Exiting Special Measures

The College’s Primary Care Development Team helped a practice exit special measures and improve their CQC rating from ‘inadequate’ to ‘good’.

RCGP Primary Care DevelopmentThe issue

A practice of approximately 4,000 patients was placed in special measures in 2016 following a CQC inspection which found the practice inadequate overall with: 

  • ‘Inadequate’ for safe and well led
  • ‘Requires Improvement’ for effective and responsive
  • ‘Good’ for caring
  • Seven ‘must’ and four ‘should’ improvements.

How we helped

Our team of three advisers comprising a Lead Practice Manager, GP and Practice Nurse carried out an initial scoping visit and interviewed all the staff present. Our advisor team broadly agreed with the CQC rating. The following key issues were identified:

  • Two longstanding partners were approaching retirement, and one admitted having ‘let things slip’. 
  • Two new partners and a new and inexperienced practice manager had been appointed following the CQC visit.
  • The newly appointed Lead Partner had a clear vision for the practice but had limited time and resource to deliver the changes required to get the practice out of special measures and felt overwhelmed.
  • The practice did not have clearly defined and effective systems and processes in place. For example, for recalling and reviewing patients with long-term conditions. 
  • Team communication was an issue. Practice staff were loyal but were demoralised by the CQC rating.

The turnaround plan addressed the specific concerns identified by the CQC and focused on:

  • developing the leadership team, particularly through support and mentoring of the practice manager
  • up-skilling staff. For example, ensuring all staff had training in safeguarding adults and children
  • improving team communication. Regular staff meetings and appraisals were introduced
  • introducing and embedding a wide range of clearly defined systems, processes and practices.

The advisers also supported preparation for CQC re-inspection including an interactive training session for the practice team.

Outcomes / impact

The CQC re-inspection went well and the immediate feedback was very positive. The practice exited special measures and was given an overall rating of ‘good’.


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