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CQC Transitional Monitoring Approach (TMA) call
Receiving the dreaded email notification from CQC is every manager's worst nightmare!
For so long CQC have had such an ominous reputation amongst dental practices which I think stems back to the very first round of inspections and the approach that was taken.
I vividly remember back to 2012 where the inspector made me feel so inferior, when it felt like they enjoyed belittling us, walking around the practice making notes in silence. It made us feel really uneasy, left a bad taste in our mouths, and solidified the consensus of them being out to get us. However, I have had the pleasure of being involved in several inspections since then that has changed my perspective and allowed me to see the importance of quality compliance in healthcare teams.
So what is a TMA and why now?
Well with the pandemic in full swing and all non-essential face to face visits taking place; CQC had to ensure they were able to maintain their commitment to their regulatory services. TMA stands for Transitional Monitoring Approach — and focuses on safety and how effectively a service is led, particularly during a global pandemic. It can take place over video call or telephone call via Microsoft Teams.
My experience of the TMA
After receiving the email, I had a good hour of just staring into my computer screen trying to comprehend the additional workload that had just hit me like a ton of bricks. This was on top of the new NHS 60% target for Q1 & Q2, and the ongoing management of patients and staff on a day-to-day basis, I now had to evidence it all to CQC. The original negative emotions associated with CQC came flooding back, and I must admit, I had a moment of despair!
I took some time to read up on the new approach on CQC's website, I reread the invitation email and I scrolled aimlessly through my forums for advice and guidance. By the end of the day I felt really relaxed about it as I had managed to organise my thoughts and compile some notes. I started with an action list of mandatory requirements such as policies and procedures, audits and risk assessments.
My mind has always worked a little differently, so I approached this differently
I tend to approach projects from a different perspective. I imagined what it must be like for the inspector sat at home asking repetition questions over camera, forming opinions on a practice with no real insight. I was confident in my management skills enough to know that I had nothing to worry about. So I took the decision to film a tour of our practice. It was 20 minutes in total, and I included our patient journey.
I demonstrated all of the compliance requirements, showing COVID-19 safe procedures, health and safety provisions, fire exits and equipment, X-ray equipment, medical emergency drugs and oxygen, defibrillator, and hearing loop etc. I flicked through folders referencing important documentation such as safeguarding certificate, complaints folder, significant events and risk assessments.
I covered an inspection in short clips and photos that I then edited together and captioned - at the end of the video I turned the camera around and described our practice's core values and culture so that when we came to have our video call, the inspector would already have a feel for who I was as a manger, what I was capable of and what I stood for. I had planted the seed of confidence and fingers crossed I would have halved the questions they needed to ask me because it had been evidenced in the video.
I prepared the written questions and answered them in a different colour font, so I could see clearly; I increased the font of the text, so it was easy to read on my PC.
I created a folder on the desktop titled TMA, and I added my most recent audits and risk assessments, I dropped my business plan and SOP into it, I added any training evidence I had and any recent meeting minutes. It took me a good day’s work of organising to finally feel ready for the call. I sent the video tour the day before our scheduled call, I referenced my reasoning for sending the video despite it not being a requirement and waited for the feedback.
So what did the Inspector think of my approach?
I received a warm and gracious reply thanking me for my video and for being so forward-thinking. I was so pleased I trusted my gut feeling and sent the video.
On inspection day, I felt relaxed and prepared. I didn’t feel stressed or anxious, however I did experience some minor technical difficulties with reception and connection, so we had to cut our call from video to just audio.
As I had predicted, the video had halved the questions I needed to answer, I had provided so much evidence in the video that they could see we were a well organised and forward-thinking practice which demonstrated our well led key line of enquiry.
During our call we had a relaxed conversation, and I was able to speak freely and explain our policies and procedures. I was able to provide clear examples of times when we had gone above and beyond to safeguard a patient or respect a patient’s dignity. I thoroughly enjoyed the call and the opportunity to speak to another professional who understood the amount of work that goes into making sure we are operating efficiently and safely.
How did the call end?
At the end of the call, I received warm praise and was even asked if I would grant permission for the video to be shared amongst CQC's compliance team.
The inspector made a comment that stuck with me after, they said ‘it’s been so long since I have been into a practice to actually inspect that I forgot what it was like, your video allowed me to get inspired and excited again, and I look forward to the day when I can get back to inspections and work with managers to support them’.
Our follow-up feedback email was equally positive referring to how I was an empowered manager with a bright future. I was really pleased that I took a gamble and did what I felt was right for myself and our practice.
So what advice would I give?
The best advice I can give any manager preparing for their TMA call is to just relax!
It’s a conversation about stuff you do every single day. Prepare as best you can and be open and honest during your conversation. If you don’t know the answer or can’t reference the information, ask to move on and come back to that question at the end. If, at the end you still cannot recall the answer, again be honest and ask if you can take the time to look into it and send a response ideally the same day. In my experience, they prefer the honesty rather than scrambling and giving a potentially more damaging answer.
Try and make some notes of examples of good management, complaints, COVID-19, safeguarding and oral cancers etc. I was asked to give an example of when our practice had utilised the oral cancer urgent 2 week wait referral and how our intervention impacted the patient.
Listen to CQC's podcast as they cover the reasoning behind the calls, I would highly recommend using your QCS TMA call questions and answers and reading the information in the Resource Centre to prepare yourself for the call.
And lastly smile; no one can resist a happy smiling confident face on the screen.
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