dwellers in Leicester’s city centre, has been rated outstanding for the way it looks after its troubled patient list by the Care Quality Commission (CQC) as part of its first-ever – and controversial – quality assessment of all the UK’s 8,000 GP surgeries. |
| “We regard what we did for that young man as a crucial part of wellbeing,” says Dr Anna Hiley, Inclusion’s chief executive . “It is about looking at caring a little bit differently.” | “We regard what we did for that young man as a crucial part of wellbeing,” says Dr Anna Hiley, Inclusion’s chief executive . “It is about looking at caring a little bit differently.” |
| Related: 'We wouldn’t go back into the NHS': Plymouth's pioneering social enterprise | |
| The same top ranking has been awarded to the semi-rural Wigton medical practice in North Cumbria, where caring for the whole person means close working with charity West Cumbria Carers, which takes over seamlessly where the surgery leaves off and supports carers through home visits. The accolade has also been given to Boundary House medical centre in Sale, Cheshire, where one of the GPs has for the past 20 years been giving free acupuncture on the NHS to patients with irritable bowel syndrome, migraines and chronic fatigue. Only 3% of GP practices have reached this level. | The same top ranking has been awarded to the semi-rural Wigton medical practice in North Cumbria, where caring for the whole person means close working with charity West Cumbria Carers, which takes over seamlessly where the surgery leaves off and supports carers through home visits. The accolade has also been given to Boundary House medical centre in Sale, Cheshire, where one of the GPs has for the past 20 years been giving free acupuncture on the NHS to patients with irritable bowel syndrome, migraines and chronic fatigue. Only 3% of GP practices have reached this level. |
| This is not about gimmicks. The key component binding these three very different – but all outstanding – practices, according to the CQC’s chief inspector of GPs, Steve Field, is their focus of care. He says: “In all our outstanding practices, it is about putting the patient at the centre of everything they do.” | This is not about gimmicks. The key component binding these three very different – but all outstanding – practices, according to the CQC’s chief inspector of GPs, Steve Field, is their focus of care. He says: “In all our outstanding practices, it is about putting the patient at the centre of everything they do.” |
| Since GP Harold Shipman was tried and convicted in 2000 of the serial killing of at least 15 patients, family doctors have not enjoyed the same unchallenged authority to carry out their work as before. The prospect of this CQC assessment has made even the well-functioning practices engage in major navel gazing, faced with a process with legal powers to close any found wanting. | Since GP Harold Shipman was tried and convicted in 2000 of the serial killing of at least 15 patients, family doctors have not enjoyed the same unchallenged authority to carry out their work as before. The prospect of this CQC assessment has made even the well-functioning practices engage in major navel gazing, faced with a process with legal powers to close any found wanting. |
| The CQC says it is motivated by a search for excellence and a desire to distribute that throughout the GP system. The five key areas inspectors are assessing are whether each organisation’s care is safe, caring, effective, responsive to people’s needs and well-led measured against 28 regulations governing health and social care. | The CQC says it is motivated by a search for excellence and a desire to distribute that throughout the GP system. The five key areas inspectors are assessing are whether each organisation’s care is safe, caring, effective, responsive to people’s needs and well-led measured against 28 regulations governing health and social care. |
| An inspection consists of a one-day site visit, with teams of usually about six people, including NHS managers, a GP, a nurse or other health worker and a patient. Before an inspection, inspectors examine all available data on the surgery (including how easy it is to get an appointment, medicines management and how patients feel they are treated), including any complaints, contacting clinical commissioning groups (CCGs) and local area teams for information. Often they hold patient meetings in an practice catchment area to pick up comments and views. | An inspection consists of a one-day site visit, with teams of usually about six people, including NHS managers, a GP, a nurse or other health worker and a patient. Before an inspection, inspectors examine all available data on the surgery (including how easy it is to get an appointment, medicines management and how patients feel they are treated), including any complaints, contacting clinical commissioning groups (CCGs) and local area teams for information. Often they hold patient meetings in an practice catchment area to pick up comments and views. |
| Related: How patients can help GPs make the NHS run better | Related: How patients can help GPs make the NHS run better |
| Inspection day begins with the surgery’s team being invited to give a 30-minute presentation on what they do well under the five examination criteria, given their area and population mix. This is scrutinised by inspectors before they go through the practice with a fine-tooth comb, looking at all systems and questioning staff from receptionists to GP partners and practice managers. | Inspection day begins with the surgery’s team being invited to give a 30-minute presentation on what they do well under the five examination criteria, given their area and population mix. This is scrutinised by inspectors before they go through the practice with a fine-tooth comb, looking at all systems and questioning staff from receptionists to GP partners and practice managers. |
