PRIMARY CARE QUALITY ASSURANCE STRATEGY

Transcription

1 PRIMARY CARE QUALITY ASSURANCE STRATEGY Last Review Date Approving Body Not Applicable Quality & Patient Safety Committee Date of Approval 5 May 2016 Date of Implementation 5 May 2016 Next Review Date May 2019 Review Responsibility Head of Quality Version 1 Page 1 of 9

2 REVISIONS/AMENDMENTS SINCE LAST VERSION Date of Review Amendment Details Page 2 of 9

3 1. Background From 1 st April 2016 Doncaster CCG has a statutory duty to assist and support NHS England with quality of services in primary care and has the delegated authority for contracting primary care services. Whilst Practices as providers are accountable for the quality of services and required to have their own quality monitoring processes in place, NHS England and CCGs as commissioners have a shared responsibility for quality assurance. The principle is to be supportive and enhance quality and prevent harm to patients. Through the duty of candour and the contractual relationship with commissioners, practices are required to provide information and assurance to commissioners and engage system wide approaches to improving quality. NHS Doncaster CCG is committed to improving the quality of care for our patients and therefore assessing, measuring and benchmarking quality is a key focus. Quality in the NHS can be defined in 3 dimensions to quality that must be present to provide a high quality service (Darzi, 2008): Patient Safety Clinical Effectiveness Experience of patients The NHS Outcomes framework defines 5 domains of quality: 1 Preventing People from dying prematurely 2 Enhancing quality of life for people with long-term conditions Effectiveness 3 Helping people recover from episodes of ill health or following injury 4 Ensuring people for a positive experience of care Patient Experience 5 Treating and caring for people in a safe environment and protecting them from avoidable harm Safety Quality improvement can be defined as a process within general practice through which individuals who provide care adopt various approaches to self-reflection and benchmarking in order to understand and address reasons for poor quality or variations in quality and patient experience to identify areas where acceptable quality can be improved further. Quality assessment can take different forms and uses various tools to appraise the standard quality of particular aspects of general practice care; examples already exist such as the safeguarding self-assessment tool. Quality assurance is the systematic and transparent process of checking to see whether a service is meeting specified requirements and involves the assessment of quality of care against agreed thresholds and standards, to determine the level of Page 3 of 9

4 quality. This also includes assurance that actions identified are implemented via reviews against progress and improvement in quality. Figure 1 Doncaster Primary Care (medical) Delivery Model The Quality Strategy will be developed in line with the transformation agenda for Primary Care, where the quality and safety element of the programme is integral and the golden thread that runs through each pillar of care. 2. Quality Assurance Framework The approach will be for the 3 domains of quality to be monitored through routine internal contractual processes and clinical governance structures and external sources such as CQC, Monitor, peer reviews, national surveys etc. There is a process for escalation in relation to Quality Assurance: 1. Routine quality assurance monitoring 2. Local enhanced quality assurance 3. Regional enhanced quality assurance 4. Formal action Page 4 of 9

5 Increasing Risk Formal Action Reducing Assurance Regional: Quality Assurance Visit Local: Enhanced Quality Assurance Measures Routine: Quality Reporting Evidence Monitoring, Assurance Meeting The Governance arrangements will be for a primary care quality dashboard and a risk matrix to be jointly reviewed and share information through the Primary Care Delivery Group which has membership from performance and information, commissioning, contracting and finance and NHS England in order to identify potential or actual risks to quality, agree a response and to ensure that concerns about quality reported to the Quality and Patient Safety Committee and risks are escalated appropriately to The Primary Care Committee. Stage 1 Routine Quality Assurance (GREEN): Evidence monitoring To include the following Quality Metrics: Patient Safety Indicators include: monitoring of HCAI, safeguarding vulnerable children and adults, reporting of patient safety incidents, mortality rates, workforce numbers, skills and training, access and screening compliance. Clinical Effectiveness Indicators include: The implementation of the National Institute of Clinical Excellence guidance (NICE), delivery of the service specification, key performance indicator monitoring, learning from audit and peer reviews and using benchmarking resources such as the Primary Care Web Tool. Patient Experience Indicators include: Patient reported outcomes measures, patient survey results, FFT, respecting privacy and dignity, complaints, access and responsiveness, referral times monitoring, CQC inspection results, patient advisory and liaison service, health watch etc. Page 5 of 9

6 Working in partnership with Performance and Intelligence, information from the different components will be aggregated from a dashboard to stratify practices into different levels of risk using a RAG risk matrix which in turn will identify the level of surveillance appropriate for each practice. Figure 2 Dashboard Concept The methodology used to rate the GP Practices in the dashboard above will be as follows: Each GP Practice will generate a score for the following sections: o Improvement and Innovation o Easily Accessible Services o Sustainable Infrastructure and Workforce o Good Patient Experience o Delivery High Quality Clinical Outcomes o Maintaining System Resilience o Safe and Appropriate Clinical Care Various data elements within each of these sections will have different weighted scores. This is because certain data drives a higher level of significance than others. Page 6 of 9

