Care Quality Commission Patient Participation Group Sounding Board Core Group Meeting

15th January 2013,Birmingham

Draft Report

1.Introduction

The Care Quality Commission Patient Participation Group (PPG) sounding board was recruited in collaboration withthe National Association of Patient Participation (N.A.P.P) to look at how CQC should work with PPGs when regulating providers of NHS primary medical services.

All GP practices and all other primary medical services will be registered with CQC by 31 March 2013. From April CQC will monitor whether they continue to meet essential standards of quality and safety.

22 PPG representatives attended the workshop in Birmingham on 15th January facilitated by CQC and N.A.P.P staff.The workshop followed meetings in May and June in 2012 and a series of pilot inspections which involved PPGs.This was the first meeting of the sounding board.See Appendix for a list of the PPG attending.

At the meeting we:

  • Introduced the next stage of our work with PPGs and provided an update on CQC work with primary care
  • Looked at how recent examples of PPG work relate to the CQC inspections of GP practices including how can we share information, and what CQC inspectors should know
  • Agreed a contents list and framework for a ‘Guide for PPGs ‘

The full notes from all the table discussions have been fed into theplanning of a guide for PPGs on how they can work with CQC. Below are some of the key points from each discussion.

2.Relating PPG work with patients to CQC’s monitoring of services

The meeting heard about the recent work from each PPG, which included:

  • Extensive patient surveys and reports
  • Work on complaints systems and how to learn from them
  • Communication with practice populations on particular health issues,
  • Research into patient views on opening hours
  • Work with receptionists to improve the patient experience

Most of the PPGs present ran patient surveys and some PPGs held planning meetings to look at the analysis of the survey together with the practice manager and sometimes with GPs, and from this planned a schedule of work for the coming months/ year.

2.1Using the Essential Standards in PPG Work – areas of common concern

Participants commented that the essential standards, used by CQC to monitor care, did not always fit into the priorities of individual PPGs. However, when they analysed their patient surveysand looked at the results of collated patient experiences, many found links between their findings and the essential standards. The key outcome areas which link CQC and PPG work are:

Outcomes

1, 4, 7, 8, 9, 11,10,16 and 17, please see the appendix B for a quick list of CQCessential standards.

2.2Complaints and concerns

A number of PPGs gave examples of how they had looked into complaints raised by patients and agreed this could provide evidence for CQC on an inspection. Many had also looked into complaints systems in their practices. Key concerns were reception experience, appointment systems and waiting times.

2.3Measuring Involvement in a Primary Care Setting

Participants were keen that CQC recognised the difference between different levels of involvement of local people in primary care. There is an important difference, between:

- virtual patient reference groups, with no physical meetings and very little chance to share views

- patient reference groups usually managed by the practice manager and set up by the practice to meet pre-determined criteria to qualify for an Enhanced Service per capita payment

- and ‘true’ grass roots patient participation groups, which have been established in mutual partnership with the practice team and are independent ‘critical friends’ to the practice.

Inspectors should ask for evidence of action taken as a result of surveys, and ask questions about the independence of a PPG.

2.4Other sources of information that PPGs hold

Information for CQC inspectors may also be found in:

  • Locality groups working on topics such as Health and Wellbeing boards
  • Feedback from comments boxes and patient surveys
  • Exit polls – such as mother and baby clinic
  • Pieces of work and information which has been shared from other local PPGs

3.A Guide for PPGs on working with CQC

Phil Eadie, Operational Improvement Manager CQC, explained the role of inspectors and outlined what an inspection to a primary care service would look like. Phil explained CQC had carried out a pilot in the summer with primary medical services to test our methods for checking whether providers are meeting essential standards. The output from thepilot had helped toenabled usrefine current methodology and develop new methods.

PPGs raised concerns over primary care services being given 48 hours noticeof their inspections.Some participants felt this would give the surgery time to ‘put things right’. However, it was recognised that notice was neededso that staff, such as the Practice Manager would be available for the inspection and to accommodate areas for speaking to patients.

