Behind the scenes of a comprehensive CQC inspection. The role of the inspector and what a practice can do to keep the process as smooth running as possible
We know that Care Quality Commission (CQC) inspections are new experiences for most practices so I hope this is helpful in explaining what is involved.
While an inspection can be worrying for some, I want to reassure you that we’re looking for good and outstanding practice and we will celebrate it when we find it.
To help you make the most of your inspection, I’m setting out how it works and what you can expect.
Preparation
We started inspecting with our new approach last October and all surgeries in England will be inspected with this methodology and rated by September 2016.
Inspection managers such as myself decide where to prioritise inspections by looking at information from a number of different sources. We talk to NHS England’s regional representatives and clinical commissioning groups (CCGs) as well as looking at data from the National Patient Survey and key clinical indicators from Quality and Outcomes Framework (QOF) reports, such as childhood immunisation rates and cervical smear rates.
Our proportionate approach to inspection means we inspect a wide range of practices concurrently to help us shape an accurate picture of performance across the country.
Once you are chosen for a planned inspection, you will receive a letter two weeks before your inspection takes place and with it will be a document setting out what information we would like you to provide in advance. We call this a provider information request (PIR).
Around the same time, an inspector will call and talk through what will happen next. They will create a timetable for the inspection with the practice, taking into account the way the surgery runs and making sure patient care is not disrupted.
There are times when we will inspect unannounced, if we have been notified of concerns, sometimes by whistleblowers, NHS England or the CCG. This is called a focused inspection. For the purposes of this article, we will be discussing a comprehensive inspection (a regular check on health an social care services).
The provider information request (PIR)
We want to avoid interrupting your daily work as much as possible, which is why we ask for some documentation in advance.
This documentation can include evidence of clinical audits, completed audit cycles that can demonstrate improvements in practice. We know that while GPs have to do this as part of their continuing professional development (CPD) and as part of
their revalidation, the quality of such audits vary.
We will also ask for a list of significant events from the previous 12 months and normally this arrives as a spreadsheet – although it doesn’t have to. Some practices record absolutely everything but we’re really just looking for a balance of good and bad. It is the process the practice has gone through to identify what went wrong and what’s changed as a result that’s important. We want to see: are staff aware of significant events? Has anything improved?
We ask for a staff breakdown in terms of numbers and skill mix and for any patient surveys that the practice has done. Practices can always send more information if they want to – they don’t have to stick to our list if they think they are doing something outstanding.
There is a standard PIR template for all GP practices.
The day of the inspection
You will be asked to prepare and deliver a presentation about your practice at the beginning of the day.
We are looking for information about the service you provide and to find out what’s good and outstanding. A CQC inspection is your chance to tell us your vision for the future, what you feel is working well and what areas require improvement. It is an opportunity for the practice team to meet the inspection team and share with us how the practice works.
We will assess how you are performing by assessing against five key questions; are you safe, effective, caring, responsive to people’s needs and are you well-led?
We also explore how well services are delivered to particular groups of the population. These are: older people, people with long-term conditions, families, children and young people, working age people, people whose circumstances make them vulnerable, and people experiencing poor mental health. Detailing how well you care for these important groups is always a helpful thing to include in your presentation.
While it might sound obvious, we do recommend you read the questions in advance that we will ask you on inspection, as well as the characteristics we are looking for when rating. These are on our website along with other useful information on tips and myths. Don’t be afraid of being honest about where you feel you need to improve.
During the rest of the day, the inspection team will talk to GPs and other clinical staff at the practice, as well as administrative staff.
We will also talk to patients and will send you comment cards to leave in the waiting room for people to fill in. We’ll then collect these on the day.
I look for certain policies to be easily accessible, for example those on child safeguarding, whistle-blowing and what to do in the event of an emergency. If you can’t produce everything we ask to see on the day, try not to panic. The inspector will give you the opportunity to produce further evidence, such as up to date data, and will agree a timescale with you.
Inspection team
The size of the inspection team will depend on the size of the practice’s patient list and the range of services provided. The team is led by a CQC inspector and they will always be accompanied by a GP. There may also be a practice manager or practice nurse and sometimes a pharmacist. We sometimes have people with experience of using services on the team, called experts by experience, depending on the complexity and size of the practice.
Wrapping up
At the end of the inspection, we will give you some initial high level feedback with examples of what we’ve found and we’ll explain the next steps. We won’t, however, be able to give you a rating on the day as all of the evidence needs to be corroborated within the team, and after your report has been drafted it will go through a robust quality assurance process to ensure consistency in the judgements we make. We’re pleased we’ve found so many practices that are good or outstanding since we started our new approach to inspection last October. This shows there really is a lot of innovative practice out there giving patients the care they deserve.
More information can be found on our website at www.cqc.org.uk/content/gp-practices-and-out-hours-service-providers.
Rebecca Gale, CQC inspection manager.
