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Sunday 25 September 2016
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Aiming high and managing risk

Insight: Quality Matters

Fiona Dalziel
MA(Hons) CIHM FIHM

Independent Consultant in Practice Management

Fiona is an experienced primary care trainer and facilitator. She is the national RCGP QPA Adviser and has advised on both the original and the review of the Quality and Outcomes Framework of the 2004 GP contract

The Quality and Outcomes Framework (QOF), introduced in 2004, was the first time that many practices had used a tool to measure the quality of care delivered to patients. In its first few years, the QOF also offered practices organisational standards that provided a basic framework for identifying and managing significant risk areas in the practice.

However, these QOF standards have become reduced over time as points have been moved to other areas of activity. Managers who want to look at all aspects of the delivery of quality care cannot assume gaining full QOF points will ensure risk is adequately managed in the practice.

Practice managers in England and Wales will be aware that Care Quality Commission (CQC) registration will be a legal requirement for all providers by April 2013. If your practice provides a "regulated activity", and your "sole or main purpose" is to provide NHS primary medical services, then you must register. "Regulated activities" include treatment of disease, disorder or injury, diagnostic and screening procedures, surgical procedures, family planning and triage or medical advice provided remotely. All practices will need to register to provide each regulated activity – full details are on the CQC website (see Resources).

QOF data collection processes are now firmly embedded into the daily fabric of running a practice. However, the breadth of the CQC standards will mean that providing evidence that you meet them will be more onerous than providing evidence for the organisational standards in the QOF.

Practice Accreditation
The Royal College of GPs (RCGP) has developed an award called Practice Accreditation (PA), which not only demonstrates a practice's commitment to continuous improvement but also provides a framework and guidance for compiling CQC evidence (see Resources).

This three-year project has identified standards specific to general practice. Practices working towards PA can access guidance documentation that includes:

  • Quality standards specific to general practice.
  • Guidance on what form of evidence to provide, as well as the content and volume of the evidence.
  • A list of CQC essential standards with which each piece of PA evidence would be compliant.

Practices working towards PA will develop a portfolio of supporting evidence and information. This will be through the use of a web tool. Participating practices will be able to store their evidence online in a systematic and consistent format to demonstrate they meet the standards.

In terms of how this links with CQC, the PA journey helps a practice to collect the evidence for CQC and includes a set of standards designed to demonstrate compliance with the CQC essential standards of quality and safety.

RCGP PA also moves the practice to being ready for assessment for the PA award and includes the standards that the RCGP regards as "good practice", designed to encourage ongoing development within the practice team.

The assessment of evidence for the full award is conducted online by RCGP trained assessors. Practices successful in achieving PA will have demonstrated that they work effectively as a team on continuous quality improvement and will be entitled to display an RCGP PA certificate as a mark of quality assurance in addition to their CQC registration.

Practices should note that these are two separate assessment processes and achievement of one does not exempt a practice from assessment for the other. Practices working on the compilation of CQC evidence but not ready for the challenge of undertaking assessment for PA will soon be able to purchase access to the PA web tool as a standalone product. This would support the practice in gathering evidence for CQC registration.

Taking it further
For some well-developed practices, the level of challenge and amount of organisational progression offered by CQC registration and the RCGP's PA will not be appropriate. The practice may have specific needs to address or challenges they wish to set themselves.

In addition, undertaking any quality award or organisational development tool will have the useful side-effect of enabling a practice to identify and manage risk more effectively. So it is useful to be aware of further options that demonstrate
practice quality.

Quality Practice Award
Now on its 14th version, this is a well-established award for practices that wish to find a way of demonstrating the delivery of excellent services across the board. The award has seen a recent increase in uptake, helped by enthusiastic support provided by some primary care trusts (PCTs) in England for groups of practices working on the Quality Practice Award (QPA) together.

Currently, around 240 practices across the UK have achieved QPA. It is appropriate for well-developed practices wanting a challenge that will engage and progress the whole team.

Practices can choose to achieve QPA by the traditional route or by the modular route. Practices choosing traditional QPA have 18 months from payment of an initial fee to submit their evidence for assessment. Practices choosing modular QPA have three years in which to complete all six modules and can then choose whether or not to have an assessment for the full award of QPA. Practices also have an option simply of opting to undertake a module.

The six QPA modules are:

  • Patient Centred.
  • Management of Illness.
  • Records.
  • Special Groups.
  • Learning Organisation.
  • Practice Team.

Criteria and evidence required are available on the RCGP website (see Resources) along with details of timescales and costs. Practices are supported by an adviser throughout the process of compiling their evidence and then have a full-day practice visit from four assessors – a GP, a practice manager, a practice nurse and a lay assessor.

Investors in People
This highly respected award is applicable in any industry. Its aim is to help businesses improve their performance through the development of their most important resource: people. The award is tailored to the needs of the organisation and uses the business's own key priority areas and business plan as a framework for working towards the award.

Assessment is based on interviews with staff in order to demonstrate that outcomes are met in key activity areas. These include:

  •     Business strategy.
  •     Learning and development strategy.
  •     People management strategy.
  •     Involvement and empowerment.
  •     Performance management.
  •     Continuous improvement.

This is not a comprehensive list and detailed information is available on their website (see Resources). This award does not look specifically at the delivery of clinical care, although its outcomes would impact on it.

Productive General Practice
Not so much a quality award or risk management tool as a development framework, 'Productive General Practice' is the new programme from the NHS Institute for Innovation and Improvement.

The 'Productive Series' helps teams redesign working practices in order to work more effectively. This is achieved by redesigning key processes so improvements are made to systems that impact on safety, staff experience and patient experience. Practices work through a series of self-guided modules. More information is available at the NHS Institute's website (see Resources).

Next steps
Many practices currently feel overwhelmed by the rate of change and challenge they are handling. This is a situation that can lead to a feeling of lack of control, disengagement and demotivation.

Practices who use change as an opportunity to re-evaluate the quality of what they are doing and who are active in identifying and managing risk find themselves well-placed to tackle whatever the future holds.

Using a quality award as a tool to guide you through what is important can often be a significant move that both demonstrates you are doing everything well and that unifies and develops the practice team as a whole.