I’m sure many practices believe that other types of organisations and healthcare providers will be inspected before they are but they couldn’t be more wrong. GP practices are very much on the CQC’s radar, and the second wave of practices being inspected under the new approach is well under way.
The new inspection teams now have clinical input from GPs and nurses. The inspectors will look at how well the service responds to patients’ needs and consider the quality of communication between GPs and out-of-hours care and other local services, including care homes and emergency services.
What happens during an inspection?
The CQC inspectors will spend much of their time during an inspection talking to patients and staff, or even members of the Patient Participation Group (PPG) if they are available at the time. Wherever possible they will observe the interaction of staff and patients in different working areas such as reception. They will base the focus of their inspections on the experiences people have when they receive care and the impact the care has on their health and wellbeing. They make their judgements against the regulations, and the judgements they make are informed by these experiences.
The CQC would like healthcare providers to encourage patients who use the service to show how they experience it, and this can easily be done using patient surveys. Try to keep it quick and simple by setting up a short survey on your practice website if possible. The CQC want to see how you review and act upon patient feedback gained through suggestions and audits. This will show the CQC how you assess and monitor the quality of care to assure them you are meeting the essential standards. It’s also important to make sure you have read the CQC’s guidance about compliance and have information readily available to help demonstrate how you comply with each of the outcomes.
Another thing to consider is having a room from which the CQC team can operate on the day of the inspection that doesn’t disrupt your services. Make sure you identify a member of staff who can introduce the CQC inspectors to other staff and patients and be available to accompany the inspector if needed. It’s definitely worth displaying a notice for your patients to explain that an inspection is taking place. It’s important that services are not disrupted more than is necessary during a CQC visit so think about how their presence throughout the day will be managed.
On the day of the visit
When the CQC inspection team start their review of the practice they will speak with managers and members of staff of all levels. They don’t expect all staff to have the same knowledge, but they do expect them to understand their role in providing good outcomes for people and know what to do if they have concerns.
It is useful to make staff aware of the methods the CQC uses to gather evidence, making it clear that inspectors don’t expect all staff to have the same level of knowledge and understanding. Documents will be required for inspection on the day, although if there is a valid reason why the practice can’t locate documents during the visit they usually allow 24 hours to produce them. The CQC doesn’t usually expect you to produce new documentation specifically for the visit; you should have the relevant evidence readily available to show you are meeting the standards. Don’t forget to keep records up to date though, including medical and training records.
Evidence of non-compliance
CQC inspectors focus on identifying non-compliance, although where they see compliance in other areas, they will use it to provide a balanced view when reporting their findings and judgements. For example, when they check compliance for safeguarding, they will focus on areas such as an understanding from staff about what to do if they identify that a child or vulnerable adult may be at risk.
The CQC will always check evidence of non-compliance with other evidence, unless the non-compliance evidence is so strong that it can be used on its own. For example, if they find that staff are not sure what to do when they have safeguarding concerns, this may lead the CQC to check staff training records and policies, to confirm their findings and inform their judgements about non-compliance.
At the end of the day
At the end of the inspection, to make sure that their judgements are robust, the CQC inspectors may ask for additional information to confirm evidence that has been gathered during the inspection. They may be able to tell you this at the end of the visit or they will contact you to ask for it. If asked, the evidence must be provided within 48 hours. Before the inspectors leave they will usually meet with key staff to give feedback and an update about the inspection. This is also an opportunity for you to give them feedback and ask any questions. It’s important that you ask the inspectors any questions you may have and ensure you understand what happens next in the process.
CQC inspectors will:
- Look at how well the service responds to patients’ needs.
- Consider the quality of communication with other healthcare providers.
- Talk to patients and staff.
- Observe the interaction of staff and patients.
- Base the focus of their inspections on patient experience.
- Make their judgements against the regulations.
- Be keen to see evidence of patient surveys.
- Want to see how patient feedback is reviewed and acted upon through suggestions and audits.
- Want information readily available to help demonstrate how you comply with each of the outcomes.
- Not expect all staff to have the same knowledge, but they do expect understanding of their role in providing good outcomes for people and know what to do if they have concerns.
- Expect to see relevant evidence and check that records are kept up to date.
- Focus on identifying non-compliance but will have a balanced view.
- Expect additional information and further evidence to be provided within 24-48 hours.