This outcome is about delivery of care and making sure that the patient experience is that of effective, safe, and appropriate care, and treatment and support that meets their needs and protects their rights.

Outcome in plain English

4A Appropriate care

  • Plan the care carefully right from the beginning
  • Tailor the treatment to the patient's requirements
  • Involve the patient in planning
  • Make sure this is what they want
  • Tell them what the risks are
  • Follow practice on informed consent
  • Need regular reviews of this plan in case things change or don't work
  • Make sure it is good for the patient all round
  • All providers should work as a team to provide the care
  • Try not to disrupt their personal life too much
  • Remember you are doing this to improve their health
  • Try and spot potential health problems early on
  • Help them to lead healthy lifestyles
  • Make sure your system works

4B Your systems and procedures

  • Review your performance and procedures regularly
  • Learn from your mistakes
  • Tell the patient and apologise if you've messed up
  • Act on your alerts
  • Try and anticipate emergencies and plan for them
  • Who will deal with the emergency and how
  • What will you do for backup help

4C Treatment and plans

  • Tell the patient who will be treating them
  • Help them plan out how to cope on their own after the treatment

4D Staff competency

  • Show that you are competent to spot when patients are seriously ill, need treatment and you can respond
  • That you will quickly transfer them elsewhere if they need to be

4E Follow practice on informed consent

  • Help patients make decisions where help is needed
  • Give them full information to make an informed choice

4H Diagnostics

  • Diagnostic tests and assessment should be done by suitably qualified staff
  • Same applies even in telemedicine

4I Children

  • Follow practice on informed consent
  • Involve children in the process as far as possible
  • Ask if they would like parent or guardian involved

4J Pregnancies and termination

  • Follow correct referral procedures
  • Provide 24-hour helpline
  • Ask their preference on disposal of foetal tissue
  • Refer to a trained counsellor
  • Where children or persons with learning disability are involved, make sure counsellor has this experience


What the BMA says

Your practice is likely to be compliant if your practice does the following:  

  1. Establishes or reviews the individual health needs and risks of all patients when they have an appointment so that they can plan and/or deliver the appropriate treatment.
  2. Offers newly registered patients a health check with a healthcare assistant, practice nurse or a GP within six months of registration and provides on request a consultation for any registered patients aged 16-75 that have not attended a consultation in three years.   
  3. Has patient plans for care (or similar) that patients (or their representatives) are involved in planning as appropriate and reviewed on an appropriate timescale.
  4. Provides lifestyle information to patients when appropriate (see Appendix B3 for a lifestyle information protocol).
  5. Conducts regular significant event reviews and analyses and learn from incidents, errors and near misses. We suggest that if there is an adverse event or error during a patient’s treatment you offer an apology and give a full explanation of what happened in accordance with paragraph 30 of Good Medical Practice guidelines.
  6. Observes its local incident reporting procedure
  7. Arranges for patients to be transferred to the appropriate service when a patient becomes/is seriously ill at your practice.

Your practice has the following:  

  1. A protocol for reviewing and acting on correspondence, reports and investigation results.
  2. A procedure for disseminating the latest national/local clinical guidance, medical device alerts and safety alerts to staff.
  3. A business continuity plan in place to ensure that the needs of patients are met during and after a non-medical emergency (e.g. a power cut). You may wish to refer to NHS Connecting for Health’s example business continuity plan.
  4. Appropriate policies for training reception and other practice staff in respect of dealing with emergencies and seriously ill patients, including resuscitation and anaphylaxis training and procedures.


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