Moving beyond barriers and sharing outstanding practice

Monthly column for providers and professionals working in primary medical and dental services from Prof. Steve Field, Chief Inspector of General Practice.

This month Prof. Steve Field shares his thoughts on a landmark publication from CQC looking at local systems and how they care for over 65s and also talks about CQC’s role in sharing outstanding practice.

This month we published our landmark report Beyond barriers: how older people move between health and care in England. The report followed our 20 local health and care system reviews looking at how services work together to support and care for people aged 65 and over. It has been a real privilege to lead this work over the past year with my Deputy Chief Inspector, Alison Holbourn, and a team drawn from people across CQC. Our reviews provide a detailed insight into the journey through health and social care for people who use services, their families and carers — and identify where there are gaps which mean that people experience fragmented or poor care.

Beyond barriers shows that positive outcomes can be achieved when those working in a local system have a clear, agreed and shared vision together with strong leadership and collaborative relationships. However where we met some outstanding professionals, their efforts were often despite the conditions in place to facilitate joint working, rather than because of them.
For providers working in primary care, where we did see local systems working well together, GPs were often at the heart of this. We saw many services and initiatives across the reviews that were helping people to access care and support when they need it and in the communities they live in, preventing them from needing to go to hospital. These benefits are now universally understood, however barriers remain. We found that commissioning priorities were influenced by funding pressures and funding flows to support hospital care. As a consequence, the ability to invest in services that prevent people becoming unwell (from social care, primary care, community care, or the VCSE sector) was limited.

We know that the system is under unprecedented pressure as the NHS celebrates its 70th birthday. A genuinely person-centred coordinated health and care system fit for 2018 cannot just be a long-term ambition — it is an urgent and immediate requirement for meeting the changing health and care needs of people living longer with increased complex conditions.

The report was an important moment for CQC as we look to paint a picture of the quality of care in a local system, rather than just at the service level. We will build on these themes in this year’s State of Care report in October.

If you haven’t seen the report already, I would encourage you to take the time to read it and consider how the findings and recommendations could apply to the local system in which you operate. You can also find each of the 20 local system review reports on our website.

Through this column I regularly like to share with you my experiences of visiting outstanding practices. This month I had the pleasure to visit Brinsley Avenue Practice, rated as Outstanding in all five key questions and population groups.

One of the areas in which the practice excels is in assessing the needs of older patients. The practice has a befriending group to benefit those who are socially isolated. The health, social and care needs of older patients is assessed and the practice has a list of patients who receive regular contact from an elderly care facilitator. Over time, the practice has made a difference by helping patients to secure benefits or referred patients to others for example, the fire service when home safety issues had been identified.

As we saw in our local system reviews, this social prescribing work from GPs and their practice teams can have a huge impact on the populations that practices serve, particularly the most vulnerable.

Our strategy for 2016 to 2021 sets out a priority to encourage improvement, innovation and sustainability in care. We know that over 90% of general practices are delivering good and outstanding care but as we look to take a more targeted, responsive and collaborative approach to regulation, we have a duty to share best practice and innovation with those who need our support.

We publish examples of outstanding practice on our website, as well as highlighting examples where we find them in all our inspection reports.

Have a great month everyone.


We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

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