Good Business Practice

Article by Dr Aumran Tahir, Founder and Director of AT Medics

Outstanding; defined as ‘clearly much better than what is usual’. As of 31 July 2018, 91% of GP services in England were rated as ‘good’ by the Care Quality Commission (CQC) with 5% rated as ‘outstanding’.

Considering these figures, that seems like a very fitting description. But what does it take to be outstanding?

Despite having five standards, and a range of criteria in order to meet those standards, achieving an outstanding CQC rating is far from a tick-box exercise. It has to be approached with pride and confidence rather than dread.

I once heard someone suggest that the difference between providers with outstanding ratings was based on how they viewed inspections.

If the entire team sees an inspection as an opportunity to showcase the positive work they are doing then it is this team that is likely to see an outstanding rating. This is an interesting theory and certainly one that rings true at AT Medics. We are confident in the services we provide and take pride in the difference we make to our patients lives every day.

So back to the question…what does it take to achieve an ‘outstanding’ CQC rating?

It might sound a strange place to start considering we are discussing how to be ‘clearly much better than usual’ but the recognition and acceptance of error goes a long way towards achieving greatness (from a CQC perspective). The reality is that, sometimes, things go wrong. It is important to be accepting of this fact and ensure that there are effective systems in place that allow for the reporting and recording of these issues. Above and beyond this, any issues need to be handled in a transparent and honest manner.

At AT Medics we strive to inform patients as soon as possible, provide an honest and open dialogue, support and a written apology.

I appreciate that this isn’t always easy. Unfortunately fear is alive and kicking but, I believe, the courage to admit mistakes comes from positive leadership. In addition to having the right processes and procedures that not only flag, but then prevent further issues you also have to have a leadership approach that embraces openness and honesty.

Staff need to feel confident that they will find a supportive listener if they identify that mistakes have occurred. Resilient people aren’t afraid to admit they have weaknesses but, instead, learn from them and use them to drive improvements.

Resilience is something that is required in bucketloads in the present economic and political climate. How else can we expect to improve or, at the very least, maintain standards despite increasing demands and budgetary pressures if we don’t show resilience?

We have been able to ensure this through the development of bespoke solutions that enable us to have relevant data and analytics at our fingertips. One of the issues, often, with scale is that you begin to lose sight of the detail. We have turned this on its head by having a ‘Hub and Spoke’ model where, for every seven practices, we have a centralised resource which monitors performance and is able to identify when extra resources are required.

With a supportive environment also comes morale. I defy any organisation to achieve an outstanding rating without first having focussed on the team within.

According to the CQC themselves, deterioration in CQC ratings can be attributed to the poor management of staffing levels, staff deployment, training and turnover. It doesn’t take a genius to figure out that unhappy staff are unlikely to provide a welcoming and engaging environment for patients.

The ‘Hub and Spoke’ model helps ensure that a surgery is not overwhelmed and has the resilience to operate smoothly. By combining this with other, relatively simple and costeffective measures such as regular staff meetings, regular staff communication and staff performance reports, we received comments from the one of our CQC inspections which included:

A genuine open culture in which all safety concerns raised by staff were highly valued and integral to learning and improvement.

Staff has been trained to provide them with the skills and knowledge to deliver effective care and treatment.

When you consider 15 months prior, the practice in question had significant staff issues with incredibly low morale and were not registered with the CQC – it was at this point that AT Medics began to manage the practice. Following the changes the practice achieved an ‘outstanding’ rating. An obvious testament to the impact such interventions can have.

We also try and look at areas where we could improve the roles for individuals and enable them to focus on the tasks more relevant to their skills. For example, an average GP receives between 40 and 60 letters per day and may spend up to two hours per day managing documents.

Now whilst I appreciate that might be a symptom of the role (no pun intended) I very much doubt any medical student sat studying for their exams relishing the chance to tackle a pile of admin.

Through the development of a bespoke solution (yes another one!) we have developed a range of programmes that through upskilling the workforce and centralising admin, we successfully reduced the GP admin burden by up to 80% enabling more time to be spent on patient care (we are sharing these programs with practices across the UK).

As a result, the GPs in our AT Medics family and others who have adopted our solutions feel less stressed and rushed and, therefore, have greater job satisfaction.

It sounds simple (a developing theme) but being able to support the needs of differing population groups is also key. Despite all of our primary care services being in London, they have very differing patient populations and, as such, differing needs.

One of our ‘outstanding’ services is a case in point: The Greenhouse Surgery provides primary medical services to approximately 1000 patients in the London Borough of City and Hackney. It is a specialist service providing GP services to Street Homeless people or those in temporary or hostel accommodation in Hackney. 40% of the population are rough sleepers and 60% live in hostels or other temporary accommodation.

The social and economic issues surrounding homelessness can mean that individuals often struggle to book appointments in advance or have difficulty adhering to a scheduled appointment. In recognition of this, the Practice now has no limit on the number of walk-in appointments available on any one day.

Two thirds of homeless people in the UK cite drug or alcohol abuse as a reason for first becoming homeless and those who use drugs are seven times more likely to be homeless. In order to support these specialist needs, a substance misuse clinician was recruited to deliver alcohol and substance reduction programmes.

Another of our ‘outstanding’ examples, Kings Road Medical Centre, provides primary medical services to just over 11,000 patients in the London Borough of Kensington and Chelsea. The practice has a much higher than England average of patients aged between 20 and 39 years and a far lower than average number of patients aged under 19 and over 40. Despite being one of the smallest boroughs in London (at just over 4.7 square miles) it is one of the most densely populated areas in Europe.

With a diverse population, half of which are from ethnic minority groups, the area also has a higher incidence of mental health problems than most urban areas. As a result this is a key area of focus for the Practice.

This is an area that requires experience, knowledge and a genuine understanding of the local community and their beliefs. In some communities, there is a hesitancy to discuss mental health as it can be viewed as something that could bring shame to a family.

Regardless of the scientific validity of this claim, beliefs are something that deserve respect, especially if we want to earn the trust and respect of the local community. In response to this, we teamed up with a local charity to tackle health and social issues affecting Muslim communities, such as mental health.

In partnership we produced a set of multilingual short films called ‘Talking from the heart’ which explored mental health diagnosis and therapy combined with medical and faith advice from local respected leaders.

According to the CQC you need to go ‘above and beyond’ to achieve an ‘outstanding' rating. At AT Medics, that has become central to everything we do. There is always more that can be achieved. So what does it take to become outstanding? The belief that ‘outstanding’ is what you can achieve is a very good start!

For further information on AT Medics:

www.atmedics.com

www.attech.london

info@atmedics.com