Good News for Patients and Practices
– the Verdict on RCGP Provider Accreditation
The results of the RCGP pilot on provider
accreditation are announced today – revealing strong support for a
professionally-led, voluntary and developmental scheme to recognise
quality in non-clinical aspects of the care.
The Primary Medical Care Provider
Accreditation (PMCPA) pilot was led by the RCGP in partnership with
Professor Helen Lester and her team from the National Primary Care
Research and Development Centre at the University of
Manchester.
The pilot was funded by the Department of
Health but the standards were developed by a team which included
the General Practitioners Committee of the BMA, patient
representatives, the General Medical Council, Healthcare
Commission, Royal College of Nursing, NHS Confederation, National
Patient Safety Agency and others.
The pilot was conducted over 15 weeks but it
is envisaged that the full programme will take place over a two or
three year period when properly rolled out.
Despite the short time, 30% of participating
GP practices passed 100% of the core criteria and half of all
practices scored 90% or above.
The key findings are:
- RCGP leadership was “critical” to motivating practices to sign
up to the pilot and ensuring the successful implementation of the
scheme
- GPs generally made the initial decision to be involved and then
led the scheme, supported by practice managers who co-ordinated the
day to day workload
- PMCPA demonstrated excellence to patients and led to
improvements in patient safety
- It is valuable, achievable and relevant to primary care and
creates a sense of “professional pride” among practices
- It works best where there is teamwork with designated
responsibilities; shared goals and GP leadership within the
team
- Practice size does not affect achievement
- Financial incentives were not a motivator for taking part
- Workload was higher than expected but almost all practices
emphasised that this was due to the 15-week duration of the pilot;
the timing (over the summer) and the fact that it coincided with
practices being busy with concurrent demands including the IMT
DES
- PMCPA could be rolled out as a two or three year programme
(with new Care Quality Commission standards seen either as
eligibility criteria or as part of the first year’s work)
RCGP Chairman Professor Steve Field said: “The
pilot has been a huge success. It demonstrates that accreditation
is feasible – and that it is acceptable to the profession.
“I am particularly pleased that the pilot
attracted such a positive and enthusiastic response from individual
practices who were prepared to invest their time and effort.
“I am also indebted to Helen Lester and her
colleagues Stephen Campbell and Umesh Chauhan at Manchester who
have achieved a project that meets the highest standards of
academic rigour yet still manages to be realistic and add value to
busy practice teams going about their work with patients.
“Professionally led accreditation is the way
forward to further improving the quality of care provided by
practices and it has the potential to satisfy the regulatory needs
of the Care Quality Commission once additional work has been done
to incorporate their new requirements which will be announced
shortly.”
Helen Lester, Professor of Primary Care at the
National Primary Care Research and Development Centre said: “We
were delighted by the positive responses from GPs, practice
managers and practice nurses to PMCPA, particularly that the
criteria were sensible and fitted with their views of what quality
practice should be like. We were also really pleased that there was
evidence, even in the short pilot timeframe, of real benefits for
patients.”
Barbara Young, Chairman of the Care Quality
Commission said: "We are pleased to see the positive outcome of the
pilot scheme. We look forward to continuing to work with the RCGP
and partners on the further development of PCMPA as the Care
Quality Commission's approach to the regulation of primary care
moves forward."
Health Minister Ben Bradshaw said: “We welcome
the successful outcome of this pilot and look forward to seeing
further progress on this scheme. Accreditation schemes such as this
one, will help improve quality and safety as well as the patient’s
experience of visiting the GP."
The RCGP is now in the process of setting up a
group to implement the full programme and has had in-depth meetings
with the GPC, Department of Health and the CQC.
NOTES TO EDITORS:
The RCGP is awaiting publication of the
Department of Health’s standards which, after consultation, will be
adopted by Care Quality Commission and will become part of the
final programme so that regulatory requirements are satisfied.
Lessons learned from the programme will lead
to a reduction in the number of criteria to avoid duplication
Lessons drawn from the assessors’ experience will also inform
future work.
The PCMPA scheme was developed using the
methodology of the RCGP Quality Team Development (QTD) scheme
supplemented with international primary care accreditation schemes
and other recent related policy.
The pilot took place over a 15 week period and
involved 36 practices in 4 Primary Care Trust areas – 10 in
Haringay; 8 in Nottinghamshire; 9 in Oldham; and 9 in
Warwickshire.
The sample of practices was nationally
representative in terms of QOF scores, and practice sizes were
almost identical to national values but tended to be in slightly
more deprived areas than the national norm.
Of these, 32 practices fully completed the
pilot and 30 practices (with over 200,000 patients) completed the
entire scheme including an assessment visit by a PCT-appointed
three-person team (clinical, practice manager and lay
assessor).
Two of the initial 36 decided to withdraw
early on in the pilot scheme due to unexpected staff changes. Two
others uploaded some data during the pilot but withdrew during the
15 weeks.
PMCPA has six domains: 1) Health Inequalities
and Health Promotion, 2) Provider Management, 3) Premises, Records,
Equipment and Medicines Management, 4) Provider Teams, 5) Learning
Organisation, 6) Patient Experience / Involvement.
The PMCPA pilot scheme included five key
stages:
- A pre-entry qualification stage: Providers were asked to
demonstrate compliance with contractual criteria and to sign a
confidentiality agreement
- A set of 30 core or summative criteria: Providers were asked to
self-assess and provide written documentation against all these
criteria.
- A set of 82 developmental or formative criteria divided into
six domains: Providers were asked to self-assess against chosen
criteria within their randomly allocated developmental domain.
- Data on QOF organisational indicators was collected from the 31
March 2008 Quality Management and Analysis System for each of the
participating providers.
- Practices also had an independent assessment visit from PMCPA
trained assessors and were given a Quality Improvement Plan.
The Royal College of General Practitioners is
a network of over 36,000 family doctors working to improve care for
patients. We work to encourage and maintain the highest standards
of general medical practice and act as the voice of GPs on
education, training, research and clinical standards.
FURTHER INFORMATION
RCGP Press office – 020 7344 3136
Out of hours: 07885 958 632
press@rcgp.org.uk