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Why practice teams should embrace accreditation

12 December 2008

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Professor Stephen Field

GP, Birmingham
Chairman, Royal College of General Practitioners (RCGP)

Steve became Chairman of the RCGP in November 2007, and has led the College through Lord Darzi’s NHS review, successfully promoting the RCGP “federated” model of patient care – with GP practices working together to provide more services for patients in their local communities – as a workable alternative to polyclinics, and repositioning general practice at the heart of the NHS. Steve led the College’s radical review of GP training, which led to the introduction of the first-ever training curriculum for GPs in August 2007. He has published many academic papers, reports and books, and is coauthor of the landmark RCGP document The Future Direction of General Practice: A Roadmap and its follow-up Primary Care Federations: Putting Patients First, published in June 2008

Patients have the right to expect and receive high-quality care from their GP practice. In the aftermath of Shipman, negative headlines about access and out-of-hours care and, most recently, Lord Darzi’s Next Stage Review of the NHS, patients’ expectations have changed.

Now, more than ever, we need to ensure that patients have confidence in their GP and their primary healthcare team. In turn, GPs and their practice teams want to be reassured that they are providing an exemplary level of care.

There are more than 8,500 general practices in England, all providing primary medical care services – without any system of accreditation of the quality of organisational aspects of care.
To continue to improve primary care services, we need to have an effective way of measuring performance in this area.

Recognising this need, the Royal College of General Practitioners (RCGP) has been developing a scheme of provider accreditation to enable healthcare providers to demonstrate their current standard of practice organisation.

What accreditation will mean
Voluntary, patient-focused, developmental and professionally led, the purpose of the Primary Medical Care Provider Accreditation (PMCPA) is to:

  • Enable healthcare providers to demonstrate their current standard of practice organisation. This applies to Alternative Provider Medical Services providers as well as General Medical and Personal Medical Services.
  • Encourage continuous quality improvement within the provider team.
  • Mark the provider as a learning organisation.
  • Enable patients to see and be reassured that their provider is delivering a level of service that is above that required by law.
  • Encourage providers to focus on patient responsiveness and the patient experience.

Developed using the methodology of the successful RCGP Quality Team Development (QTD) scheme, it focuses on organisational rather than clinical issues, and has a balance of both summative and developmental criteria. It has been widely consulted on by RCGP stakeholder groups – including our Patient Partnership Group, the British Medical Association, the General Medical Council and the Department of Health.

The aim of the scheme is to support practices to aspire to further quality improvement, and reduce variability of care and health inequalities. Crucially, it will also reassure patients on the safety of provision of their care.

The fact that the programme is professionally led – not something imposed on us from the outside and definitely not a star ratings system – must not be overlooked.

It is far better to have professionally led solutions than imposed regulation and micromanagement, and GPs, practice managers and their teams must embrace the opportunity to take the initiative, and lead rather than follow.

Key stages and domains
The proposed scheme will include three key stages as follows:

  • A pre-entry qualification stage: this consists of contractual criteria that every provider is required to fulfill in law, eg:
    – Provide free certificates in certain circumstances.
    – Ensure staff are fully qualified and receive training to keep skills up-to-date.
    – Refer patients where appropriate.
    – Offer a registration check.
    – Keep adequate records.
    – Notify the primary care trust (PCT) of deaths on surgery premises.
    – Co-operate with any investigation.
    – Hold a register of gifts.
  • A set of 30 core or summative criteria.
  • A set of 82 developmental or formative criteria.

The PMCPA will have six domains:

  • Domain 1 – Health Inequalities and Health Promotion.
  • Domain 2 – Provider Management.
  • Domain 3 – Premises, Records, Equipment and Medicines Management.
  • Domain 4 – Provider Teams.
  • Domain 5 – Learning Organisation.
  • Domain 6 – Patient Experience/Involvement.

Pilot process
When the RCGP announced its intention to pilot the scheme, we were inundated with requests from practices to take part – a sure sign that the profession is in need of, and is ready to welcome, professionally led schemes.

Thirty-four diverse providers around England, with differing numbers of staff and serving different populations, participated in the pilot that included self-assessment, an accreditation visit and drawing up a development plan for the practice to help providers aim for continuous quality development.

We are indebted to them all for the time, effort and co-operation they have invested, and the results will be independently evaluated to assess: which criteria are the most/least challenging; providers’ opinions of the domains criteria and the wider assessment process; and PCT views. There will also be an opportunity to identify areas where criteria are missing and to highlight where potential new criteria might be included.

If the pilot proves successful – and we have every confidence that it will have been – the RCGP will devolve the assessment process to PCTs as in the QTD model.

Assessment of high-quality care
RCGP assessor training will include calibration to help ensure assessments are valid, reliable, repeatable and equitable. PCTs will assemble the visiting teams, organise the assessment visits and review the evidence. They will also be responsible for ensuring financial support for all aspects of delivery of the system at a local level.

To be eligible to seek accreditation status, practices must fulfil the pre-entry legal and contractual criteria. To achieve accreditation status, they will need to fulfil each of the 30 summative criteria in the six domains and at least 50% of the formative criteria in each of the six domains (approximately 41 criteria). They will be assessed and accredited at that point.
Each practice must then achieve more of the formative criteria in each domain in a year-on-year fashion from when they were accredited, submitting evidence of achievement on an annual basis.

The provider will then be revisited three years after initial accreditation. If an agreed percentage of formative criteria have been achieved by the time of this assessment visit and all summative criteria are still met, they will be reaccredited.
As well as encouraging continuous quality improvement, the system will enable patients to be sure that their provider has achieved high-quality care in all areas.

It might seem a lot to take onboard, but good practice teams are doing much of this work already, albeit informally, with no official recognition of how they are driving up the quality of care they provide for their patients.

At its heart, provider accreditation is about professionalism. The role of the practice team in today’s NHS is wide and complex; as well as providing excellent clinical care, we need to be at the vanguard of raising standards.

General practice is getting better all the time but we need to continue to lead the way in improving quality. Ultimately, this is what provider accreditation is all about. It is important that we take it in the spirit it was intended – to support practice teams, protect patients and standardise good practice across the board.

Practice managers are crucial to the success of this scheme, and at the RCGP we will do everything we can to support you in making it happen.