By now GP practices will be used to the familiar feeling of the arrival of a team of CQC inspectors. A nervous couple of days will follow where every aspect of the practice is run over with a fine tooth comb. Data will be scrutinised, patient experience analysed and key staff members interviewed.
The inspection process can make many GPs and practice managers feel completely out of control, unsure of what findings the CQC will make and how this will impact the rating and reputation of the practice. By its nature, an inspection itself is not an experience that feels open or collaborative, but it does not have to be this way. There are a number of ways that GP practices can use CQC’s own guidance and the anecdotal experience of other providers to ensure that they are as prepared as possible for the inevitable regulatory knock on the door.
Ridouts often assists GP practices with inspection reports and enforcement action arising out of an inspection. We have noticed a number of trends that repeatedly appear. This article examines how providers can approach these areas before or during an inspection in order to give themselves the best possible chance of a positive outcome.
The recording and use of patient data
We have seen innumerable inspection reports in which the CQC complain about the way that GP practices record, interpret and present patient data (for example relating to the uptake of screening tests etc.). These gripes can range from the system that the practice uses (which may not be to the CQC’s taste but is very much to the taste of the NHS) to the way that data is used to drive and meet KPIs. It is important for Practice Managers (and the teams that support them) to regularly reflect on this data and consider it from the point of view of a person that has never seen it before and needs to be able to understand it quickly. The CQC will have a set period of time available to review this information and are likely to make a snap judgement based on their initial interpretation of it. On that basis, data should be clear and comprehensive with relevant staff members able to speak about its relevance to the practice should the inspection team ask.
Where, in the opinion of the practice, the data is well presented and meets all relevant requirements but is still criticised by the CQC, then the practice should seriously consider challenging any negative judgements contained within the draft report through the CQC’s own factual accuracy process. It should not be that the personal preferences of an inspector have an impact on the way that a service is rated by the CQC.
Training and competency
Ridouts has seen a number of inspections where the CQC have felt strongly that there was insufficient evidence demonstrating that staff had received the appropriate and required training. Reports then go onto conclude that, on that basis, the staff are not competent and are placing patients at risk. In analysing those criticisms in a draft report, many practices discover that they do in fact have the evidence to show that training has taken place, but that it simply is not held together in a way that can be easily accessed by the CQC or that is spread across a number of files. As such, the inspectors could not (or indeed, would not) take the time to present the true picture. It is essential that documents can be accessed with ease during an inspection and that the practice is able to do itself and its staff justice.
In addition, GP practices will be required to show that relevant staff members, for example, advanced nurse practitioners or clinical pharmacists, receive regular one to one clinical supervision from the GP partners and that their patient consultations are reviewed by the relevant members of the practice management team. Many practices fall foul of the informal way in which they perform these reviews and supervisions and so it is important that practice partners and the practice manager can point to evidence that these supervisions are regularly scheduled and detailed summaries recorded and placed in the staff member’s file. This is essential evidence in demonstrating that staff carrying out clinical duties are competent and reassuring the CQC that the practice is meeting all regulations in relation to staffing.
The CQC may contact patients directly to obtain information about their experiences and satisfaction. They may also consult the practice’s own feedback from patients. On that basis it is vitally important that firstly, the practice is proactive in gathering patient opinion and that, secondly, the practice reacts positively to consider and remedy any concerns raised as a result of the submission of those views. There is little value in being open to hearing about issues that patients may have faced as part of their experience if the practice has no intention of reacting in a positive way. The same goes for the way that the practice responds to patient complaints. Not only will the CQC want to see a detailed complaints register but it will also expect to demonstrate how the complaints have been followed up and resolved, with lessons learned by the practice. Ridouts has seen many GP providers offer the opportunity for patients to be heard whilst failing to react. This will obviously not be looked upon favourably.
Giving patients the space to feedback and being able to resolve complaints or negative feedback quickly, will result in patients being less inclined to deliver a negative account of your practice directly to the CQC should they be contacted. Their feedback will be less about the issue that they felt the need to report and more about how positively the practice reacted and resolved the problem.
In a similar vein to garnering the opinion of patients, the CQC will also seek to understand the experience of staff members working at the practice. It is not uncommon for inspectors to dedicate time to 1:1, confidential discussions with staff during site visits. Ridouts have noted that during any inspection that involves discussions with an aggrieved member of staff, the focus of that inspection will quickly turn to the areas relating to their grievance. The CQC will often take the staff member’s feedback as fact without consulting relevant documentation or speaking to the practice manager to clarify areas of potential concern. There have been many occasions where we have seen statements from staff included in draft inspection reports such as “I haven’t been trained on that system” or “I have never had a supervision” but that can then be directly contradicted by readily available documentary evidence that the inspector has not asked for or reviewed. This can be addressed during a factual accuracy review but is potentially entirely avoidable.
In order to limit instances where staff may feel that venting to the CQC is their only option, practices should engage staff in regular feedback questionnaires and staff meetings. That way, any issues arising as a result can be quickly reviewed and resolved. Records of that feedback or minutes of any such meetings, alongside the resultant improvement work will go a long way to also demonstrating that the practice is “Well-Led”.
Using the regulations and guidance to your advantage
It may be obvious but the standards by which GP practices will be judged are all set out in the regulatory framework and CQC’s own guidance. It is vital that practice managers are fully versed on the standards expected of them and link those standards to what evidence they believe will be required to demonstrate that they are being met. This is also important in being able to challenge the CQC and its interpretation of whether or not your practice is compliant.
This in depth understanding of the CQC’s expectations might involve having an evidence folder for every key question or individual regulation. This will also allow easy access to documents when the inspector calls.
Many practices also use the regulatory framework to create their own mock inspections in order to periodically assess compliance. This offers a benchmark and indicates any further work required but will also give the staff at the practice a flavour of the inspection process and build confidence in the types of answers they might give to the CQC when the real inspection takes place. Ridouts have found that staff feel less anxiety and are better able to present their skills to the CQC when they feel more familiar and engaged with the inspection process.
Having mock inspections demonstrates a service’s willingness to reflect and develop and will be viewed favourably by the regulator.
In short, basic and ongoing preparation for inspection will go a long way to making compliance more achievable. Enabling easy access to clear and detailed records and data will assist the CQC in finding the answers to various questions and demonstrating that the practice is meeting all legal requirements. Not only will this be hugely beneficial in the long run, but will also provide ongoing evidence that the service is assessing and analysing its own performance regularly.
Practices should also remain mindful that in the event that the CQC still find areas of their service delivery a concern and the practice believes that there is no justification for that view, a robust challenge can and should be submitted through the CQC’s own factual accuracy process.
If you would like advice on the CQC inspection process or have a report you disagree with, the Ridouts team can assist. To speak with one of our specialist lawyers, please contact us on 0207 317 0340 or email email@example.com.