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Primary Care Scrutiny under the 5 Year Forward View – Part 1
The House of Commons health committee is launching an inquiry into primary care which will include scrutiny of GP pay and workload.
Quality & Standards and Demand & Access
The inquiry, which launched last week, will also look at issues including GP recruitment, patient access and the future models of general practice described in the Five Year Forward View. It will look to review:
- The quality and standards of care for patients
- Demand and access (including out-of-hours access and proposals for seven-day access)
- Funding (including local and national distribution of resourcing)
- Future models of care, as piloted by vanguards
- Workforce: current and future challenges (including recruitment, retention, training, skill mix, contractual models, workload and pay)
Announcing the inquiry, which will look at the evidence later this year, the committee said: ‘The aim is to consider whether the Department of Health and its arms’ length bodies have the plans and policies in place now to ensure that high quality care is consistently available to patients at the point of need.’
This article, the first in a series of three, will address the first two areas which are quality and standards, and demand access, and how practices can address them.
What is quality?
Quality can be described as ‘the standard of something as measured against other things of a similar kind; the degree of excellence of something’. Generally all practices are committed to the provision of exceptional standards of care and service to its patients, whose individual needs and safety remain the priority at all times.
Having a rigorous quality framework helps practices to aim to continually review and evaluate practice to improve the outcomes of care and ensure the health and wellbeing of patients, staff and visitors. It’s important to monitor these processes and outcomes – both internally and externally – as validation of the services we deliver, and compliance with regulatory, legislative and best practice requirements and guidance. Being registered with, and regulated by, the Care Quality Commission means that we should be fully compliant.
How can we evidence quality?
One of the ways in which practices can evidence quality is through regular activity performance audits. CQC operates a risk-based approach to inspection and performance indicators, and evidence of audit results and audit cycles will enable them to assess the practice’s quality achievements. The review and evaluation of outcomes against agreed standards is essential to clinical governance and a comprehensive audit schedule should be in place to support staff in achieving and maintaining the exceptional standards of care for our patients.
Monitoring activity should be afforded a high level of importance in identifying areas for improvement and providing reassurance that the expected standards of practice are often achieved and maintained. It’s also a useful tool for GPs and nurses to use for revalidation.
Demand and access
Last year the Prime Minister announced a new second wave of access pilots, with further funding of £100m for 2015/16. The Government asked NHS England to lead the process of inviting practices to submit innovative bids and overseeing the new pilots. The pilots aimed to explore a number of ways to improve access, including:
- Longer opening hours, such as 8am-8pm weekdays, and opening on Saturdays and Sundays
- Joining-up of urgent care and out-of-hours care
- Greater flexibility about how people access general practice
- Greater use of technology to provide alternatives to face-to-face consultations e.g. via phone, email, webcam and instant messaging
- Greater use of patient online services
- Greater use of telecare and healthy living apps to help people manage their health without having to visit their GP surgery as often
Demand and access
There is already a general drive by CCGs to encourage practices to demonstrate a wider range of benefits to patients including a more integrated approach to providing general practice and wider out-of-hospital services, involving community nursing, community pharmacy, diagnostic services and voluntary organisations. There is also impetus for a more integrated approach to providing urgent care services across a local health economy; connecting with hospitals to deliver 7-day day services; and more innovative ways for people to access and relate to general practice, including for children and young people and from groups that find it hard to access general practice, i.e. the six groups which I have mentioned in previous articles.
Delivery the service
GPs want to do their best for patients and many practices already offer extended hours surgeries, so how can we improve what we already do? Many Practices have innovative ideas on how to deliver better and more convenient services and are already developing them for their patients. However, these programmes usually need support and resources to make them a reality. Nevertheless, there are many ways to offer improved access including promotion of services that practices already offer including online appointment booking, text messaging facility, and telecare or telehealth for certain medical concerns. The use of technology to record and monitor a patient’s health using a variety of applications is rapidly on the increase.
Improving access, responding to patients
The NHS Practice Management Network have produced a ‘how-to’ guide for GP practices. It’s a great resource for practices to identify challenges and solutions that are workable in most surgeries, enabling them to improve their systems and processes to benefit both patients and the practice by adopting new ways of working.
In my next article, I will address the next two areas which are Funding (including local and national distribution of resourcing) and Commissioning.
The House of Commons health committee is asking that anyone with an interest in the problems and opportunities facing primary care to submit a maximum of 3,000 words to the inquiry by 3 September 2015.
Alison Lowerson – QCS Expert GP Practice Manager Contributor