With GPs able to enrol to register with the Care Quality Commission (CQC) from July 2012, and registration needing to be completed by 1 April 2013, many practices will be beginning to think about the impact of CQC inspections.
The CQC says that from April 2013, it expects to inspect practices every two years and will announce its visit, unless responding to a specific concern. However It is also possible that a few practices may be visited by the CQC before next April if there are registration queries.
Other professionals’ experience
As part of an inspection, the CQC will talk to staff and patients and in monitoring compliance, they may gather information from patients. The MDU has been advising dentists about CQC inspections since they became registered in April 2011. Drawing on the experience of dental practices, one of the common dilemmas raised about CQC inspections is ‘Can we disclose confidential patient information if it is required as part of the inspection?"
The CQC has the power, under the Health and Social Care Act 2008 to access documents and information, including patient records. However, the CQC’s Code of Practice on Confidential Information states that it will only obtain personal confidential information when it is necessary to do so.
CQC not obliged to get consent
The CQC sets out a number of principles to consider people’s privacy, while ensuring it can perform its functions effectively. Principle 2 states that ‘to ensure that we are not restricted in our ability to protect and promote the health, safety and welfare of people who use health and social care services, we will not seek consent where it is necessary to obtain, use or disclose confidential personal information to perform our regulatory functions.’
However it will try to involve people in decisions to access their information.
Wherever it is possible and practical to do so, the CQC will keep individuals informed about how, why and when they use and disclose their confidential information and they will only use the minimum necessary or use anonymised information.
Asking patients first
In our experience of helping dental members, it is often possible to seek patient’s consent for the disclosure of their information to the CQC in connection with its inspection. For example, one dental practice was asked to provide a list of dental patients who had recently received treatment, along with details of the treatment.
This was so that CQC could approach the patients to ask them to fill in a questionnaire about their treatment experience. The dentist was concerned about disclosing these details and the Dental Defence Union (the specialist dental division of the MDU) advised that it may be preferable for the dentist to approach the patients first to ask if they would be happy for the dentist to pass on their details to the CQC and to answer questions from them.
It was also suggested that the information could be anonymised, if the dentist sent out the questionnaires to patients who could return them direct to the CQC, without the patient being identified.
Your ethical duty
Doctors have an ethical duty, according to paragraph 19 of the GMC’s guidance, Confidentiality, to ensure patients are informed about how their information will be used. The GMC also states that wherever practicable you should inform patients about disclosures required by bodies that have statutory powers, such as CQC, unless that would undermine the purpose, even where the patient’s consent is not required.
With this in mind, once registered with the CQC, practices may wish to review their practice leaflets and information on their websites and elsewhere, to ensure they make it clear that in some cases they may occasionally need to disclose identifiable information as part of the CQC inspection process. The practice can explain that this is usually done with the patient’s consent and, wherever possible, anonymised information will be provided so that individuals are not identified.
- Dr Old is a medico-legal adviser at the Medical Defence Union