Elliott Hall Medical Centre in Middlesex is the first practice in London to be awarded an ‘Outstanding’ rating by the Care Quality Commission (CQC).
The practice was rated as outstanding in all areas: Safe, Effective, Caring, Responsive, and Well-led.
Ursula Gallagher, CQC deputy chief inspector for primary care in London, told Management in Practice how the practice achieved this.
Arrival
‘As soon as the inspectors walk in they realised very fast that the heart of the culture there was different.’ They staff were ‘positive, enthusiastic and happy,’ Gallagher said.
The patient and public involvement group were present when the inspectors arrived, ‘they weren’t only sitting there,’ Gallagher said, ‘they were contributing and talking and demonstrating in real life what the culture of the practice was about – involving and empowering staff and patients in all of their decisions.
Staff involvement
The practice recognises that ‘all of their staff have a perspective on what is working well and what isn’t working as well from the point of view of patients,’ she said. ‘And the practice actually wants that information feeding in to help them improve.
‘They recognise that empowered staff who have been given permission to do the right thing for patients contribute to a better practice.’
Administration
‘Some patients experience interfaces with receptionists and feel like the receptionists’ job is to protect the doctors from them.
‘You can have two very different conversations here. Even if appointments are scarce, patients can be offered other choices or telephone conversations as opposed to just saying “You can’t have an appointment for three weeks”.
‘The receptionists at Elliot Hall aren’t just at the brunt of the “there are no appointments” conversation, but are empowered to try and find ways to help patients and that’s what comes across.’
Teamwork
‘We found that the teams of people were able to spend real quality time together. If staff members weren’t able to make it to a staff meeting, if they were on holiday – the practice has really effective systems of communicating with staff who weren’t able to be there.
‘They invest a lot in both training together, but also training separately so that the staff form very good relationships and also a very good understanding of what the practice is trying to achieve strategically, and all of the staff feel that they are being invested in to make that contribution.
‘In outstanding practices all staff have a really strong sense of what they’re doing to contribute to the overall project.
‘There’s a famous story about president Johnson going to visit NASA in 1964 and he stops to talk to a janitor who’s sweeping the path. He asks him “What’s your role? What do you do here?” And the janitor says, “I’m helping to put a man on the moon”.
‘Everybody in the practice is important to the practice objective of high-quality, effective, safe patient care. And there isn’t a hierarchy of doctors and nurses above admin staff.
‘That’s the cultural difference but it’s then practically manifested by staff feeling consulted with, feeling valued, feeling empowered, and getting the training and development they need to be able to feel confident in those roles.
Safe practice
The most difficult domain, in which the fewest number of practices have achieved outstanding, is the ‘Safe’ domain, the deputy chief inspector said.
‘The Safe section is very driven by things like data and having routine systems and processes in place.
‘One of the things for Elliot Hall is that they have been doing these things for a very long time – they didn’t just start doing them when the CQC came around.
‘They have 17 years worth of analysis of serious untoward incidents and complaints and they can demonstrate how they’ve learnt from that patient feedback over a really long time.
‘If you’ve only been doing it for a few years you can’t prove that trend data and show the impact and close all those audit loops.
However, ‘it’s better to have started than not,’ Gallagher said.
‘You have to keep closing the loops. What we’re looking for in outstanding is that you’ve made the changes, figured out that they changes worked and you’ve demonstrated that that problem hasn’t occurred again.
‘That does take time but when you set the system up if you recognise that you’re going to need to do all of those things then you’re going to be able to get to that point much more quickly.
Seeing that Elliot Hall had been implementing these systems for so long showed that the CQC is looking for the right indicators, Gallagher said: ‘In some senses it’s a vindication that what the CQC has been looking for is the right stuff because good practices knew it was the right stuff before the CQC said it was.
‘That’s the other thing about outstanding practices, they haven’t just been ticking the CQC boxes.’
Practice run down
- List size – 11,200 patients
- Opening hours – 8am to 6:30pm Monday to Friday
- Extended hours – 7am to 8am Monday to Friday
- Contract – Personal Medical Services (PMS)
- CCG area – Harrow Clinical Commissioning Group
- Premises – Three storey building with 19 consultation rooms
Staff numbers
- Four GP partners
- Six GP associates
- One GP returner
- Four GP trainees
- One medical student
- One nurse practitioner
- Four practice nurses
- One healthcare assistant
- Two phlebotomists
- One practice manager
- One deputy practice manager
- Administration staff
- 12 receptionists
