In May, the CQC inspected our inner city practice in York. We are a single-handed GMS practice, with the following features and demographics:
GPs: one full-time sole partner plus one part-time salaried GP
Other staff: one part-time practice manager, one part-time nurse, a part-time secretary and three part-time receptionists
List size: approximately 2,200 patients
Practice type: non-dispensing, inner city
Patient demographics: ageing population
Premises: converted residential terraced property
We were given reasonable notice - more than the required 48 hours – for our CQC inspection, which was to be a half-day visit. The CQC telephoned me on a Thursday to say they were coming the following Wednesday. When that day arrived we waited nervously for two hours for inspectors to turn up. After a call to find out where they were, it turned out they’d told us the wrong day and weren’t due until the following day, Thursday.
That proved an advantage in the end. Our nerves had eased a little by the next day. It also served as a reminder that the inspectors were only human too!
During that initial call, I had been told which outcomes would be reviewed. As we were the first practice in our area to be inspected I asked why we had been chosen. I was told the CQC was starting with the practices that had declared non-compliance in some outcomes and had action plans in place (we had action plans in place for infection control and staffing).
On the day of the vist, two inspectors arrived, incuding the one I had previously spoken with one the telephone, which I was pleased about, since I had already established a rapport with her.
I found the inspectors to be fair and reasonable and didn’t feel they were trying to catch us out. One did play more to the role of ‘bad cop’, checking everything meticulously, while the other one was chattier while still carrying out the necessary checks.
It was an informal and friendly process though still efficient and professional. However, I think that was partly down to my open and honest approach as well. I suspect if they had found any issues and were met with an uncooperative response the process may have become more formal.
I placed a notice in reception about the inspection and asked staff to inform patients about it as well. Patients were advised they might be invited to speak with the inspectors but that they were also welcome to ask to see the inspectors or leave their telephone number for them, so they could be contacted at a more convenient time. We found patients were happy to be spoken to and the inspection did not create much disruption for them.
Being the practice manager, the inspectors spoke to me for quite some time. One of the inspectors then went on to talk to the GP, nurse and reception staff. In total, they also spoke to three patients.
The inspectors looked at four outcomes, including those we had action plans for. These were:
- Safeguarding. The inspectors asked staff about various safeguarding scenarios and what they would do if they had concerns. For example, did they know who to contact? Did they know where to find the relevant policies? Had they been trained? Staff responded positively. Evidence of all training they had received was also checked as well as whether information was available for patients.
- Privacy and dignity. The inspectors had, prior to the visit, viewed the practice leaflet on our website. They asked about our chaperone policy and checked we had a poster advertising this to patients. They also commented on the fact that staff knocked before entering rooms (which was a tick) and that we had simple things in place such as privacy curtains and modesty covers (couch roll). They asked about our consent procedures, and whether we could provide our leaflet and correspondence in different formats.
- Staffing. I was asked about the recruitment and induction process and whether I had all relevant documentation. I was able to produce this since it had been one of our action plans (previously we didn’t have formally documented procedures in place). I would therefore advise, if you have recruited recently, to take steps to show you have put your policies/induction policies into action and reviewed them if necessary. The inspectors asked if all staff had been CRB checked, which clinical staff have. Current administration staff haven’t been checked, but this had been risk-assessed and was part of new recruitment policies.
- Infection Control. We previously had an action plan in place for this outcome so the inspectors wanted to know more detail. They were pleased we had carried out risk assessments and infection control audits and had had an informal infection control inspection. If you haven’t undergone this I would recommend doing so, along with the audit and an action plan if necessary. We have comprehensive, up-to-date cleaning schedules in place and could evidence staff infection control training which was checked.
Another area of interest for the inspectors was patient feedback. While we don’t have a patient participation group (PPG) we have a feedback book that is advertised to patients. We were able to demonstrate we had changed opening hours in response to demand. We also showed the inspectors the results of our GPs’ 360-degree feedback (using Edgecumbe Doctor 360°). This went down well so make use if it during an inspection if you can. The inspectors indicated they might ask practices for that in future.
Overall, the inspectors checked two-out-of-nine staff folders for all relevant training and evidence of items I have mentioned. They required relevant policies and protocols to be emailed to CQC within the next two weeks, rather than taking them away.
At the end of the inspection they told me their findings and were satisfied we had met the outcomes. I was advised about what they intended to put in the report and when we might receive a draft copy. They also asked me how I felt the process had been for us.
It wasn’t nearly as bad an experience as I had expected. My concern had been that the inspectors would pick up on things such as the fact the building itself, an old converted residential property, is less than perfect (for example, there are cracks here and there). Yet they took a very reasonable approach towards such issues since we could show that we had risk-assessed them and were included in future plans for replacement or improvement.
On reflection, I feel the inspection was a positive exercise. It confirmed we are doing things right, not just on the clinical side. A lot of work had gone in to preparation but it was a good opportunity to review all aspects of our practice.
I felt a real sense of achievement once it was over. Despite the nightmares ahead of the visit, that evening the team was left with a real sense of pride (and huge relief!). We went out for a well-deserved celebration.
How to survive the CQC inspection process – key tips:
- Be honest. If you don’t meet an outcome or don’t have certain things in place, don’t bluff or lie. Just be clear about where you are, show you understand where you need to be and how to get there and put a simple, reasonable, timely plan in place that takes account of any risks that need to be assessed.
- Make sure staff are involved and briefed on the process. Ensure they understand what the outcomes actually mean. For example, if you ask staff, ‘how do you respect privacy and dignity’, they may not know the answer can be as simple as offering a chaperone or having privacy curtains.
- Make sure processes follow through. For example, if you’ve conducted an infection control audit link it to an action plan, to cleaning schedules, clinical waste/sharps procedures and to staff training and patient information. It shouldn’t be an isolated paper exercise.
- If you have patient feedback, show you have acted on this. If you have the Edgecumbe Doctor 360° feedback for your GPs, use it.
- Be prepared. I had a folder which I’d prepared for my own use which showed what each outcome was, how we met it, and what evidence I had for it. This was a great reference tool on the day and meant I could be confident I knew what I was talking about.
- Make sure your website/practice leaflets are up to date. Don’t be let down by trivial things.
- You may think the inspection process is a waste of time but it is going to happen whether you like it or not, so treat it as a positive and get out of it what you can. It won’t be as bad as you think!
- Sarah Bean is practice manager at East Parade Medical Practice.