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​Six Signs of Good Governance in a GP Practice that the CQC Love to See

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When considering the way in which a GP practice is managed and led, the CQC look at how patient care and service delivery are both maintained and continuously improved. This is at the heart of a well-led practice, and forms the basis of its governance. It is this governance that supports the strategy of the practice, the roles and responsibilities of individuals and it permeates through performance and risk management. It has impacts at all levels and while governance is led by the practice’s senior members it should engage all employees.

Ensuring good governance

When the CQC makes its inspection, expect the inspector to discuss governance with staff from all levels of the practice. The inspector may ask questions about roles and responsibilities, and how decisions are made. He or she may want to know how policies and procedures are communicated down the line, and will want to see evidence that supports the assumption that governance arrangements are functioning well (for example, minutes of practice meetings).

Here are six signs of good governance that you know the CQC will look for:

1. A framework that supports the delivery of the practice’s strategy and good quality of care

The CQC will examine for accountability processes and systems, and that these are identifiable, understood by all, and that they are effective. This includes governance of partnerships, joint working arrangements, and shared services.

2. Employees understand their roles and responsibilities

The CQC will want to ensure that employees have clearly defined roles and that each knows their responsibilities that they are accountable for.

3. Performance requirements are understood and integrate with people’s views, safety requirements, and supported by quality information

Information that supports performance management should be accurate, reliable, timely, and relevant. A range of information should be produced to support improvements. This includes (but is certainly not limited to: information about unexpected deaths, significant events, patient feedback, complaints, QOF data, risk assessments, policy reviews, etc.

4. Performance is correctly measured and monitored with appropriate actions to improve performance

The practice should have processes, procedures, and systems in place that monitors performance and enables actions to be taken to improve quality and safety.

5. Regular audits to assess quality and identify appropriate action to improve

Services provided should be regularly audited. These audits should be used to both monitor and improve quality and safety, including at the clinical level. Audits should be comprehensive. For example, a clinical audit will cover four stages:

- Preparation and planning

- Performance measurement

- Implementation of change

- Sustaining improvement

6. The practice has in place systems to identify, record, and manage risks and provide mitigating actions

Risks are not limited to those present today, but also to potential areas of risk in the future. The practice should have in place a system of identifying areas of concern, recording risks and where quality and safety are being compromised, and then keep a record of responses taken.

For more information, see:

Regulation17: good governance

Regulationsfor service providers and managers

Guidance for providers on meeting the regulations (PDF)

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