Prof. Steve Field’s monthly blog

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

In this month’s column I want to give readers working in general practice an update on positive changes to how we regulate the sector. I also want to reflect on the extension of the local system review programme and the recent announcement that I will be stepping down in March 2019 after over five years in post.

Regulating general practice

Our strategy for 2016 to 2021 set out our new approach to the regulation of general practice. This approach was based on the fact that the vast majority of GP practices have been rated good or outstanding, allowing us to introduce a more proportionate approach to regulation. This means only inspecting a sample of good and outstanding practices each year with a maximum re-inspection timescale of five years.

There are two key elements to implementing this approach — firstly, by introducing an annual provider information collection (PIC) for practices rated good or outstanding to complete online; and secondly, by moving away from comprehensive inspections to using focused inspections as standard.

The PIC will replace the Provider Information Return that is currently collected in advance of an inspection for these practices. Its purpose is to enable practices to provide information on changes in the quality of care between inspections as well as contextual information e.g. changes in demographics, QoF indicators, patient survey results etc. This approach will help us to prioritise our inspections on providers where there has been most change — either deterioration or improvement — so that we can continue to focus where risk is greatest at the same time as support practices move from good to outstanding. It will also enable us to move to more focused inspections which concentrate on those areas of most change.

At this stage, we are not ready to roll out the online PIC from April 2019 as further development work is needed to the system before it can be effectively implemented. We are therefore proposing to put in place an interim approach that will allow us to move closer to our objective of the information collection, albeit one that will not be available online. This is likely to take the form of a structured phone call between the practice and inspector to discuss the practice’s response to the questions within the PIC which will have been published in advance. It is important to state that these calls are not inspections — they are a conversation about quality which underpins the development of the practice/inspector relationship.

We have consulted the RCGP and BMA on this approach and we will test it with a number of practices before it is implemented from April 2019. We remain committed to reducing the workload associated with regulation while enabling practices to provide contextual information, something that they are currently unable to formally do. Longer term, we continue to work towards a digitally-based system for collecting information, but we won’t introduce that until we are certain that we have got the end to end process right and that we are confident that the service meets your expectations.

As we finalise we will update you through this bulletin, our inspectors, and through published guidance about what will be asked of you as practices in 2019/20.

Leaving

You may have seen earlier this month in the HSJ that I announced I would be standing down in March 2019. It has been an immense privilege to be the Chief Inspector of General Practice at CQC for the last five years. Ensuring people get the high quality, compassionate care that they deserve was the reason I entered the profession in the 1980s, so I am proud to have shaped CQC’s development of how we regulate primary medical services.

Extended local system reviews

Another area I have worked closely on over the last year is our important work looking at local systems and how over 65s navigate the health and social care landscape. You may have read over the last month that this work has been extended to cover three new reviews and three follow up reviews before the end of the calendar year.

Formerly requested by the Secretaries of State for Health and Social Care and for Housing, Communities and Local Government; this further tranche follows on from our national report — the culmination of our programme of 20 local authority area reviews — published in July.

As the Beyond barriers report laid bare, our intention is that this next round of reviews will provide an important picture of what is working well; the barriers that may be preventing local people and organisations from working together effectively; and, most importantly, the impact this has on those who depend on health and care services.

This is vital work and I look forward to sharing and building on the local good practice we have seen so far.

Have a great month everyone.

Steve

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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