Monthly column for providers and professionals working in primary medical and dental services from Prof. Steve Field, Chief Inspector of General Practice
This month we published the latest in the Nigel’s Surgery series. I hope many of you already use these as hints, tips and mythbusters in your practices. The most recent addition focused on our change back in April to how we inspect and rate GP practices for the six population groups. I want to use this column to remind you of that change, and explain a bit more about what it will mean for you as providers.
As you will know, since 2014 we have looked at how a practice provides for six population groups:
· Older people
· People with long-term conditions
· Families, children and young people
· Working age people (including those recently retired and students)
· People whose circumstances may make them vulnerable
· People experiencing poor mental health
We know that individuals can frequently straddle these groups, but taking this approach allows us to consider care and outcomes for everyone and present information to the public about local services that are relevant to them.
Services will assess and classify patients in a way that allows them to effectively serve their patients’ needs and we recognise that services may not organise their approach to patient care according to CQC population groups. When we request evidence of how a service meets the needs of a specific population group, the service should provide as much information as possible about patient care and meeting patient need.
It may be helpful for services to consider how their approaches relate to the six population groups. This may help services to organise and communicate their evidence of good and outstanding practice.
What has changed?
Back in April 2018 we changed the way we inspect and rate these groups as part of the phased roll out of our next phase approach. For all inspections of GP practices, we now rate each of the population groups against the effective and responsive key questions only. These two ratings will then be aggregated to reach an overall rating for the population groups. This means that after we inspect a practice, its new ratings will not include all previous ratings for the population groups for the safe, caring and well-led key questions.
The assessment of the five key questions for the practice overall remains unchanged and practices will continue to receive a rating for each of the five key questions and an overall rating for the practice. This remains central to our work.
Why have we made this change?
Following the learning from our first round of inspections, it was evident that the majority of the differences in quality between the population groups were in the effective and responsive domains. The majority of population group specific evidence we gather when inspecting also relates to the effective and responsive key questions, providing evidence about how services assess and meet the needs of patients.
Another reason for the change is that we found from our previous inspections that the ratings for safe, caring, and well-led were broadly consistent for each of the population groups and at overall practice level. As a result, when applying our previous aggregation principles we found there was little variation between the overall population group ratings.
These changes will allow us to more easily highlight outstanding care where we find it, while ensuring our ratings indicate where we have identified poor care. These changes will also result in a more accurate reflection of the quality of care provided and greater transparency for patients and you as practices.
What if you do not provide care to all population groups?
There are times when a service may not provide care to all population groups, or provides care to a very limited number of people within a group. In these circumstances we expect our inspectors to be proportionate when rating. They also have the option to not rate a population group if there is insufficient evidence to do so. We will however consider whether evidence gathered can relate to multiple population groups before deciding not to rate for a certain population group or groups.
For example, where a practice is providing services to an exclusively homeless population there will be evidence of meeting the needs of patients whose circumstances may make them vulnerable. There may also be evidence of care being provided for people experiencing poor mental health, as well as people with long-term conditions.
Where a practice doesn’t currently serve people within a particular population group, they should be able to demonstrate what arrangements are in place to enable them to meet the needs of people who may register with the service.
Through this column I always like to shine a light on outstanding practice. Our website holds a number of examples of outstanding practice in this area that I urge you to look at and consider adopting or drawing inspiration from for your own practice. All our inspection reports also draw out examples of outstanding practice where we find them.