PPGs agreed that a guide for PPGs should firstly and most importantly give a detailed explanation of the role PPGs and the role and remit of CQC and where they fit in the landscape with the other regulatory bodies which monitor GPs, such as the GMC. A Guide should also include:

  • Relationships and how information is shared with stakeholders and localrepresentative groups and how CQC uses information from these and PPGs
  • The inspection process, including the types of inspectionsand frequency
  • What evidence a service needs to submit in the registration process
  • The role of the PPG chair or nominated member and their role during an inspection – would they be expected to support patient interviews?
  • How CQC will communicate the findings of their inspection – where PPGs can find the report, can they have it sent to them?
  • A case study on how working together worked – One suggestion was for a practice, their PPG and CQC inspector to undertake a case study on how they worked together before, during and after an inspection.
  • How to contact CQC and what a PPG can expect from CQC – PPGs want ongoing, meaningful dialogue with CQC
  • How information can be accessed from PPGs – website, email etc
  • How to complain about CQC

The guide must be jargon free, accessible and available in accessible formats. There would need to be hard copies available and sent to each PPG.Some felt the guide should be short and informative keeping detail to the appendices or links to sections of the website.

4. Working with CQC; What Inspectors should know?

Most PPGs agreed that contact should be made through the chair or a nominated PPG member however the question of how to contact PPGs would need further discussion through the sounding board. Akey message for CQC staff is that PPG members are volunteers and have limited time.Inspectors should also be aware that PPGs are at different stages of development – some are virtual groups and some don’t have independent chairs.

Tools and templates that PPGs could adapt to use in there own practice were identified as being essential, particularly information on mapping PPG issues from members of the public against CQC essential standards. Some PPGs spoke about their planning meetings and felt it would be helpful to design a template to detail their plan for the year mapped against outcomes.This would help an inspector identify quickly whether the PPG held relevant information to focus on.

All PPGs wanted a two-waysystem of information and feedback and would like CQC to attend planning and or networking events. However, while many PPGs present wanted to build a relationship with CQC staff, they were concerned that this would affect the relationship they had with their practice.

5.Next Steps

The CQC team, together with N.A.P.P will:

Write up some of the case studies provided and ask relevant PPGs for their comments

Develop a draft guide for PPGs and share this with the sounding board for comment

Work on some material for the N.A.P.P national conference

At the workshop we also said we would:

Provide a link to our report on Primary medical services pilot - Testing our current inspectionmethods with GP practicesand other primary medicalservices

Provide a link so PPG can sign up to receive email alerts from CQC about inspections of your local care services

Jay Harman, Clare Delap, CQC

Stephanie Varah, N.A.P.P

6.Appendix A: List of PPGs attending

PPG
Moorlands Medical Centre
Park Medical Centre
The Stag Medical Centre
Towerhouse Health Centre
3 Villages Patients Forum
Jesmond House Practice
Cookham PPG
Randolph Surgery
Highcliffe and Mudeford PPG
Wheatbridge PPG
Park View Surgery
Canbury Medical Centre PPG,
Tower House Surgery
Albrighton Patient’s Group
WellsCity Practice
Greasby PPG
Baslow Health Centre
Mansfield Medical Centre
Hillview Surgery PPG
Hollybrook & Sinfin PPG
  1. Appendix B: Quick list of essential standards

Of the complete lust of 28 essential standards, there are 16 that are most aligned to preventing acceptable care. When a GP practices registers, they will need to declare whether or not they are meeting these 16 standards

1 / Respecting and involving people who use services / People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run
2 / Consent to care and treatment / Before people are given any examination, care, treatment or support, they should be asked if they agree to it
4 / Care and welfare of people who use services / People should get safe and appropriate care that meets their needs and supports their rights
5 / Meeting nutritional needs / Food and drink should meet people’s individual dietary needs
6 / Cooperating with other providers / People should get safe and coordinated care when they move between different services
7 / Safeguarding people who use services from abuse / People should be protected from abuse and staff should respect their human rights
8 / Cleanliness and infection control / People should be cared for in a clean environment and protected from the risk of infection
9 / Management of medicines / People should be given the medicines they need when they need them, and in a safe way
10 / Safety and suitability of premises / People should be cared for in safe and accessible surroundings that support their health and welfare
11 / Safety, availability and suitability of equipment / People should be safe from harm from unsafe or unsuitable equipment
12 / Requirements relating to workers / People should be cared for by staff who are properly qualified and able to do their job
13 / Staffing / There should be enough members of staff to keep people safe and meet their health and welfare needs
14 / Supporting workers / Staff should be properly trained and supervised, and have the chance to develop and improve their skills
16 / Assessing and monitoring the quality of service provision / The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care
17 / Complaints / People should have their complaints listened to and acted on properly
21 / Records / People’s personal records, including medical records, should be accurate and kept safe and confidential

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