Issue being addressed
Ensuring patient safety and the high quality of services is paramount to the NHS. This is a particular responsibility for commissioners (those who plan, purchase and monitor services), for services delivered across the NHS, from GP practices to hospitals.
Unlike contracts with larger NHS providers (acute trusts or community hospitals), contracts with GP practices have no mandated quality monitoring requirements. Therefore, commissioners could potentially be unsighted on quality concerns or patient safety risks. With 127 GP practices across Leicester, Leicestershire and Rutland (LLR), it was agreed that a more robust and effective approach was needed to assess and confirm that the GP services being delivered locally are safe and effective.
Action taken
A GP quality assurance toolkit was developed to enable improvements in patient safety and quality of general practice. By completing a self-assessment toolkit, GP practices can demonstrate compliance against regulated activities and patient safety standards for the practice, commissioners and the Care Quality Commission (CQC).
Working across 11 domains of quality and safety, the self-assessment increases ownership and accountability, encouraging practices to look at their own systems and processes to improve patient safety, in a supportive way.
If the GP practice does not assess themselves as compliant in any domain, the associated support and guidance can be provided by specialists, clinicians and Primary Care Quality Team members from the Integrated Care Board, Local Medical Committee or the local primary care network.
The creation, development, launch and analysis of the toolkit was a whole team effort. The Primary Care Quality Team includes nurses, paramedics, administrators, managers and a
GP quality lead.
Outcomes
The 2022-23 submissions enabled the provision of 138 additional requests of support which would not routinely have been sought without the initiation of this toolkit. Submission responses evidence a significant increase in practices wanting to improve patient safety and the quality of services being delivered. The toolkit has encouraged requests for support in a number of key areas such as safeguarding, infection prevention and control, and clinical audit.
CQC ratings concur that the implementation and support shared via this toolkit, as a response to the submissions, has resulted in safer and higher quality GP services across LLR. From 2021-22 to 2022-23, the CQC ratings of LLR practices increased from overall 56% ‘good’ to 64%, with a reduction in overall ‘inadequate’ ratings from 13% to 9%.
In the GP practice patient survey results, while consistent performance remained across LLR, for those practices who completed the toolkit and sought specialist advice, we saw notable improvements in the question ‘overall positive experience of GP Practice’, with one practice increasing from 41% in 2022 to 63% in 2023.
Dr Rawal, NHS England Regional Medical Director for Primary Care, said: “LLR ICB have created a toolkit to help improve the standards of safety and quality across their GP practices, ensuring the LLR patient population receives the best care possible. The toolkit can evolve in line with future system changes and patient safety regulations and continue to deliver sustainable improvements in general practice. The hard work of LLR general practice clinicians and non-clinicians alike deserves recognition, as do the ICB team who have developed and support this process.”
