How Staffing Levels And Satisfaction Can Affect Your CQC Rating

Growing Levels Of Dissatisfaction Levels Among Medical Professionals And How This Can Negatively Affect Your Inspection Rating As A GP Provider

On 23 June 2023, the General Medical Council (“GMC”) published a report examining the experiences of medical professionals in the UK throughout the years 2022-2023. The report titled ‘The state of medical education and practice in the UK Workplace experiences 2023’ (“GMC Report”) highlights the extent of the growing levels of employee dissatisfaction in the medical profession. This article will explore how GP providers can mitigate the rising levels of employee dissatisfaction and the increased rate of burnout. In particular, GP providers should be aware of the effect of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (“Regulation 18”) which governs staffing requirements with which GP Practices have to comply. Under the Care Quality Commission’s (“CQC”) current inspection regime, a breach of regulation can have drastic consequences on your inspection rating and can act as a rating limiter, meaning that you cannot be rated higher than Requires Improvement overall. This will result in the need for a robust Factual Accuracy Challenge (“FAC”) to try and evidence that you are not in breach of the regulations.

What Does The GMC Report Say About Staffing Levels?

The GMC Report contains some damning responses received from medical professionals in the UK. For example, 25% of doctors surveyed were categorized as being at high risk of burnout in 2022, compared with just 17% in 2021, and 10% in 2020. This demonstrates an ongoing risk of burnout for GPs in the UK medical profession. Furthermore, more doctors than ever said they were likely to leave the UK profession and had taken hard steps towards doing so (excluding doctors of retirement age who were planning to retire). Currently, 15% of UK doctors said they had taken steps to leave, compared with just 7% in 2021 and 4% in 2020. With both factors such as burnout and the temptation of jobs outside the UK, it leaves GP providers in a precarious position. GP providers should be aware of the effect this will have when demonstrating compliance of Regulation 18 ahead of CQC inspections.

The Importance Of Regulation 18 For GP Providers & Tips For Ensuring Compliance

The purpose of Regulation 18 is to ensure GP providers deploy enough suitably qualified staff, who are experienced and competent in their roles. In the GMC Report, the following open question was asked to doctors:

“What were the main barriers that prevented them from providing good patient care?”

Doctors most commonly answered and identified inadequate staffing 33% as the main barrier to providing good patient care. It is therefore no surprise that the CQC, as a regulator focused on risk, would pay particular attention to Regulation 18. GP providers should pay particular attention to staffing levels in the forthcoming months in preparation of any potential CQC inspection. The majority of inspections for GP providers are usually announced two weeks in advance, to minimise any disruptions to the level of care provided. Here are a few tips for GP providers to help demonstrate compliance with Regulation 18.

Firstly, as a GP provider amidst an ongoing staffing crisis, at a bare minimum you will have to demonstrate to the CQC that you have sufficient numbers of staff, across all levels, not just GPs. In accordance with the CQC Regulation 18 guidance, the CQC will assess the level of staff required against people’s care and treatment needs at your service. Therefore, as a GP provider if you have a large patient backlog, you are at an increased chance of being criticised for insufficient staffing levels and non-compliance with Regulation 18. Whereas if you have a patient backlog that is under control, it is indicative of staffing requirements being fulfilled. Also, ensure your staff across all levels are receiving adequate support and development.  In accordance with the GMC Report, this is the key to reducing burnout and increasing retention and preventing staff pursuing oversea opportunities. By ensuring support and development you increase the chances of retaining staff, which is important now more than ever for GP providers.

Secondly,  ensure that you have effective induction systems in place for staff. This is crucial in demonstrating to the CQC that you have suitably qualified staff, who are competent in their role. This is important now more than ever with the challenges that are associated with integrating doctors arriving from overseas or incorporating locum and bank staff into teams. Therefore, it is crucial to have effective induction systems which train and ensure staff are familiar with the GP provider’s service and patient needs. This enables staff to be competent and transition easily, resulting in good patient care. This should be well documented and accessible to allow CQC inspectors to review this easily.

Thirdly, ensure you have appropriate and effective training systems in place. CQC will closely scrutinize staffing records in deciding whether you are compliant with Regulation 18. Therefore, scrutinize your own records and identify any weaknesses. GP providers should note that if CQC identify gaps in the training records it can deduce that staff are not competent and are placing patients at risk. Furthermore, even if you have evidence demonstrating effective training records, if you have not effectively organised this in an accessible format for CQC to review, it may potentially assert that the evidence could not be shown on the day of the inspection.

Fourthly, ensure you have effective appraisals for staff. Effective appraisal systems serves a dual-purpose. The first is to monitor staff satisfaction and act upon any feedback, which will help reduce the chance of members of staff leaving their roles. It provides staff with an opportunity to raise any concerns. GP providers should encourage a culture where feedback is embraced and acted upon, not ignored. This will also help monitor an employee’s satisfaction levels and improve retention rates. In addition, document these appraisals clearly. As a GP provider “informal” appraisals with no recorded documentation will not assist you in persuading the CQC that you are complying with Regulation 18. To help demonstrate compliance the appraisals should be documented, and it needs to be accessible and easy for CQC inspectors to review.

GP providers should not hesitate to challenge the CQC’s inspection findings via the FAC process, especially if it is not a fair or accurate representation of your GP service. It is vital as it allows the GP provider to put forward its perspective. Without this, the CQC’s perception is automatically accepted as if it were the truth. By not acting you are accepting CQC’s position as the correct and factual position, without putting these assertions to proof. It is important for GP providers to remember that the strength of a robust FAC challenge is all on the strength of the evidence. If you as a GP provider ensure you have the paperwork/evidence as outlined above, it will increase the chances of a successful FAC challenge.

Conclusion

Therefore, it is vital GP providers continue to mitigate these staffing pressures by implementing robust induction, training, and appraisal systems to avoid Regulation 18 breaches. If your GP service is negatively rated in a draft inspection report do not hesitate to contact us. At Ridouts we specialise in providing GPs with bespoke advice tailored to their needs to help navigate the regulatory demands of the CQC. This includes working alongside GP providers and assisting them in challenging the CQC via the FAC process.