New style inspections of GP practices and out-of-hours services at England started in the back end of 2014 and have lead to the first ever ratings of practices, which may be ‘Outstanding’, ‘Good’, ‘Requires Improvement’ or ‘Inadequate’.
Effective April 2015, GP practices will now have to publicly display their ratings, meaning the pressure on achieving the highest ratings is greater than ever.
In this article we look at the four crucial stages of your inspection process; what you should expect and how you should be preparing for your GP CQC inspection.
Prepare before your notice period – what are CQC looking for?
QCQ guidelines state: To get to the heart of people’s experiences of care, the focus of our inspections is on the quality and safety of services, based on the things that matter to people. CQC always ask the following five questions of services:
- Are they safe?
- Are they effective?
- Are they caring?
- Are they responsive to people’s needs?
- Are they well-led?
These are the five basic categories that CQC will be looking at in their new approach of GP practice inspections and, within that, CQC will also look at different patient groups:
- Older people
- People with long-term conditions
- Families, children and young people
- Working age people
- People whose circumstances may make them vulnerable
- People experiencing poor mental health
This is CQC’s Key Line of Enquiry.
Using a combination on ‘intelligent monitoring’ (looking at your data and information e.g. patient surveys) and a formal day-long inspection of the surgery, CQC will answer the above five questions in relation to the six patient groups, completing a detailed and clear report on the practice’s rating.
This rating will then publicly be published on the CQC website with a full report detailing all findings.
- In order to be fully ready for the QCQ inspection, you need to start making preparations now.
- Prepare and monitor ongoing records of all complaints and serious incidents. Remember to also keep track of what you did to address these issues, as the CQC will be looking for this when they inspect your files.
- Ensure all staff files, including details such as training certfificates, DSB checks etc. are fully up-to-date.
- Think about the ‘Key Lines of Enquiry’ and what CQC will be looking for.
- CQC will be asking patients various questions, so make sure you have formally reviewed any suggestions patients have put forward. A good idea is to start carrying out systematic surveys, with a documented procedure of how to follow through and review and suggestions made.
- Previous inspection reports are available on the CQC website and are an invaluable resource. The website also includes the 10 most recently inspected doctors/gps and details on all inspections to date, so is well worth looking at. At the time of writing the latest inspection checks are as follows:
Use your notice period
- Two weeks before your inspection you will receive a letter from CQC to confirm your inspection date. The letter will also request various information from you, including your statement of purpose and information on complaints or serious incidents.
- The lead inspector will also call you to discuss what happens next and make arrangements for your inspection date. This is a good opportunity to understand what staff you will need on the day and book them well in advance.
- Finally, CQC will send you a selection of comment cards and posters. The comment cards must be distributed to patients to complete, and the posters must be displayed in key areas of the practice to advertise the inspection.
- Medical staff will be provided allocated interview times, of which will be discussed in the agenda for the day. These interviews can last anywhere between 20 minutes and 1 hour, so make sure you have made the necessary arrangements to mitigate any disruptions this may have.
- Speak to patients to ensure they know what is happening and what to expect on the day of the inspection. You should also distribute the comment cards and make patients aware of the the CQC posters, which include details on how to make contact.
- Speak to all members of staff to ensure they also know what is happening and what to expect on the day of the inspection. Discuss with members of staff what questions they may be asked and offer any support in helping them prepare for the inspection and interviews.
On the day
- The CQC inspection team will be tailored to your practice, depending on the size of the surgery. It will include a minimum of an inspector and a GP, but may also include a practice manager, practice nurse and an Expert by Experience.
- The inspection will not only review the policies, procedures and data that the practice has, but also involve interviews will staff and patients.
- The inspection team are likely to arrive early, so make sure you and your staff are ready and prepared to start straight away. Make sure everybody knows what to expect.
- The inspection team will want to speak to as many members of staff and patients of possible, going beyond the prearranged interviews with medical staff, so make sure everyone is prepared.
- Welcome the inspection team as they arrive by introducing your staff.
- Take the first meeting time as an opportunity to talk about the practice, where it is performing well, providing context on surrounding areas and any challenges the practice may be facing e.g. a nearby surgery may have recently closed, meaning that there is increasing demand.
After your inspection
- At the end of the day the inspection team will hold a feedback session, in which they will share their initial thoughts and discuss anything that they have found on the day.
- Using a combination on ‘intelligent monitoring’ (looking at your data and information e.g. patient surveys) and a formal day-long inspection of the surgery, CQC will complete a detailed and clear report on the practice’s rating.
- CQC will then send you a draft inspection report, after they have had time to consider their findings. This is sent to the practice to seek clarification on any matters and to give the practice the opportunity to challenge any factual inaccuracies, before being reviewed by quality assurance mechanisms.
- The final report will then be published on the CQC website.
- A good idea is to record the initial end of the day inspection debrief so that you can refer back to it in the future. Make sure you check with the inspection team that this is OK first.
- The inspection team will provide you with loads of advice on how you can improve certain aspects of your practice; make note of them, or listen back to your recording of the debrief, and take any necessary actions.
It is important to remember that this proactive approach is not just about preparing for your inspection day, it’s about improving the standards and performance of your practice. The sector is facing challenging times with the redistribution of funding and increasing cost pressures remaining key factors. This is a great opportunity for practice managers to highlight the key areas where their practice can improve and, crucially, implement new policies and procedures to work towards a stronger financial future.
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