It has been nine months since the Care Quality Commission suspended its routine inspections in response to the Covid-19 pandemic and as yet, there has been no full return to business as usual.
For now, the regulator has rolled out a different set of measures – known as the ‘transitional regulatory approach’ (TRA) – which started in October and involve carrying out ‘targeted visits’ to providers where concerns about quality of care have been identified remotely.
The CQC told Management in Practice it has carried out 64 on-site inspections of GP practices since rolling out the TRA – an 85% drop on the number of practices inspected during the same period last year (6 October and 3 December), when 430 routine inspections took place.
The regulator has also conducted nine inspections remotely since October, by working with practices to review information.
Rosie Benneyworth, CQC chief inspector of primary medical services, told Management in Practice: ‘We know that GPs and practice teams are under immense pressure, that is why we have suspended routine, frequency-based inspections.
‘It is also why we have worked with the sector to respond and adapt – finding ways to support providers while balancing our duty to provide public reassurance.’
She added that the TRA is flexible, builds on learning from the first wave of the pandemic and importantly means that any inspection activity ‘is more targeted and focused’ on concerns.
From an ‘inadequate’ to ‘good’ rating
One practice that has been inspected under the TRA is Harford Health Centre in London, which had a CQC inspection in November and saw its rating increase from ‘inadequate’ to ‘good’, after making a series of improvements during the Covid pandemic.
The practice manager, Susie Hannah, told Management in Practice that she and her team viewed the need to make improvements as a ‘high priority’, equal to its Covid response, following the practice’s ‘inadequate’ rating in February 2020.
She said: ‘Inadequate is a big red alarm – and it would have been completely negligent of us to not keep the momentum going on general practice improvements.
‘We had it as a standing item in every single meeting, because there were clinical, organisation and processing improvements that needed to be made.’
Ms Hannah said the ‘inadequate’ rating was mainly due to shortcomings in leadership and high-risk drug monitoring on the clinical side, and the fact she had just returned from maternity leave – leaving little time to implement planned changes.
‘I had already made an action plan and identified areas for concern. This showed [the CQC] that we were already putting in steps to improve those areas that had been overlooked while I was on leave.’
The practice reviewed its structure and appointed a new lead for prescribing and high-risk drug monitoring, as well as for health and safety, and the team met up every month to provide updates on those areas, Ms Hannah said.
The practice also went ‘full drive’ on recruitment, she added, by constantly networking and trying to attract GPs with its ‘new plan and vision’. This has led to the successful recruitment of two full-time GPs with the view to becoming partners shortly – ‘refreshing that leadership’ – and to the appointment of a new lead GP partner.
Meanwhile, the practice has imposed ‘lots of different quality improvement projects within small teams, including admin and clinical’, Ms Hannah said.
‘A much more pleasant experience’
The practice received a ‘good’ rating from the CQC after the subsequent inspection in November 2020, which took place under the regulator’s new TRA – a system Ms Hannah said she prefers to the previous approach.
In the past, practices would be given two weeks’ notice and the CQC would carry out most of its checks on the day of the visit, Ms Hannah said – an experience that was typically ‘stressful’ for the entire practice.
‘This new approach felt much more like working in partnership. You’re asked to prepare and provide lots of evidence prior to the visit and send it all over electronically, and to give access to your clinical systems for one of their clinicians to do all the necessary searches,’ she said.
‘It helps me as well because I’ve got a list and I know what I need to send, instead of them saying, ‘Oh, can I see this on the day?’’
A week before the in-person visit, Ms Hannah said the CQC carried out a virtual inspection of her practice, which ‘again went well, because everything had been submitted – taking away a lot of the burden’.
The actual visit felt like a ‘much more pleasant experience’, she added, as the CQC had only had a few checks remaining, including looking into high-risk drug monitoring, health and safety precautions and holding an interview with the clinical lead.