A Crummy Guide to CQC's New Guidelines

Written by: Georgia Dossis

In a bid to make the process easier for surgeries as well as fit into new guidelines, CQC have decided to change part of their framework on how they will begin assessing care providers going forward.

So far, they’ve explained that their five statements Safe, Caring, Responsive, Effective, and Well-led (SCREW) domains are staying, along with their four-point rating scale (Outstanding, Good, Require Improvement and Adequate).

However, they will replace their Key Lines of Enquiry, prompts and rating characteristics with new ‘quality statements’ to reduce duplicates in the four-assessment area’s and make it essentially easier for providers to follow.

To make their judgement consistent, their new framework includes the below six categories for the evidence that they will collect:

• people’s experiences
• feedback from staff and leaders
• observations of care
• feedback from partners
• processes
• outcomes of care.

The way that they will use their new framework, is that they will continue to use inspections via site visits so that they can get evidence to assess quality, use a range of information to assess providers flexibly and frequently (this is not tied to a previous rating) and produce shorter and simpler reports showing the most up to date assessment.

Which going forward means that providers can be clearer on what is expected of them from the assessments, the reports will be simpler to read and all in all will result in better quality patient care.

The Fuller Stocktake

Written by: Craig Arnott

Last year (November 2021), Amanda Pritchard (NHS CEO) commissioned a ‘national stocktake’ of Primary Care to be led by Dr Claire Fuller (a GP and ICS CEO). 

Essentially the NHS wanted a summary of how ICS’s (Integrated Care Systems – which will be established as statutory bodies July 2022) could best support Primary Care. 

ICS’s will have 3 ‘layers’ of hierarchy, although they are going to ‘supposedly’ work using the methodology of ‘subsidiarity’ – meaning the PCN’s (or neighbourhoods if you prefer) will be recommending how the money should be spend and services should be driven.

The layers (as well as how I choose to make sense of them), top down, are as follows:  

System – The new name for STP’s (Strategic Transformation Partnerships) but this time with statutory power.

Place – The replacement for CCG’s – which have been ‘subsumed’ but I wouldn’t be surprised if CCG’s just changed their names and the staff change their e-mail footers).

Neighbourhoods – PCN’s (Primary Care Networks)

The Fuller report/stocktake was always intended to shape the future structure of how Primary Care works within the new ICS structure but it has become far more significant now, as all 42 ICS leaders have signed, endorsed and committed that they agree with the findings!!!  The fact the NHS commissioned the document also means they have a responsibility to act upon them.

So, what does the report state:

In summary – very little we didn’t know already, using over-elaborate terminology and as many of the latest buzz words as one can ‘pivot’ (a mildly amusing reference if you have read through the document)!

The document isn’t really a ‘stocktake’ as it doesn’t focus or even assess the options available but looks only to develop Primary Care within the predetermined ICS boundaries.  Absolutely fair enough considering the more than likely, dramatic change coming.

The main bullet points are as follows:

The vision for integrating Primary Care consists of 3 essential offers.

      1                    Improving Access

2                     Improving Proactive, personal Care (what matters to me, not what’s the matter with          me!)

3                     Helping people stay well for longer (preventative care)

I would normally begrudge reading a document that doesn’t shed light on anything new, but one thing I really did appreciate was the ‘Annex: Framework for shared action’ (page 34 onwards)

The annex designates the responsibility for actions that need to be taken by NHSE (NHS England), DHSC (Department of Health and Social Care) and the ICS’s (Integrated Care Systems)!!! A bold move indeed (I don’t think I can remember another instance where responsibility was actually assigned UPWARDS in a report)! Fair play!

So, the management also have 3 main tasks, these are as follows: 

1                     Workforce

2                     Estates

3                     Data

So, there you have it! A very, very basic summary (A Crummy Guide) of the Fuller Stocktake, you can check out the full document and accompanying letter here: 

https://www.england.nhs.uk/publication/next-steps-for-integrating-primary-care-fuller-stocktake-report/