1. Working with Patient Participation Groups in Primary Care Inspections1

2. CQC purpose and role Our purpose Our role
We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve
Our role
We 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
Independent of politics and the system
Regulate across all sectors
Clinically driven with expert teams
Evidence-based judgement, not regulatory compliance
Highlight excellence and expose poor care with transparent ratings
Always on the side of people who use services

3. CQC approach to regulation
Model shows the different stages:
Registration
Surveillance
Standards
Expert inspection
Judgement and publication – ratings
Action where needed
This high level model applies to all the services we regulate. What differs is the detail within each of those stages, so for example the data we collect and monitor for adult social care is different to primary care, the questions we ask at registration and the expertise of our teams are different for social care than primary care.

4. Inspection feedback from practices
“My staff told me they found it a positive experience, as they don’t always get a chance to reflect on what we are doing.”
“For the first time in our lives, we feel that our work has been recognised and appreciated.”
“They worked very hard to ensure that the day was as stress free as possible whilst getting the information they needed.”
“We appreciate you making the process less stressful than we expected it to be!” 4

5. Our inspection programme
We have published 3,159 inspection reports since we launched our approach to inspecting GP practices in October 2014 (as of 18 March 2016)
What have we found?
83.7% of GP practices we have inspected are providing a good or outstanding standard of care
Please note – check with James Smith in Provider Engagement for the latest numbers before using this slide. Last updated 18 March, James Smith – Provider Engagement. 5

6. Overall rating by domain
GP Practices
(Information correct as of 18 March 2016)

7. Ratings by region The graph below breaks the ratings down by region.
Outstanding Good RI Inadequate
North
1039 41
885 80 33
3.9%
85.2%
7.7%
3.2%
Central
934 44
720
118 52
4.7%
77.1%
12.6%
5.6%
London
411 9
296 78 28
2.2%
72%
19%
6.8%
South
775 35
615 97 28
4.5%
79.4%
12.5%
3.6%
(Information correct as of 18 March 2016)

8. Key themes from our inspections
Most GP practices provide good care
However, we’ve found a small number of extremely concerning cases of poor care
We’ve found a strong link between good leadership and good care
Likewise, we’ve found a strong link between poor leadership and poor care 8

9. Key themes from our inspections
Safety culture is an area where we found room for improvement for GP practices
We often found poor incident reporting, lack of learning from significant events, poor medicines management
Practices deliver better care when they share learning through multi-professional networks
Professional isolation (common in single handed practices) can lead to lack of communication and engagement with staff and patients and lack of transparency 9

10. What makes an outstanding practice?
Effective leadership
Strong, shared vision amongst practice staff
Effective staff training and support
Positive, patient centred culture
Effective working with multi-professional colleagues, including from other organisations
Additional clinical services empowering patients to self-manage long-term conditions
Support for patients and carers with emotional needs
We found a wide breadth and diversity in the different examples of Outstanding practice across our inspections. 10

11. Working with Patient Participation Groups (PPGs)
We put people’s views and experiences at the heart of what we do
PPGs represent patient and community views at a practice level
In 2013 CQC developed an approach to working with PPGs in partnership with PPGs & with National Association of Patient Participation
The published Guide will be updated in 2016 11 11 11

12. Working with PPGs on an inspection
When we contact a GP practice about an inspection, we ask the practice manager for the contact details of two members of the PPG, if there is one
We ask that you pass on any information about how patients view the practice which may be appropriate including:
Comments or views on standards of quality and safety at the practice
Recent activity –surveys, meetings or complaints analysis
Any other work being carried out at the practice to gather patient views
PPG Chairs and members are often interviewed during the inspection and may be present when it happens
When giving notice to the practice we:
Ask whether the practice has a PPG or PRG
If they do, we ask for the contact details of the chair or spokesperson plus one other member
The practice manager may want to check with the chair or spokesperson and other member whether they can pass on details

13. Reports
If your PPG contributed to our judgement we try to refer to this in the final report of our inspection
You can receive an alert as soon as the final report is published – see our website to register to receive alerts

14. Listening to patients
On our inspections we also:
Use comments cards
Spend time talking to patients and staff
Work with experts by experience – people who use services
We also also have regular contact with Local Healthwatch, Overview and scrutiny committees and CCGs who tell us about local views and experiences of care

15. Outstanding case study: Holsworthy Doctors
Holsworthy doctors in Devon has the largest catchment area of any practice in England. The practice was rated outstanding in April 2015
The practice has a comprehensive business plan in place
Progress is regularly discussed with staff and Patient Participation Group members
Some patients live far away from the practice
So they enabled patients to request prescriptions and appointments online
The practice holds monthly multidisciplinary meetings, including with specialists from the local hospital’s palliative care team
The nearest hospital is 29 miles away
So the practice hosts a series of specialist clinics, such as diabetic retinal screening
The practice facilitated a virtual PPG, to enable them to receive a wider range of feedback and more opportunities for finding improvement
The nearest hospice is 25 miles away
So the practice helped build a satellite day hospice 15

16. What can lead to inadequate care?
Weak leadership and a chaotic and disorganised environment
Isolated working – not working closely with other local providers to share learning
A lack of vision for the organisation and clarity around individuals’ roles and responsibilities
A poor culture of safety and learning (for example, lack of significant event analysis or learning from complaints) 16

17. What can lead to inadequate care?
Poor systems for quality improvement (including quality audit)
Limited examples of assurance of clinical care
Disregard for HR processes (for example, DBS checks)
Unsafe medicines management
Limited access to advice and treatment
Lack of practice nurses or very low numbers of practice nurse sessions 17

18. Examples of inadequate care
“We identified one locum staff member who had treated patients but couldn’t provide evidence that they were medically qualified to do so.”
“We found no evidence of criminal record checks for the two practice nurses, or any of the non-clinical staff.”
“Medicines were found to be out-of-date, and requests for prescriptions had not been processed in a timely manner to ensure patients had access to their medicines.”
“There was no mechanism for the practice to seek patient feedback about services, and complaints had not been used to improve the service.” 18

19. Support for poor performing practices
What happens when a practice enters special measures?
We will inform the NHS clinical commissioning group, and NHS area team
The Royal College of GPs provides peer support to practices, using a local turnaround team. They help practices identify and deliver an improvement plan 19

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Further information
The CQC PPG Guide for Working Together can be found at:
For all CQC reports and to sign up to our alerts go to
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