The following were formed to change and improve quality of performance, monitoring of all Services under NHS, GP services forming part of the functions:
Clinical commissioning groups (CCGs) – Section 20.1
The Care Quality Commission (CQC) – Section 20.2
GPES (General Practice Extraction Service) and CQRS (Calculating Quality Reporting Service) – Section 20.3.
20.1 Clinical Commissioning Group (CCG)
CCGs are a core part of the government’s reforms to the health and social care system. In April 2013, they replaced primary care trusts as the commissioners of most services funded by the NHS in England. They now control around two-thirds of the NHS budget and have a legal duty to support quality improvement in general practice.
CCGs are clinically led groups that include all of the GP groups in their geographical area. The aim of this is to give GPs and other clinicians the power to influence commissioning decisions for their patients.
Each CCG has a constitution and is run by its governing body.
Clinical commissioning groups work with patients and healthcare professionals and in partnership with local communities and local authorities. On their governing body, Groups will have, in addition to GPs, at least one registered nurse and a doctor who is a secondary care specialist. Each CCG has boundaries that are coterminous with those of local authorities, though one authority may have several CCGs. Clinical commissioning groups are responsible for arranging emergency and urgent care services within their boundaries, and for commissioning services for any unregistered patients who live in their area. All GP practices must belong to a clinical commissioning group.
The announcement that GPs will take over this commissioning role was made in the 2010 White Paper, “Equity and Excellence: Liberating the NHS”. This is part of the Government’s wider desire to create a clinically driven commissioning system that is more sensitive to the needs of patients. The 2010 White Paper became law under the Health and Social Care Act 2012 in March 2012.
In June 2014 there were 211 CCGs in NHS.
Commissioning involves planning and buying services by assessing the needs of the population; prioritising outcomes; purchasing medicines, equipment and services; managing service providers; measuring impacts and planning next steps.
Regardless of the organisational structures used to plan and purchase services, key priorities are similar. The focus is on offering high-quality healthcare to meet the needs of local people as effectively and efficiently as possible. There is a shift away from focusing on outputs towards delivering optimum health outcomes.
CCG’s commission most of the hospital and community NHS services in the local areas for which they are responsible. Commissioning involves deciding what services are needed, and ensuring that they are provided. CCGs are overseen by NHS England, which retains responsibility for commissioning primary care services such as GP and dental services, as well as some specialised hospital services. All GP practices now belong to a CCG, but groups also include other health professionals, such as nurses.
Services CCGs commission include:
- Most planned hospital care
- Rehabilitative care
- Urgent and emergency care (including out-of-hours)
- Most community health services
- Mental health and learning disability services.
A set of performance indicators:
That will help measure how well an individual CCG is tackling theses health issues include:
- Preventing people from dying prematurely
- Enhancing the quality of life for people with long-term conditions
- Helping people to recover from episodes of ill health or following injury
- Ensuring that people have a positive experience of care.
There are various publications on CCG’s role, performance and rating and these can be seen via Google on sites like NHS UK, Kings Fund, and Wikipedia.
20.2 Care Quality Commission (CQC)
CQC is an executive non-departmental public body of the Department of Health. It was established in 2009 to regulate and inspect health and social care services in England.
It was formed from three predecessor organisations:
- The Healthcare Commission
- The Commission for Social Care Inspection (CSCI)
- The Mental Health Act Commission (MHAC).
The commission was established as a single, integrated regulator for England’s health and adult social care services by the Health and Social Care Act 2008 to replace these three bodies. The Commission began operating on 1 April 2009CQC.
In October 2014 Government announced that the Commission was going to begin inspecting health systems across whole geographical areas from 2015, including social care and NHS.
GP Practices’ Compliance
Running a primary care business is now more complex than it has ever been before. In the case of general practitioners this is in part due to the need to achieve CQC registration and meet on going compliance requirements.
The QCS (Quality Compliance System) is to manage the CQC for GP practices’ compliance obligations of registration and inspection in simple and effective fashion.
Health and social care services are provided to ensure people with safe, effective, compassionate, high-quality care and to improve continually.
Role and Inspections
To monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and publish findings, including performance ratings. Our job is to check whether hospitals, care homes, GPs, dentists and services are meeting national standards.
We currently inspect most hospitals, care homes and home care services at least once a year, and we inspect dental services at least once every two years.
Types of inspections
These are unannounced inspections that focus on a minimum of five of the national standards, and they’re also tailored to the type of care that is provided at the service.
These are unannounced inspections that are carried out where there are concerns about poor care.
These inspections focus on specific standards of care or care services.
Home care inspections:
Inspect home care agencies differently from other types of services. Find out more about how they inspect home care agencies from web sites.
CQC work in partnership with organisations such as Monitor, Ofsted, and Health watch England, NHS England and more.
These services include your typical GP surgery but also a range of other services such as out-of-hours or mobile doctor services, walk-in centres, minor injury units or urgent care centres
Doctors/GPs and Clinics:
Diagnostic and screening procedures
Family planning services
Maternity and midwifery services
Services for everyone
Treatment of disease, disorder or injury.
Part of the commission’s remit is protecting the interests of people whose rights have been restricted under the Mental Health Act.
Rights under the Mental Health Act Categories:
Public, Mental health community services, Mental health hospital services.
Monitor the use of the Mental Health Act and protect the interests of people whose rights are restricted under that Act.
Most people receiving mental health care do not have their rights restricted. However, in some instances this happens to protect the person receiving treatment or others.
The CQC recently released guidance setting out how its new inspection and regulation regime will work in general practice. The new approach will see practices rated as either outstanding, good, requires improvement or inadequate.
Medeconomics has distilled the guidance into a useful three-part series that looks at different aspects of the inspection process, with links to key sections of the guidance.
What will the CQC assess?
How will inspections work?
How will the CQC rate practices?
The CQC has said that all 8,000 English practices will be inspected using the new ratings system by April 2016.
20.3 GPES and CQRS
The General Practice Extraction Service (GPES) is a primary care data extraction service managed by the Health and Social Care Information Centre (HSCIC). GPES will extract information from general practice IT systems for a range of purposes.
From April 2013, GPES forms part of the new process to provide payments to GPs and clinical commissioning groups (CCGs). GPES will extract data from GP clinical systems and pass this to the Calculating Quality Reporting Service (CQRS). CQRS is the system responsible for making payments to contractors.
The first major deliverable for GPES will be the data for the Quality and Outcomes Framework (QOF). With QMAS being replaced by CQRS, GPES will in future become the primary means for extracting data to support the QOF. GPES will extract data, including year-end data, direct from general practice clinical systems and pass this to CQRS to calculate payments. Payments will continue to be made via the Exeter system.
Potential patient benefits include:
- Improving the screening of patients for serious conditions like cancer, so that treatment is given as quickly as possible
- Improving the provision of health care for vulnerable and disadvantaged people
- Helping the NHS to understand major public health issues like flu epidemics so that services can be delivered to those who need them most.