Primary Care Development

The brief

The RCGP was commissioned by a Clinical Commissioning Group (CCG) in a deprived area of London to support seven practices as a part of a wider quality improvement programme. This involved working alongside several other organisations. The practices were identified by the CCG as requiring the most hands-on; support due to the depth of the issues they were encountering.

The approach

The practices were taken through a diagnostic review to determine the support they needed - these covered areas such as:

• Improving operational efficiency
• Mentorship and management change
• Coaching
• Specialist advice and guidance
• Partnership challenges
• Succession planning
• Recruitment difficulty

The RCGP and CCG held regular meetings to monitor and report on progress with the support and engagement from the practices. These meetings and close contact allowed for the programme to be agile in tailoring the service to the changing needs of the practices and provided a mutual system of support for all parties.

The value

The results of the programme were extremely positive for both the CCG and the practices involved.

From the CCG:

"The RCGP worked closely with each individual practice and provided bespoke and varied support after their scoping visits. Support delivered to practices who were struggling with their long-standing issues that were not necessarily quick fixes was very successful, for example, dealing with partnership issues, succession planning or helping a practice address its issues with a local care home are difficult to quantify yet highly valuable. Furthermore, the RCGP supported practices with impending CQC visits. The feedback from practices to the CCG has been consistently positive".

From the practices:

"This is the best thing the CCG has ever done".
"Having something like this is such a breath of fresh air, it can only lead to improvement and change really, so it’s good."
"One word: Magnificent. We didn’t actually expect an outcome like this, and it was so supportive and friendly. Absolutely fantastic, we recommend to everybody".

The brief

The RCGP was commissioned by a large, at-scale practice that had previously been rated 'good' by the Care Quality Commission but was placed in special measures following an inspection. This led to regulatory actions and included a significant incident raised by the Clinical Commissioning Group.

This gave a short time frame to explore the issues from all perspectives of a large team (formed from several practices) who were shocked and upset and needed both sensitive interview and constructive support to move forward.

The approach

The RCGP multidisciplinary support team undertook a diagnostic visit and conducted a root cause analysis with the senior management team. The analysis followed a similar pattern seen in smaller practices:

• Weak corporate governance, where, despite a detailed management structure, there was a lack of definition of boundaries and accountability.
• A strategic focus on expansion rather than ensuring the safe day-to-day running of the organisation.
• Weak operational delivery systems based on historical working patterns with individual practices behaving autonomously, with little central reporting or oversight, and an inequitable distribution of staff and resources.
• An unhelpful culture. Although nominally one organisation, individual practices remained wedded to their original teams and sites.

A diagnostic report and action plan were produced based on these findings, along with the significant incident report and action plan required by the CCG.

The value

The RCGP team worked with the senior management team to develop a clear shared vision, robust central governance and a plan to 'win hearts and minds'. Specific regulatory actions requested by the CCQ, and the CCG were also addressed.

In addition, the College team provided diagnostic and targeted support for individual practices to address specific safety concerns and develop practice teams. As a result of these actions, the organisation was stabilised. Corporate governance was strengthened, and the senior management team undertook an extensive programme of quality improvement which has satisfactorily addressed the most pressing CQC and CCG concerns but is moving far beyond that needed to get out of Special Measures.

In turn, communication improved across the organisation, staff and resources are more equitably spread, allowing more effective operational delivery and a new single organisational culture was developed.

The brief

The RCGP was brought in to support a practice based in a deprived area of a coastal town. The practice was the result of the merger of two practices and had a patient list of approximately 16,000. The practice had been recently placed in Special Measures after receiving a rating of 'Inadequate' across all but one area of its most recent Care and Quality Commission (CQC) inspection.

Along with the inspection results the practice was also having trouble retaining GPs, served a large care home population and had taken on additional services (for example, walk-in centre and special allocations) due to its isolated location.

The approach

The RCGP assigned a multi-disciplinary team to the practice covering GPs, practice management and nursing to provide an initial scoping exercise followed by intensive support. The scoping revealed that there was uncertainty among key staff members with a senior GP thinking of leaving the practice, and the practice managers feeling unsettled. There was also no leadership of the large nursing staff and limited governance in place.

The advisory team used various delivery methods to maximise delivery impact and minimise costs by making use of face-to-face meetings along with online calls and email correspondence. Once the reinspection date was announced support focused on CQC preparedness.

The value

The practice came out of Special Measures as a result of the inspection, however the lasting impact on the practice reached far beyond the inspection grading. The practice team reported that they felt motivated and empowered, and retention rates had improved because of the support they received.

The brief

The RCGP was contacted for assistance to prepare a practice for their CQC reinspection. This practice was placed into special measures - it was rated as 'Inadequate' by the Care and Quality Commission (CQC) specifically in the areas of 'Safety' and in being 'Well-Led'.

According to the CQC, the leadership challenges faced by the practice included not communicating their leadership vision with staff, no regular performance reviews, no documentation around internal investigations, a lack of training and not meeting cleanliness standards.

The approach

The RCGP assigned a team of three advisors: a GP, Practice Manager and Practice Nurse who each worked within their relevant area of the practice to bring the leadership back on track. The team found that the practice had recently gone through a merger which had not gone well, and at the same time had changed their computer system. As a result, the practice’s leadership had neglected to notice issues that had arisen regarding support for their nursing staff, and their Practice Manager was overwhelmed and not coping well.

A detailed action plan was drawn up for the practice and advisors to have a common document to work with and to measure progress. The action plan covered:

• Implementing a staff appraisal process
• Reviewing their processes and risk assessment procedures
• Putting infection control and cleanliness processes in place
• Improving communication with staff through updated policies
• Ensuring minutes from regular staff meetings were available to all staff.

The value

In addition to the development of a practical action plan, the RCGP advisory team provided personal, peer to peer support to encourage and guide the individuals of the practice through the challenges they were facing and bring them back to be a high performing team.

As a result of this work the practice was rated overall as 'Good' in four out of five areas by the CQC at their reinspection.