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What Can We Learn from the Latest Inadequate Practice Ratings?

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In our last article we looked at five GP practices that had been awarded the highest rating in recent CQC inspections and asked, “What can We Learn from the Latest Outstanding Practice Ratings?” In that examination, we found there to be four areas where the CQC appears to focus its praise:

- Leadership

- Community presence

- Innovation that is patient focused

- Employee improvement and motivation

This got us asking if there are any areas that are consistent across those practices rated as inadequate: in other words, if there are any elements of practice procedures and environment that you need to focus on to ensure they don’t catch the natural ire of the CQC inspectors. Here’s what we found when we looked at the last five inadequate GP practice ratings:

Hove Medical Centre

Hove Medical Centre has been put into special measures for its failing in providing safe, effective, caring, well-led, and responsive healthcare.

The inspector found that systems were not embedded well enough to keep patients and staff safe – in particular, it highlighted poor procedures in employment checks, infection control, and managing unforeseen events.

Windsor Medical Centre

The concerns of the CQC here centred on its leadership, that was found to be severely wanting. However, the centre was found to be both caring and responsive to patients. In particular, the practice was found to have inadequate processes and procedures to:

- Report all safety incidents

- Prevent infection

- Record and maintain medical records consistently

- Train staff according to their roles

- Ensure effective day-to-day management

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Droylsden Road Family Practice

This practice suffered in a number of areas and was found to provide inadequate services to all population groups. Of particular note was the lack of leadership, with no one responsible for the running of the practice or with clinical accountability. Systems were found to be inadequate to reduce the potential of harm to patients – including infection control – and the premises were found to be in a dirty and cluttered state.

Falcon Medical Centre

At this practice, patients overwhelmingly said they were treated with compassion and respect, but the CQC found that treatment was not always delivered in line with best practice. Again, systems and processes lay at the heart of the problem, with premises, equipment, and infection control at the top of a list of failings that also included poor management.

Blueberry Lane Medical Practice

Here, leadership lacked clarity and there was an additional lack of clarity over practice leads (for example, who the safeguarding lead is). Systems were found to be lacking to protect vulnerable adults and children, and patients expressed concerns over appointment making, staff attitudes, and issues with prescriptions. Verbal complaints were not being recorded, and staff had received inadequate training.

Summing up

In all these inadequate ratings, there is evidence of consistency with the areas that most regularly lead to inadequate ratings:

- Staff and patient safety

- Infection control

- Employment checking and training

- Premises and equipment

- Lack of leadership

Perhaps the most important of these is lack of leadership, for good leadership is paramount to the other elements improving and reaching thestandards required and expected. With this in mind, it might be prudent for GP practices to ensure that funding is made available under their training budgets for leadership coaching: doing so will provide the impetus to ensure that the other common factors of inadequate ratings are led to apposition of quality – that will pull the practice closer to an outstanding rating.

How much emphasis does your practice place on leadership training? Have you experienced poor leadership? How do you think good leadership has impacted your practice?

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