7 Data elements include (but are not limited too) patient experience data, secondary care activity, risk stratification, SUI incidents and infrastructure intelligence. A more defined list can be found in figure 2 (above). The combined score of each of the sections above will give the GP Practice a single overall level of surveillance. The levels of surveillance will be RAG rated into 5 areas: Overall RAG rating Aggregated Score (no CQC score) Aggregated Score (with CQC score) Surveillance Level Red Stage 4 Formal Contractual Action Amber/Red Stage 3 Regional Enhanced Assurance Amber Stage 2 Local Enhanced Assurance Amber/Green Stage 2 Local Enhanced Assurance Green Stage 1 Routine The Quality and Patient Safety Committee may determine following triangulation of the dashboard data with other sources of information/intelligence, that the surveillance ratings need to be amended. If this is the case the rationale will be clearly recorded on the risk matrix. Stage 1 Routine Quality Assurance (GREEN): Meetings Commissioners and practices will be involved in a number of meetings where quality and safety should be the key priority and focus of those meetings, for example, District Infection Control Committee, Immunisations and Vaccinations Group; this gives opportunities for quality monitoring and assurance to be gained. Additionally the CCG will identify a quality lead to offer a scheduled annual visit to practices as part of stage 1 supportive arrangements, ensuring an on-going dialogue with the CCG. It is important that lead clinicians are involved in t h e s e practice meetings to enable a full and comprehensive discussion around quality to include: Routine quality metric monitoring using the agreed primary care dashboard Other patient safety indicators including HCAI, safeguarding, reporting of patient safety incidence, workforce numbers, skill mix and training, vaccination and immunisations uptake and adherence to screening programmes Other patient experience indicators including complaints, FFT, Healthwatch feedback, National GP Survey Outputs from and links with other informal discussions with the CCG about areas of practice, for example medicines management, safeguarding assurance etc. Page 7 of 9

8 Potential risks/concerns identified via regular routine monitoring will be assessed for importance and urgency to inform the short and medium term response. It will need to be considered that an outlying score does not necessarily mean that there is a concern but may indicate that performance in the area identified needs further examination. These visits and the use of the dashboard and risk matrix as well as other identified intelligence will help to identify those practices that require escalation to stage 2. Stage 2 Local Enhanced Quality Assurance (AMBER or GREEN/AMBER) This will be reactive based on the outcomes against the framework. The provider is escalated where there are a number of potential concerns or risks or that a risk/concern is considered significant. Actions should be focused on supportive measures to bring about improvements in practice quality performance. Enhanced Assurance includes: Enhanced Quality Assurance meetings Commissioners should work closely with providers in ensuring processes are transparent in how we gain quality assurance. This may involve being invited to join provider governance and patient safety meetings. Clinician to Clinician meetings, Commissioning joining PEAT inspection visits and patient safety walk rounds. The Duty of Candour placed on all providers should support this process as they will be required to be open and transparent. Enhanced Local Targeted Quality Assurance Visits Doncaster CCG patients will be able to access safe care, which is evidence based, personalised and responsive. If commissioners are not gaining sufficient assurance that our pledge to patients is being met then we may want to take extra steps to understand where the assurance gaps are. Commissioners would work closely with providers in undertaking a targeted quality assurance visit using an appreciative inquiry approach. This should be done within the NHSE policy framework to ensure that the approach follows a structured and purposeful methodology, with an independent clinician who will have no conflict of interest with the practice. Local Quality Review Meeting with Commissioners and regulators Where there are quality concerns identified or the level of assurance is insufficient a Local Quality Review meeting is held with commissioners and regulators to share intelligence and determine if the actions undertaken or proposed by the provider give the appropriate level of assurance. Local Quality Review Meeting with Commissioners and regulators and providers If the Quality Review Meeting does not gain assurance the next stage is a Quality Review Meetings held with commissioners, regulators and providers where further actions and monitoring are considered. Quality Assurance visit using appreciative enquiry methodology Page 8 of 9

9 Stage 3 Enhanced (Regional if appropriate) Quality Assurance Rapid response review This will include formal investigation including conversations with the practice to share intelligence, understand the situation/substantiate concerns and risks identified. Where necessary there will be formal agreement of improvement actions and support that will be required. Regional Rapid Response review where indicated The CCG will identify a team of both internal and external expertise to review a content area /collection of content areas of the practice system agreed by the PCC. Regional Risk Summit Where indicated. Any statutory organisation including providers themselves who has a serious concern about the quality of care in a provider organisation can trigger a Risk Summit. The Risk Summit should normally be convened within 24/48 hours of the request; it would consider the Regional Rapid Response review. Stage 4 Formal Action Formal Contractual actions may be /considered to be taken when all other elements to support improvement have been exhausted. Appropriate action/monitoring via the Quality Patient Safety Committee and Primary Care Committee will be needed and at all stages of the process. Additionally potential/actual/perceived conflicts of interest will need to be effectively managed. Escalation Process Risk assessments and risk profiling will help to establish further work that is required to provide assurance that the risks are being managed effectively and any gaps in assurance or controls are being addressed. Page 9 of 9