Response from the CQC: the importance of effective leadership

The intention of the special measures framework is to make patients, providers, and commissioners aware that we have serious concerns and to identify the need for urgent coordinated support within clear timescales. As you highlighted,¹ there can be local awareness of issues long before the CQC inspects. We strongly back the need for earlier identification of problems rather than waiting for an inspection to unearth the issues. This will involve closer collaborative working with CCGs, NHS England, and the local health economy.

At the CQC we are passionate about improving standards. We have for the first time provided a comprehensive description of good-quality care.² We encourage improvement by championing examples of good, innovative, and outstanding practice.³ Indeed, the vast majority of England’s GP practices are providing a good service to their patients, so why are the 4% rated inadequate falling significantly short? As identified in our State of Health Care report,⁴ the key may be in effective leadership.

The CQC assesses leadership and organisational culture of providers in the ‘well-led’ key question; by well-led, we mean that the organisation assures delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture. Every practice in special measures has been rated inadequate in ‘well-led’.

Investing in leadership has consistently been shown⁵ to pay off in the ongoing running of a successful organisation. This has been a central theme in supporting Acute Trusts in special measures, and should be for general practice. The RCGP’s Pilot Scheme has been doing essential work. However, we must take more collective responsibility in identifying struggling practices early, championing innovation, driving improvement, and providing long-term support.

• © British Journal of General Practice 2016