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What a CQC inspection visit means for GP practices

Fiona Barr says practices will normally receive just 24 or 48 hours' notice of a Care Quality Commission inspection visit.

A visit from the Care Quality Commission (CQC) is unlikely to be a welcome prospect. Yet from April every practice in England is expected to be subject to a CQC inspection at least once every two years.

Inspections are not to be taken lightly. They could take several hours, a range of staff may be questioned and patients in the surgery are also likely to be interviewed. If this sounds daunting, the good news is that most practices will be given some notice.

Be prepared

Dr Jeremy Phipps, a GP in Lincolnshire, is not particularly perturbed by the prospect of a visit and points out that inspections are a part of life for practices.

He says: ‘We have inspections as a dispensing practice and a training practice and for QOF and minor surgery so in many ways it’s a duplication of procedures that are already happening.’

Even with little to fear though, Dr Phipps does believe CQC is an additional burden for busy practices and the advice from the experts is to be prepared.

Gerry Kennedy, a former CQC inspector who now runs consultancy Healthcare Regulation Solutions, says:  ‘You need to be ready for that knock on the door at any time. Getting registered is in many ways the easy bit. The challenge is staying compliant.’

Mr Kennedy says inspectors will focus on the CQC’s 16 essential standards on quality and safety of care that every practice will have signed up to as part of registration.

The CQC has the right to visit unannounced but it says the vast majority of practices will get 24 to 48 hours notice. Unannounced visits will only be used when the CQC has been alerted to a potential problem with a practice.

The CQC is running mock inspections in 40 GP practices next month (July) before deciding on the final form inspections will take but the experience of dentists is probably a good indicator of the way visits will work (see box).

How an inspection will work
  • Except in the case of a specific concern, practices are likely to be given notice of a visit.
  • Inspectors will spend several hours at the surgery checking compliance with the CQC’s 16 essential standards.
  • A likely focus of inspectors’ interest is the outcome on respecting and involving service users. Expect patients to be interviewed.
  • Other outcomes likely to attract attention are care and welfare, infection control and safeguarding people.
  • Practices found non-compliant will be required to produce a detailed action plan in from 28 days to three months depending on the severity of the concern. Such practices will be revisited.

Donna Hickey is head of compliance for dgb, which has worked extensively with dental practices registering with the CQC and is now working with GPs. She says inspectors usually focus on between two and six outcomes of the 16 CQC standards (each standard has an outcome) during a visit that takes from three to six hours.

She adds: ‘Inspectors always look at the outcome about respecting and involving service users. Another one they are likely to choose is the outcome on care and welfare.’

Getting patients' views

Ms Hickey says they will want to speak to patients and says conversations often happen away from staff to avoid patients feeling pressurised.

Staff may be asked to demonstrate, for example, hand washing or to describe the procedure they would follow if they suspected someone was being abused. Ensuring your staff are familiar with procedures and carry them out routinely is essential.

One dentist, who did not want to be named, says inspectors on the visit he witnessed were not interested in paperwork but in crosschecking that staff were following the procedures the practice claimed to follow.

‘For example they would ask a question such as "How do you know your surgery is clean?" and would be looking for an answer about doing regular cleaning audits, ’ he adds.

Dentists' representatives have voiced some concerns about the varied background of inspectors and about consistency of rulings between teams.

However, overall feedback has been that inspections are thorough but fair. Andrew Darke, managing director of Assura’s property division, says his feedback from dentists is that practices will be treated fairly so long as any shortcomings are highlighted by the surgery rather than being brushed under the carpet.

He adds: ‘From a premises point of view, the cost of remedying any shortcoming is not likely to be high if practices are providing core services. But if they are providing a range of enhanced services it could involve further expense on areas like flooring and clean and dirty utilities provision.’

Help with registration

Dr Liz Orton, a GP in Birmingham, says her practice has invested in special software to help it ease the burden of registration and hopes a visit will not be too stressful.

She adds: ‘It is a lot of work but I think we tend to do things pretty well and most of our patients are happy with the service.'

The CQC itself says guidance on visits will follow once the trial of inspections is completed.  In the meantime the biggest tip from those already involved in inspections is to ensure that CQC standards are not just confined to the practice manager’s filing cabinet.

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