I came back from annual leave to find out that we had received notification of our CQC visit. The moment I had been dreading had finally arrived.
The following two weeks seemed to both last forever (lots of late nights) and fly by too quickly (if only I had a few more days I could make sure everything was perfect…).
It is my experience that a real deadline produces panic, but also results. I thought we were all ready, but the reality that inspectors would be here in two weeks pushed us all to ensure that the practice was gleaming and re-stocked properly, that all our protocols were up to date and that everyone was aware of what might be asked of them.
Before the visit
The CQC requested some paperwork ahead of the visit:
- Statement of purpose
- Patient survey results
- Summary of complaints
- Summary of significant events
- Audits (the CQC want to see a full two cycle of audits so you need to make sure that the second cycle has taken place and been written up)
- Recruitment policy and procedures
- List of staff and their qualifications
We were also asked to provide evidence of how the six population groups the CQC assesses are cared for by the practice (older people, people with long term conditions, families, children and young people, working age people, vulnerable patients, and people experiencing poor mental health)
We were visited by three inspectors (the lead inspector, one GP and one lay member). They wanted to interview a range of clinical and non clinical staff and also speak to patients.
Below is a summary of the documentation we were asked to produce and the questions asked. However the inspectors are free to ask any questions they want and they may ask other practices to produce different documentation.
Go through the Preparing for a CQC Inspection guide on Medeconomics to ensure you have all the necessary paperwork.
I was asked to show the following paperwork:
- HR folders (nurse practitioner, two HCAs, two salaried GPs, two non-clinical members of staff and one locum)
- Fire risk assessment and evidence of fire drill
- Infection control audits, COSHH and legionella documents
- Training certificates for staff (mandatory training, safeguarding training and Mental Capacity Act training) and evidence that we check locum keeps up to date
- Details and analysis of significant events
- Disaster recovery plan
- Our locum pack
- Our induction process
- Minutes of palliative care meetings
- Evidence of equipment calibration
And I was asked about the following:
- Recruitment policy and DBS checks
- How the patient participation group has contributed to the development of the practice
- How the practice deals with bereavement
- How to report on safety incidents
- How the practice supports carers
- Staff interviews
The nurses were asked about
- Infection control
- The policy for patient specific directives
- How they keep themselves up to date
- Whether they felt supported by the GPs
- Whether the GPs listen to their concerns
- The Mental Capacity Act
The inspectors also asked to inspect the fridge logs and the emergency kit.
The inspectors asked the HCAs about
- Manual handling
- Infection control
- Policy for monitoring INRs
They also asked:
- Are you happy here?
- Have you had an appraisal?
- How long have you worked here?
The inspectors asked to see the following patient leaflets:
- Mental health services
- Patient participation group
- Fire procedure
- Bereavement information
- Information for carers
They also asked staff how long they had worked at the practice, if they were able to raise concerns and whether they had had an appraisal.
The GPs were asked:
- How are NICE guidance and best practice evidence implemented?
- What meetings does the practice have to help share information and keep clinicians up to date?
- How does the practice demonstrate good governance?
- QOF data was reviewed to compare the practice against local and national benchmarks
- Audits were reviewed – must be two cycles
- And data from the National GP Survey was looked at and discussed
What did we learn
- Premises – an obvious one but the better the building looks on the day, the more confident you will feel!
- Prepare as much as you can before the day – know how to lay your hands on all the paperwork they may ask for
- Prepare staff – we did a daily briefing every day for ten minutes before the inspection. Everyone is nervous about being ‘inspected’ so practice questions that may be asked, so that staff are confident in answering these questions (insert link to questions document)
- Think of examples of good work you have done as a practice to highlight to inspectors and be proud of what your practice does.
We received the report a month after the visit along with a factual accuracy form. We were pleased our final report – we were awarded a good overall rating, with outstanding for our care to elderly patients (we look after many of the nursing homes in our area).
We were given an opportunity to correct anything that was wrong. The form to do this is divided into the following sections:
- Typographical or numerical errors
- Accuracy of the evidence in the report
- Completeness of the evidence
- Conduct of the inspection
- Representations against a warning notice
Following the report, we went back to the CQC and added a few examples to 'completeness of the evidence', which were accepted and added into the final report that is available on the CQC website (although it didn’t change our rating). This reinforces the point about ensuring you have examples of good practice to share with the inspectors as they are looking for examples for the report.
My impression is that it is probably difficult to change a CQC decision once made, as the process would be too unwieldy if there were frequent changes post-report. So, unless there are glaring errors it may not be worth challenging the report.
All in all I would say our experience of CQC was a good one. It is a lot of hard work and preparation but ultimately I think we demonstrated that we are a good practice and it allowed us to reflect on what we do well and where we could improve.
Read the Medeconomics guide to Preparing for a CQC Inspection for more tips on getting ready for a CQC inspection.
- Fionnuala O'Donnell is a practice manager in Ealing, West London, and a CCG board member