Promoting Excellence in Family Medicine

RCGP Special Measures Programme

Alison Johnson, SM AdviserJayne Dewhurst, Deputy Lead

RCGP SM Programme What do we offer?

Peer advice and support to GP practices that enter special measures after a CQC inspection Commissioned by NHSE MOU between practice, RCGP, contract holderUp to £10k per practice, funded by NHSE

Volume of PracticesDescription Numbers %Total Number of Enquiries

146

Total Number of Practices Ever Supported

93 64%

Current Number of Active Practices

36

• Numbers at 8th February

• Further 6 Practices due to come on stream

• Large Number of enquiries pending

Methodology

Initial conversations, various sources Pre-scoping clinical lead/deputyScoping – CQC report, stakeholders, practice visitScoping –Root Cause analysis --Improvement plan—practice with supportTurnaround plan costed—RCGP teamOngoing support to practice

Examples of Support

Stabilise, increase capacity, embedUnderstanding key documentsPrioritisingImprovement planningLiaison with NHSE and key stakeholdersHelping with basic policiesSupporting appointment of key staff

More examples

Looking at practice viabilityActing as a stabilising influenceRaising clinical governance issuesLiaising with other sources of support AssuranceFacilitating meetings e.g. strategy, audit, CQC preparation

Interim Evaluation key themes

Root causesScoping VisitInsight and EngagementRemediable practicesRelationships with stakeholders

Root Causes

Lack of effective Clinical LeadershipLack of effective Practice Management

Both must understand what needs to be done and be able to make it happen

IsolationFrom others externallyWithin the practice

Root causes inter-related

Branch surgeriesBuildings issuesFinancial Contract issues

Negative cycles common

Other root causes

Predictors of Success

Early RCGP interventionHelp write realistic action planLonger period of supportPossible marker of good engagement

Stakeholder support goodPositive monitoring against clear actionsGood communication

Local resources and peer to peer support

Predictors of success

InsightEngagementGiving/getting the whole picture

OutcomesOutcomes of Reinspection Number %Good 26 48%

Requires Improvement – Out of SM 9 17%

Inadequate – Emergency Closure 2 4%

Inadequate – Stay in SM 4 7%

Inadequate Closed with Notice 1 2%

Requires Improvement – Stay in SM 5 9%

Closed prior to Reinspection 0 0%

Early Withdrawal 3 5%

GP Retired/Resigned 2 4%

Practice Merger/Acquisition 0 0%

Other 2 4%

The Future

RCGP plans to offer commissioners smaller suite of services for upstream support

e.g.Scoping visit, root cause analysis and improvement planFollow up pre-CQC visit Facilitation of away days (Well Led)