CQC specialist adviser Tracy Green takes a look at the 34 new quality statements used to rate standards of care by GP practices
The Care Quality Commission (CQC) has changed the way it regulates all health and social care providers and is now using the Single Assessment Framework (SAF).
The CQC has said it needed to make these changes to:
- make things simpler so they can focus on what really matters to people
- better reflect how services are delivered by different types of service as well as across a local area
- have one framework that connects the registration activity to their assessments of quality.
The SAF will be used for all providers (albeit with some variations in the quality statements and evidence gathered). It consists of:
- 5 key questions (as per the previous model): safe, effective, caring, responsive and well-led
- Quality statements: these are new and sit under the five key questions
- Gathering evidence.
In a separate article, I explained all the changes being made under the new inspection regime.
This article focuses on the quality statements in particular, exploring what evidence is needed to demonstrate compliance.
What are the Quality Statements?
The 27 key lines of enquiries (KLOEs) have been replaced by 34 quality statements. These are the commitments and standards the CQC will hold providers to account known as and are expressed as ‘We statements’.
Under the old methodology, the number of KLOEs were allocated across each of the five key questions as such:
| Safe | Effective | Caring | Responsive | Well-led |
| 6 | 6 | 3 | 4 | 8 |
Under the new Single Assessment Framework, the 34 quality statements are allocated this way:
| Safe | Effective | Caring | Responsive | Well-led |
| 8 | 6 | 5 | 7 | 8 |
Below is an overview of all 34 quality statements.
Although 16 of the 34 quality statements are from the ‘well-led’ and ‘safe’ key questions, the CQC states that all 5 key questions are equally weighted.
Meanwhile, the CQC has also introduced six new ‘evidence categories’ to organise information under the statements and use for scoring. These categories are:
- People’s experience of health and care services
- Feedback from staff and leaders
- Feedback from partners
- Observation of care
- Processes
- Outcomes of care
Not all evidence categories are assigned to quality statements. You can find out what categories are assigned to each quality statement on the CQC website.
So, what evidence is required for the quality statements?
There is so much covered under the 34 quality statements, so I shall provide a broad overview of them all – and explain what evidence is required – within each of the 5 key questions.
WELL-LED
Definition: There is an inclusive and positive culture of continuous learning and improvement. This is based on meeting the needs of people who use services and wider communities, and all leaders and staff share this. Leaders proactively support staff and collaborate with partners to deliver care that is safe, integrated, person-centred, and sustainable, and to reduce inequalities.
There are 8 quality statements within this area.
Because of the number of quality statements this area covers, there is a lot of evidence needed to demonstrate compliance. However, the good news is much of it filters into other key questions, so I would recommend that practices use ‘well-led’ as a starting point for a self-assessment of compliance.
From experience, it usually follows that a well-led practice has all the other key questions covered and will be in a good position to be rated as good or above. This is a trend that can be observed from many inspection reports.
It’s worth noting that one of the key changes within well-led is the quality statement titled, Environmental Sustainability – sustainable development. This is a new area requiring providers to work towards being net zero but importantly for 2024 it will only be rated in trusts – and not practices.
Knowing how important environmental sustainability is though, you may wish to download a toolkit from the RCGP or Greener NHS, so you can begin this work as part of your overall compliance review.
The evidence required within well-led is vast and starts with a practice’s purpose or vision and mission statements. A standard statement of purpose could be as simple as:
To improve the health and wellbeing of our community by providing patient-centred, coordinated, and accessible primary healthcare services by a well-trained and developed workforce.
Reflect on and review your current statement of purpose, and question if it should remain the same or it needs to be updated.
SAFE
Definition: Safety is a priority for everyone, and leaders embed a culture of openness and collaboration. People are always safe and protected from bullying, harassment, avoidable harm, neglect, abuse, and discrimination. Their liberty is protected where this is in their best interests and in line with legislation.
The safe area is crucial to service delivery and the breadth of this key question is as large as well-led, comprising 8 quality statements.
Safe and effective staffing includes recruitment, induction, onboarding, training and development, appraisals, and competency reviews. Providers need to be able to demonstrate there are enough qualified, skilled, and experienced people who receive effective support, supervision, and development and that they work together effectively to provide safe care that meets people’s individual needs.
Medicines management will be scrutinised to ensure that required medication reviews are taking place and there is no harm, or risk of harm to patients.
I recommend using Ardens CQC searches in this area and to track a patient’s journey as part of a practice’s self-assessment.
EFFECTIVE
Definition: People and communities have the best possible outcomes because their needs are assessed. Their care, support and treatment reflects these needs and any protected equality characteristics. Services work in harmony, with people at the centre of their care. Leaders instil a culture of improvement, where understanding current outcomes and exploring best practice is part of everyday work.
This key question has 6 quality statements some of which will cross over into other areas.
A practice’s systems should ensure that staff are up to date with national legislation, evidence-based good practice and required standards.
Patients should be informed about current good practice that is relevant to their care and be involved in how this is reflected in their treatment plan. This means that staff and leaders need to be encouraged to learn about new and innovative evidence-based approaches that can improve the way their service delivers care.
Robust and effective long-term condition management protocols evidencing effective care is crucial. Practices must ensure that people who use the service consistently experience positive outcomes.
RESPONSIVE
Definition: People and communities are always at the centre of how care is planned and delivered. The health and care needs of people and communities are understood, and they are actively involved in planning care that meets these needs. Care, support and treatment is easily accessible, including physical access. People can access care in ways that meet their personal circumstances and protected equality characteristics.
Responsiveness will be assessed based on these 7 quality statements and it is really important to evidence your knowledge of your population. Potential inequalities must be identified and addressed, such as how to engage with hard-to-reach patient groups based on social, cultural, or religious grounds.
People’s individual requirements to have information in an accessible way should be identified, recorded, highlighted, and shared. Patient needs must be met and reviewed to support their care and treatment in line with the Accessible Information Standard.
People can expect informationto be tailored to individual needs. This includes making reasonable adjustments for disabled people, offering interpreting and translation for people who don’t speak English as a first language and using British Sign Language for deaf people.
Those who have difficulty with reading, writing, or using digital services need to be supported with accessible information.
Practices should be able to demonstrate that, where relevant, they have learned from feedback given or complaints made.
In terms of the quality statement on planning for the future, this refers to people’s future care where they are at the end of life to ensure there is good communication between providers to facilitate a dignified death.
CARING
Definition: People are always treated with kindness, empathy, and compassion. They understand that they matter and that their experience of how they are treated and supported matters. Their privacy and dignity are respected. Every effort is made to take their wishes into account and respect their choices, to achieve the best possible outcomes for them. This includes supporting people to live as independently as possible.
Workforce wellbeing is included in this area to support staff being able to always deliver person-centred care. Evidence will be sought to check that people are supported by staff and feel valued by their leaders and their colleagues. It is important that team members have a sense of belonging and can contribute to decision making.
In terms of patients, the caring area covers cultural, social, and religious needs – making sure these and their communication requirements are understood and met.
What do I need to do now?
All providers must understand the new framework and how they can evidence compliance. My advice is to first carry out an honest self-assessment against all key questions and develop an action plan where evidence is not available.
If you need support, get in touch with a consultant or a colleague who can provide guidance and direction on creating that baseline assessment and developing an easy-to-follow action plan.
Tracy Green is a primary care business consultant and CQC specialist adviser. She has worked in primary care for 16 years
