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Sponsored: Why GPs need to embed quality improvements deep within the DNA of their practices

5 July 2021

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This article has been provided and sponsored by Quality Compliance Systems.

Author: QCS staff

Question: What is the best and most effective way to improve patient care?

There are many ways of doing so, including embracing new models of care and signing up to integrated healthcare paradigms (as many GP practices have done). For example, in a blog written for the NHS website, Dr Nav Chana of the National Association for Primary Care (NAPC) talks about the need for leaders to take a pragmatic and a collaborative approach ‘to achieve goals that are important to patients’ and to also enlist the support of the community.[i] I would also stress the importance of ensuring that GP surgeries embed the three P’s – Policy, Procedure and Process – deep within the fabric of their practices.

Of course, putting a robust regulatory framework in place is not optional. It is a standard requirement of the CQC. But with the shadow of Covid-19 still looming large, and with society undergoing great change as a result of the pandemic, it is vital that GPs adapt the services they provide to best cater for patient needs. Potentially, this might mean making changes to policies and procedures that form the bedrock of a practice’s regulatory framework.

As we slowly but surely begin to contain Covid-19, the difficulty for many GPs is identifying the areas of practice that need improvement and those areas of good practice that need to be reinforced. In my experience, the best way to do this is through quality improvement and regular auditing.  Again, this will come as no surprise to the majority of GPs and managers, as clinical and non-clinical audits are compulsory under Regulations 12, 15 and 17 of the Health and Social Care Act 2008. It is also a General Medical Council (GMC) recommendation for GPs to demonstrate involvement in quality improvement at least once a year, particularly when training.

Audits must be underpinned by a change in culture

However, there’s the rub. It may be a statutory requirement for GPs to carry out quality improvement checks and conduct audits every year, but it’s fair to say that the quality, the standard and the frequency of audits differs across practices.

I think the key question that GPs and their staff should always have in mind, is why is an audit necessary? GP practices promoting a culture of continuous improvement don’t carry out audits simply to conform to the CQC’s Well Led, Safe and Responsive KLOEs. Outstanding providers do not view audits as a tick-box exercise. By giving practice managers the opportunity to measure current practice and services against a clearly defined and desired standard, those practices are able to drive improvement, as well as promote greater transparency, accountability and good governance.

But being outstanding in this respect does not come from conducting regular audits alone. Rather, it’s down to instilling a culture of quality assurance and quality improvement within all of the practice team. So, how do you do this?

At QCS, the leading provider of content, guidance and policies for the healthcare sector, where I am head of primary care, we firmly believe that the cornerstone of clinical and non-clinical auditing culture lies in utilising Quality Improvement models. 

The CQC’s ‘GP mythbuster 4: Quality Improvement Activity’ document lists eight different Quality Improvement tools, but I think that the late W. Edwards Deming’s PDSA cycle, which is widely used in a number of sectors, is by far the most effective, not to mention very easy to deploy.[ii]

Quality Improvement Activity must form an integral part of audit culture

If you’ve never used the PDSA model, it’s a continuous cycle which stands for Plan, Do, Study, Act. Using this methodology in an audit, as part of the ‘Plan’ stage, practice management teams set the objectives and standards to be achieved. They then must decide themselves who needs to be involved, what needs to be measured, when and where?

In the second phase of the cycle, which is the ‘Do’ stage, whoever is managing the audit, must measure current activity and practice. Having gathered the results, the third stage, which is the ‘Study’ phase, calls for the auditor to firstly compare the results to CQC and GMC standards, before reflecting on them. Reflection is an exceptionally important part of the process and outstanding providers will leave no stone unturned. If there are gaps in standards, as part of the ‘Act’ phase,

Practice management teams will work with individuals, convene groups sessions and also link in with Patient Participation Groups, as the new updated CQC strategy advises, to ensure holistic improvements are made.

Finally, if the first audit was successful, the practice management team will commission another one to check that improvements have been made. The cycle is then repeated to ensure quality advancements continue, while a number of QCS tools can be utilised to support improvement.

In addition to creating hundreds of different policies and procedures, QCS has also developed a raft of auditing tools and checklists, which enables assessors to audit and outline quality improvement in a raft of different areas. The audit list includes the ‘Missed diagnosis’, ‘Care plans completed’, the Electronic Frailty Index, tools to monitor improvement routine referrals, medicine usage and safety alerts. QCS has also created a specialist Coronavirus Hub, which includes the Hand Hygiene Audit, the Infection Prevention Control Audit and the Coronavirus Infection toolkit. For ease of use, these tools are available on the QCS App.

Best practice points

As a CQC specialist advisor, I want to finish by providing a few more best practice points as to what providers need to do to be rated as outstanding in quality improvement.

Many people ask how many audits they need to carry out every year to be considered outstanding. Questions like this completely miss the point, however, I would advise that practice managers stage as many mock audits as they need to, to drive improvement. Surgeries that have successfully embedded a PDSA model into their practices will have the enhanced visibility to see clearly whether or not clinical and patient experience standards are being met. This, in turn, will go some way in helping them to determine how frequently quality improvement work needs to take place to maintain the required standards.

Secondly, audits and quality improvement activity should not be something to be feared. While audits are designed to shed light on gaps, they also recognise excellence in a practice. Most crucially, however, staff must not think of the auditing process in terms of success or failure, but as a process which leads to measureable improvement.

Thirdly, outstanding practices analyse audit results meticulously in order to reflect, learn and to build team members’ knowledge, skillset and experience. A big part of a culture of quality improvement is data sharing. Staff and patients need to know what is working, what is not, and how to strive for and attain the expected standards.

Finally, following a systematic process, which complies with CQC and GMC standards, is absolutely essential, as is developing a robust system that logs, evidences, records and allows for regular re-audit. If such a system is not put in place, historical benchmarking cannot take place, leaving future improvement stunted and potentially worse patient outcomes.

Quality Compliance Systems (QCS) is a leading provider of content, guidance and standards for the healthcare sector. If you wish to find out more about QCS, why not contact QCS’s compliance advisors on 0333-405-3333 or email [email protected]?

[i] NHS website

By Dr Nav Chana

Five ways to improve patient care and staff morale

Date: 2nd, February, 2017

[ii] CQC

GP mythbuster 4: Quality Improvement Activity