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22 August 2014
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Staff with specific skills and experience such as practice managers can provide valuable insight to the Care Quality Commission when inspecting
Everyone in our society deserves high quality, accessible primary care. Whether you happen to be a rich person or someone who is poor and homeless, you should have the same access to the same high quality care no matter what your circumstances are or where you live.
As an inspection directorate, the Care Quality Commission (CQC) has a unique opportunity not just to get poor or inadequate practices to improve, but also to celebrate great general practice. We need to build a system that ensures that primary medical practice in England becomes the very best in the world.
The CQC general practice inspectorate is much more than general medical practice. It covers dental practice, integrated services across health and social care, prisons and criminal justice, child safeguarding, medicines management, GP out-of-hours services and NHS 111.Within our new approach we will be carrying out two different types of inspection. Comprehensive inspections will be scheduled and we will focus on answering five key questions. Focused inspections are when we need to follow up a previous inspection, or to respond to a particular issue or concern.
The criteria that services are assessed on are:
Are they safe?
This will include checking whether practices and out-of-hours providers learn and improve following safety incidents, that medicines are managed properly, and adults and children are safeguarding from abuse.
Are they effective?
This will include checking that people are given the right diagnosis and treatment and that patients are referred properly to specialist services. We will also check how GP practices work to prevent poor health and to promote healthy living.
Are they caring?
This will include checking that people are treated with compassion, dignity and respect and are involved as partners in their care.
Are they responsive?
This will include checking whether a GP practice or GP out-of-hours provider plans its services to meet the needs of the practice population and will include checking that all patients can access appointments when they need to.
Are they well-led?
This will include checking that a GP practice supports its staff, provides training and supervision to make sure they are able to do a good job, and has good quality governance. It will also include looking at how the practice proactively gets feedback from people and learns from this feedback to improve services.
As well as focusing on the five key questions on our comprehensive inspections, we will always look at how services are provided to people in specific population groups. For every NHS GP practice we will look at the quality of care for the following six key population groups:
– Older people.
– People with long-term conditions.
– Mothers, babies, children and young people.
– The working-age population and those recently retired people in vulnerable circumstances who may have poor access to primary care.
– People experiencing a mental health problem.
We will check the quality of NHS GP services and GP out-of-hours services within each clinical commissioning group (CCG) area. Over a two-year period, we will inspect a number of GP practices in each CCG every six months as well as inspecting the GP out-of-hours service. We are not inspecting the clinical commissioning group itself. It is important that we maintain good local relationships with all stakeholders in our work, including the public and people who use services, their carers and their representative groups, providers, commissioning bodies, MPs and other members of the local health and care system such as Local Medical Committees and Local Education and Training Boards.
We will inspect and rate all NHS GP practices and GP out-of-hours services in England between October 2014 and April 2016. Once we have done this it is likely that we will inspect services that are judged to be providing poor quality care more frequently than those that we judge to be good or outstanding.
Becoming a specialist advisor
Inspection teams visiting individual practices within a CCG area will usually include specialist inspectors, GPs, nurses and practice managers. The team may also include trainee GPs. The lead inspector is the main point of contact for inspections of individual GP practices. Our inspection team will vary in size, to reflect the size of the practice or out-of-hours provider.
Inspection times vary but we usually request a specialist advisor to work with us for one inspection day per inspection. We may also need to use their skills and expertise in reviewing information we receive at any other time which may not be related to an inspection. We pay travel expenses and a daily rate.
Inspectors will always be trained by the CQC before they inspect and will attend a briefing led by the inspector prior to the inspection. This may be via telephone or video call and the candidate will receive a data pack (which includes analysed information about the CCG area and the practice) before the inspection visit, and may be involved in some planning in addition.
There will always be a lead inspector who is responsible for the planning and co-ordination of the inspection. The specialist advisor (SpA) will be asked to focus on specific lines of enquiry and report back to the team through corroboration meetings through the inspection. The SpA will also be expected to make take records in accordance with CQC methodology and to provide these at the end of the inspection visit to the lead inspector.
The lead inspector will draft the report and make judgements (ratings) and will send to the SpA when in draft for comments. We would like SpAs to contribute to the evaluation of the inspection approach, which may mean being interviewed or joining short meetings to talk about their experiences inspecting. SpAs will use their skills, experience and expertise in focusing on the key lines of enquiry. They will need to back some of the evidence gathered up with evidence-based practice/research to support the judgement we make.
Practice staff, such as practice managers, are well-placed to become inspectors.
– We need professionals to provide clinical input who are working in practice currently and who can demonstrate they are up-to-date and have the skills required.
– Inspectors need to be able to demonstrate values and behaviours of CQC and work as part of a team.
– They understand what it is like to be a nurse working in general practice and will be able to inform the inspection team of the most effective ways of gathering evidence.
– They will have the expertise to interview those in similar roles within the practices they are inspecting.