Elliott Hall Medical Centre in Middlesex is the first practice in London to be awarded an ‘Outstanding’ rating by the Care Quality Commission (CQC).
The practice was rated as outstanding in all areas: Safe, Effective, Caring, Responsive, and Well-led.
Ursula Gallagher, CQC deputy chief inspector for primary care in London, told Nursing in Practice how practice nurses can help to achieve this result as well.
What makes an ‘Outstanding’ practice?
‘We know practices that have been ‘Outstanding’ have really good multidisciplinary teams.
‘Not only with the nurses who work for them, but with the other professionals who perhaps work in their community services.
‘They have really good liaisons – they work really well in partnership with other people.
‘But in particular, they support their nurses to be able to be practicing at the top of their game.
‘They’ve usually got lots of extended roles, they’ve got the right amount of nursing hours, but they’ve also got those nurses as independent prescribers, or they’ve sent them on extra skills training.
‘And they’re then really good at saying, “This is what nurses are really good at, so this is what we support them to do”. You often find that the doctors have slightly changed their role to focus on only things that doctors can do and that the nurses and doctors liaise and work well together as equal clinicians looking after that population group.’
What is your message to practice nurses?
‘My message to practice nurses is to always put yourself into some of those spaces. So if you’re not going to the leadership meetings at the moment, or your practice is having something called a clinical meeting, why don’t you say, “Is it ok if I come to the clinical meeting?”
‘So there’s a bit about nurses stepping into that space and being seen to volunteer; and they should also be looking at our Outstanding reports or things that they read and journals like Nursing in Practice.
‘It’s about saying to their GP, “Look, there’s a really good example in this journal about what nurses are doing in other places. I think that would really work for our patients, can we talk about whether we can have a go?”
‘I think that they need, where possible, to make sure they are networking and engaging with their practice nurse community locally to find out what is going on around them, what’s working well and seeking appropriate support.
‘I think nurses need to be more positive about what the evidence base is saying about what nurses can do. They need to use those networks to enable them to be empowered so that they can have those conversations and they need to be prepared to step up and volunteer.
‘It’s no good, as a responsible registered nurse, to be sitting there and waiting for someone to come and tell me how marvellous they are and let them do something.
‘If you’re working for the need of the patients, if you know, for example, you’ve got lots of children with asthma going into hospital, you should be saying in the practice meeting, “So what are we going to do about this?”’
Practices that have been rated down
‘Over 80% of the practices who’ve been rated less than they were hoping for, particularly at the inadequate or requires improvement [ratings], have improved, and sometimes significantly when we go back.
‘So yes, it’s probably going to hurt and you’re going to be upset for a while but actually, if you demonstrate the right leadership into the system, it’s also a massive opportunity.
‘If you take that opportunity, particularly to talk about the sort of cultural and leadership things have been around some of that, it’s actually a huge opportunity to improve.
‘The second thing is, particularly practices that have been rated Inadequate, will be offered support, either by NHS England or the Royal College of General Practitioners (RCGP)
‘The practices that don’t take advantage of some of that support and who remain isolated – which is a characteristic of poor practices – can often quite alone, if they’ve got their head down on their own rabbit wheel.
‘Nurses can make those connections. Encourage the practice to access the support that’s available to them, find out what that is, help the GPs and the practice manager to get over what will be perhaps a shock or a feeling of hurt and say,actually, “This is a real opportunity for us to galvanise and to prove to everybody that actually we’re good, and we can get from Inadequate to Good in six months”.
‘And say, “There are practices out there that are doing [the same] and I’m going to be part of the solution to this thing, not just part of the problem”. You have a responsibility as a registered nurse on behalf of the patients that are in that practice, as well as the organisation, to do that.’
