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Preparing your staff for a CQC inspection

During a CQC inspection the inspectors will want to talk to staff to assess whether they understand the practice's policies, procedures and overarching strategy.

During an inspection the CQC will use its key lines of enquiry to assess a practice. Practices can use these key lines of enquiry to help prepare staff.

Below are a selection of questions that the CQC could ask during an inspection and you can use these to help stimulate conversation and check that your staff understand what may be asked by inspectors.

It would be a good idea to discuss these questions and practise answering them in your meetings with staff to ensure that everyone can share ideas on what may come up during an inspection. Not only will this help you prepare for the inspection it may highlight areas where you may need to tighten up policies, or more effectively communicate what the practice policy is to staff.

The questions are listed under headings related to the CQC's five key questions that it uses to assess healthcare providers.

Safe

Questions to discuss with all staff

  • Do you know how to raise concerns and document significant events?
  • How do you disseminate information from hospitals, NHSE, child safeguarding team, how do you know everyone has read the information?
  • How would you deal with a patient complaint?
  • How do you identify your vulnerable patients?
  • How do you protect patient confidentiality?
  • How are standards of cleanliness and hygiene maintained?
  • What is the procedure if a patient collapses in the waiting room?

Questions for management staff (practice managers and partners)

  • How are staffing levels and skill mix planned and reviewed?
  • How do actual staffing levels and skill mix compare to planned levels? Is cover provided for staff on leave?
  • What arrangements are in place to respond to emergencies and major incidents?  How often are these practiced and reviewed?
  • How is the impact on safety assessed and monitored when carrying out changes to the service or the staff?

Effective

Questions for clinical staff

  • How are needs assessed and care planned and delivered in line with evidence based guidance standards and best practice?
  • How is the practice doing compared to similar services in the area?
  • Do you understand the relevant consent and decision making requirements of legislation and guidance including the mental capacity act and the children acts?
  • How is care delivered in a coordinated way when different services are involved including between daytime GP practices and GP out of hours care and with NHS 111 services?
  • How are staff supported to make decisions ?
  • How is the process for seeking consent monitored and improved to ensure it meets responsibilities within legislation and follows relevant national guidance?
  • Do staff use every opportunity to identify potential risks to people’s health?
  • Is there appropriate follow up on the outcome of health assessments and checks where abnormalities or risk factors are identified?
  • Do people receive fitness for work advice which aids their recovery and helps them return to work?

Questions for management staff

  • How are learning needs identified?
  • How is poor or variable staff performance identified and managed how are staff supported to improve?
  • Are there clear and effective arrangements for following up on people who have been referred to other services and for following up people who have been discharged from hospital?
  • Are there comprehensive and effective screening programs including following up people who do not attend?

Caring

Questions for all staff

  • How are people’s personal, cultural, social and religious needs taken into account?
  • How are carers supported?
  • How do staff make sure the people’s privacy and dignity is always respected including during physical or intimate examination?
  • How do you recognize when patients and carers need additional support to help them understand or be involved in their care and treatment and how does the practice support them?
  • How do you signpost to other services?
  • What emotional support is provided for bereavement?

Responsive

Questions for management staff

  • How is information about patients used to inform how services are planned and delivered?
  • How are commissioners other providers and relevant stakeholders involved in planning services?
  • How do the services provided reflect the needs of the population served and do they ensure flexibility, choice and continuity of care?  
  • Where people’s needs are not being met, is this identified and used to inform how services are planned and developed?
  • How are services delivered in a  way that takes account of the needs of different patients?
  • How are services planned, delivered and co-ordination to take account of people with complex needs e.g. those living with dementia or those with a learning disability?
  • Is the appointments system easy to use and does it support people to access appointments?
  • What action is taken to reduce the length of time people have to wait for subsequent treatment or care?
  • How easy is it for patients to use the complaints system are patients treated compassionately and given the help and support they need to make a complaint?

Questions for all staff

  • How are patients’ views and experiences gathered and acted on to shape and improve the services and the culture?
  • Do staff feel engaged and say that their views are reflected in the planning and delivery of services and in shaping the culture?
  •  How do leaders prioritize the participation and involvement of people who use services?
  • Do both leaders and staff understand the value of staff raising concerns? Is appropriate action taken as a result of concerns raised?
  • How do staff strive for continuous learning improvement and innovation?
  • How is information used proactively to improve the quality of services?
  • How do staff work together to resolve problems and to review performance?

Wel-led

Questions for management staff

  • Is there a robust realistic strategy for achieving the priorities and delivering good quality care?
  • How have the vision values and strategy been developed and have staff been involved?
  • Describe the governance framework to support the delivery of the strategy and good quality care?
  • Are staff clear about their roles and do they understand what they are accountable for?
  • Is there a holistic and comprehensive understanding of performance which integrated the views of people with safety and quality information?
  • How are risks identified and managed?
  • Is there alignment between the recorded risks and what people say is on their worry list?
  • Do staff feel supported respected and valued?
  • What are the clear priorities for the leadership and is there a development strategy for the leadership team which includes succession planning?
  • How is the culture centered on the needs and experience of people who use services?
  • How does the culture encourage candor openness and honesty?

Fionnuala O'Donnell is a practice manager in Ealing, West London, and a CCG board member

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Picture: iStock

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