| Inspectors write reports – allocating rankings from outstanding to inadequate – supported by their team and reviewed by a regional panel. Inadequate ratings are referred to a national panel. The ramifications of poor ratings can be serious as the CQC has legal powers. Inadequate surgeries can be put into special measures and those that do not make the required changes face being closed down. | Inspectors write reports – allocating rankings from outstanding to inadequate – supported by their team and reviewed by a regional panel. Inadequate ratings are referred to a national panel. The ramifications of poor ratings can be serious as the CQC has legal powers. Inadequate surgeries can be put into special measures and those that do not make the required changes face being closed down. |
| Dr Paul Gray, senior partner at Boundary House medical centre, admits he was initially “totally against” the inspections, seeing them as “more bureaucracy”. But having gone through a CQC inspection, he says: “It was a good way to have a kind of spring clean of everything we do and why and we have resolved as a practice to walk through the same process every year in order to keep ourselves up to date.” | Dr Paul Gray, senior partner at Boundary House medical centre, admits he was initially “totally against” the inspections, seeing them as “more bureaucracy”. But having gone through a CQC inspection, he says: “It was a good way to have a kind of spring clean of everything we do and why and we have resolved as a practice to walk through the same process every year in order to keep ourselves up to date.” |
| Among the items the Boundary team corrected was a patient leaflet two years out of date, carrying incorrect hospital and GP telephone numbers. | Among the items the Boundary team corrected was a patient leaflet two years out of date, carrying incorrect hospital and GP telephone numbers. |
| After 31 years at Wigton medical practice, Dr John Honeyman also found the CQC process threatening, as he and his close-knit team had always prided themselves on the personal way they delivered care – in his case with a special interest in ensuring that terminally ill patients and their carers receive the individual care they need. | After 31 years at Wigton medical practice, Dr John Honeyman also found the CQC process threatening, as he and his close-knit team had always prided themselves on the personal way they delivered care – in his case with a special interest in ensuring that terminally ill patients and their carers receive the individual care they need. |
| Related: General practice may seem like a circus act but the show must go on | Related: General practice may seem like a circus act but the show must go on |
| He emphasises the crucial role of teamwork, and says: “GPs are often not the right people to see for particular issues. Nurses, healthcare assistants and rehab staff can often be far more appropriate. Patients need to see the right person, in the right place at the right time, whether in the surgery or at home. By working closely with other health professionals and our admin staff – respecting and valuing their roles – then we can begin to achieve the right care for our patients.” | He emphasises the crucial role of teamwork, and says: “GPs are often not the right people to see for particular issues. Nurses, healthcare assistants and rehab staff can often be far more appropriate. Patients need to see the right person, in the right place at the right time, whether in the surgery or at home. By working closely with other health professionals and our admin staff – respecting and valuing their roles – then we can begin to achieve the right care for our patients.” |
| The practice manager at Wigton, Lin Baillie, says the outstanding ranking is viewed as a team achievement. She had an important role in identifying working with carers as a previous weakness in the practice and built up the links with West Cumbria Carers, which so impressed the inspectors. She says: “It has been a real morale boost – not only for our team but for the patients too.” | The practice manager at Wigton, Lin Baillie, says the outstanding ranking is viewed as a team achievement. She had an important role in identifying working with carers as a previous weakness in the practice and built up the links with West Cumbria Carers, which so impressed the inspectors. She says: “It has been a real morale boost – not only for our team but for the patients too.” |
| Innovative and creative practice is coming to the fore. Dr Amir Hannan at Shipman’s old practice in Haughton Vale, Hyde, tops the country for record keeping. Among the first two rated as outstanding was Irlam medical practice in in Salford, Greater Manchester, where nurses have been voluntarily running a stroke awareness clinic in a local shopping centre. | Innovative and creative practice is coming to the fore. Dr Amir Hannan at Shipman’s old practice in Haughton Vale, Hyde, tops the country for record keeping. Among the first two rated as outstanding was Irlam medical practice in in Salford, Greater Manchester, where nurses have been voluntarily running a stroke awareness clinic in a local shopping centre. |
| Field says: “In England we are not good at celebrating the really good. I tell the inspectors to look for it.” | Field says: “In England we are not good at celebrating the really good. I tell the inspectors to look for it.” |
| Wigton patient Eveline Dugdale, aged 71, reckons quality, caring treatment shines out. As a mother of an invalid son, she was visited every week for 31 years by GPs, until he died. She says: “The beautiful thing for us when you go to the GP is that the good care goes from start to finish. At the reception they always smile and listen ... The doctors look at you and they apologise if they are late. Whoever you see, they always listen and that matters an awful lot.” | Wigton patient Eveline Dugdale, aged 71, reckons quality, caring treatment shines out. As a mother of an invalid son, she was visited every week for 31 years by GPs, until he died. She says: “The beautiful thing for us when you go to the GP is that the good care goes from start to finish. At the reception they always smile and listen ... The doctors look at you and they apologise if they are late. Whoever you see, they always listen and that matters an awful lot.” |