Regulatory recognition and sharing of innovative practice by NHS GP providers to reduce health inequalities
In this blog, Dr Rosie Benneyworth, Chief Inspector of Primary Medical Services and Integrated Care at the Care Quality Commission, and Richard Stubbs, CEO of Yorkshire & Humber AHSN and Vice-Chair of the AHSN Network, reflect on the collaborative work undertaken to better understand how to support GP practices to reduce health inequalities
Back in September, Rosie wrote about a new project aiming to reduce health inequalities through support from the Regulators’ Pioneer Fund. This blog aims to update people on how the project and its outputs have developed since.
COVID-19 has had a profound and sustained impact on health and social care, contributing to many significant changes in how care is delivered. It has also exposed and exacerbated many inequalities faced by people who use services. For many GP practices the pandemic has played a significant role in accelerating the pace and uptake of innovative solutions to tackle those challenges, increasing the need to look at different ways to adapt and respond to the needs of their local populations.
We know that many practices are developing innovative ways to reduce health inequalities in their patch, but these are not consistently recognised or measured in CQC’s current inspections of practices. It’s vitally important that we build a culture that rewards and champions innovation so we can maintain the drive and empowerment associated with ‘bottom-up’ innovation. Local workforces are in the best place to understand the specific needs of their populations and need to be encouraged and supported to be innovative in their approaches to patient care.
The collaborative project
Reducing inequalities in people’s access, experiences, and outcomes is core to both CQC’s and Yorkshire & Humber AHSN’s mission. Building on CQC’s new strategy and the Yorkshire & Humber AHSN’s existing work to tackle health inequalities through the adoption and spread of innovation, this project was the perfect opportunity to collaborate.
Through this project we hoped to better understand the experiences of GP practices in undertaking innovative projects that address health inequalities and how to best encourage this through CQC’s regulatory approach. We wanted to identify and share examples of best practice so that others may implement or scale similar strategies. We also wanted to help practices to successfully show evidence of innovative practice to reduce health inequalities as part of their CQC assessment.
Over the last six months the Yorkshire & Humber AHSN and CQC carried out desk research and fieldwork, actively engaging with GP practices and CQC inspectors. The aim of this work was to identify the tools and techniques needed to ensure innovative projects to tackle health inequalities can be better identified and evaluated through CQC’s regulatory process in the future. Feedback was also collected through a series of case studies, a roundtable event, and expert interviews.
We’re really pleased with the wealth of knowledge that practices shared with us through this work. We’re hugely thankful to all the practices who contributed to the project, as without their invaluable input, the project simply couldn’t have succeeded. The case studies and feedback we’ve gathered gives us a much more in-depth understanding of the different ways innovation can present itself in GP practices. They emphasise the importance of understanding innovation not just as a singular definition or approach for practices to follow, but something that is unique to a practice and the context they are working in. What is business-as-usual for one practice, might be innovative for another.
The research also highlights the need to not just think about innovation in terms of changing measurable outcomes, but as a trajectory or process that takes place across many stages. Innovation is risky and sometimes projects won’t work, but it’s nonetheless still important that it’s recognised and encouraged, so it leads to innovation that will work in the future.
We know from CQC’s project looking into the impact and experience of CQC regulation on ethnic-minority-led GP practices that more can be done to identify how GP practices have responded to particular challenges, such as low uptake among some populations of immunisations and screening.
We also heard that often a provider might be doing something innovative but not share it with CQC, as they didn’t think of it in those terms. So, it’s really important that practices are supported to successfully identify innovative practice and solutions that are contributing to reducing health inequalities.
It was also great to see that much of what practices told us in the research supports the aims of CQC’s new Strategy. This includes greater transparency of the evidence that will be used to make assessments of practices, and a greater focus on people’s experiences, rather than just clinical outcomes.
This has been an important piece of work and has helped CQC to understand the difficulties that practices have had in trying to demonstrate their innovative practice.
In response to this work, CQC will be developing an online resource for GP practices to support them to demonstrate their innovative practice. The next step for CQC is to also consider how to embed this learning, both internally within CQC’s own teams, but also externally with wider systems and providers.
Tackling health inequalities is an essential part of CQC’s new regulatory framework, and the findings from this research will be taken into consideration as part of the transformation of the regulatory approach.