Agenda item

5.1

The Committee received a report of the Chief Nurse, Sheffield Clinical Commissioning Group (CCG), which provided an overview of the outcomes of the inspections of Sheffield based General Practices which had been undertaken by the Care Quality Commission (CQC). 

5.2

In attendance for this item were Jane Harriman (Head of Quality, Sheffield CCG), Sue Berry (Senior Quality Manager, Sheffield CCG) and Mandy Philbin (Deputy Chief Nurse, Sheffield CCG).

5.3

Jane Harriman introduced the report, indicating that, since it had been written, 83% of General Practices in the City had been visited, with 96% rated as ‘Good’, 3% as ‘Requiring Improvement’ and one as ‘Inadequate’.  The remaining 14 practices had been visited, but the reports on them had not yet been received.  Whilst none of the practices had been rated as ‘Outstanding’, three had been rated as ‘Outstanding’ in relation to the responsiveness of services and a number of areas of outstanding practice, which were outlined in the report, had been identified.  When compared with the inspection outcomes across South Yorkshire and Bassetlaw, Sheffield’s came somewhere in the middle and were much the same as those for Leeds.  The Sheffield CCG had joint responsibility with NHS England for General Practices and they would work together to resolve any issues which arose following these inspections.  The Sheffield CCG was proactive on quality, particularly in relation to infection control and safeguarding and, if a practice was found ‘Inadequate’, it would work with that practice as to how it could improve.  With regard to the future, a CQC strategy was presently being consulted on and this may result in a movement toward self-assessment and intervention where necessary.

5.4

Sue Berry then provided the meeting with information on the CQC, explaining that it was set up to monitor Health and Social Care in relation to a set of fundamental standards, with the results of its inspections being published.  The CQC rated their inspections against five key lines of enquiry, which were whether services were safe, effective, caring, responsive and well led.  Following an inspection, the inspected practice would receive a report and a grading, which could be challenged, and the results were examined by a moderation panel.  The final report was then sent to the practice and published.  If a practice was found to be ‘Inadequate’, the CQC could then invoke powers such as issuing warning notices, changes to providers’ registration, the implementation of special measures and holding the practice to account by means of fines, cautions or prosecution.

5.5

Members made various comments and asked a number questions, to which responses were provided as follows:-

·                The Sheffield CCG employed 2/3 staff to work on quality and these were assisted by a wider team of support staff.

·                Patient experience was considered as part of these inspections, with CQC representatives speaking to patients in waiting rooms, assessing patient survey results and consulting with Patient Participation Groups.  This came under the caring/responsive heading, with all practices scoring ‘Good’ on caring. 

·                Access to GP services was recognised as a national issue and there was a need for more people to become GPs and nurses.

·                The CQC inspection reports were available online.

·                In relation to the 23 practices where Disclosure and Barring Service (DBS) checks had not been carried out on some staff, CCG officers were waiting for all the inspections to be completed, so that full evidence could be obtained and remedial measures taken.  It was important to ensure that the CCG was informed when all outstanding DBS checks had been completed.

·                It should be recognised that it was only possible to assess practices for that present moment in time and also that they operated as private businesses.

·                The turnover of staff could partly explain why DBS checks had not been carried out on some people.

·                In relation to fridge temperatures, NHS England was responsible for vaccine management and there was a strict process of monitoring.

·                The CQC had indicated that risk assessments were required where emergency equipment was not available on site, but it was accepted that most practices did have oxygen available.  NHS England commissioned GP services through a national core contract, but this contained no requirement for certain equipment to be available in practices.

·                The consultation into the CQC inspection regime would include consideration of the connectivity of all providers.

·                General Practices operated under a core contract which was set nationally and the CQC would take this into account in its inspections.  Any central support given to practices would be controlled by the CCG.

·                The CQC scoring system meant that a practice could fail in all of the five key lines of enquiry, but it may be only one issue which affected all of these lines.  If there were any concerns about a practice the CCG would offer help and support.

·                The CCG had a tight governance structure which comprised a Primary Care Commissioning Committee and a Quality Assurance Committee.

·                The CQC inspection would include relevant questions on issues such as appointments and home visits, which would come under the responsive key line of enquiry.  These aspects had not been identified as issues in Sheffield.

·                All CQC inspection reports were published on its website and Jane Harriman would provide the appropriate link to the Policy and Improvement Officer for circulation to Committee Members.

·                General Practices needed to be registered with the CQC and there was an enforcement model on assessment which was enforceable by law so, in addition to sanctions such as the imposition of fines and special measures, non-compliant practices could be taken to the criminal courts.  Any measures taken were dependent on the level of risk.

·                Every GP was accountable to their professional body, the British Medical Association, and this ran alongside any responsibility to the CQC. 

·                If a practice was rated ‘Inadequate’, the CQC would set out a plan for that practice which would be monitored and a further inspection would take place.  This was the process whether the failure related to an individual or the practice in general and there was an escalation process.  Sheffield had practices with good scores, with only one being rated as ‘Inadequate’.  Any action would depend on the risk associated with the level of failure, but Members could be assured that dangerous issues would not be left unaddressed. 

·                GP surgeries should display a notice informing patients as to how they could complain.

5.6

RESOLVED: That the Committee:-

(a)       thanks the attending officers for their contribution to the meeting;

(b)       notes the contents of the report and the responses to questions;

(c)        notes Members’ concerns at some of the areas for improvement  referred to in the report, particularly those relating to Disclosure and Barring Service checks not being carried out, lack of defibrillators and oxygen and issues regarding fridge temperatures; and

(d)       requests that a report on the final outcomes of the Care Quality Commission’s inspections on General Practices in Sheffield be submitted to the Committee in six months’ time.