So, it happened; we got the dreaded email: “We will be inspecting your surgery in two weeks.”
Two weeks! That really isn’t long! So much to do! Re-read those blogs on KLOEs and work out what on earth they’re all about, check that all the infection control stuff is okay, double-check that the HR files contain everything they should, make sure everyone’s up to date on mandatory training… Oh, what if they ask the part-time receptionist who only works on Mondays where the defibrillator is? Panic!
Before I go any further, and to put your minds at rest, we did really well. Really, really well. The word they used was “exceptional” so we’re tantalisingly close to seeing the word “outstanding” pop up in some areas, hopefully!
There’s no magic rule for doing well in a CQC inspection, but I’ll tell you how we spent the two weeks leading up to the inspection and how the day went, and perhaps this will reveal some interesting ideas.
First things first, call a meeting ASAP! We got everyone together the following day – partners, GPs, nurses, HCAs, administrators, cleaners, receptionists… everyone! The earlier you get the whole team on board the better; it really helped with the preparations.
In our meeting we talked about the impending inspection and allayed everyone’s worries and fears. Then we put together action teams, one team for each area (Safe, Well-led, Caring, Effective and Responsive).
The action teams met over the next three days and looked over the Key Lines of Enquiry for their given area. I attended every team meeting so that I could maintain an overview. Each team worked really well together, sparking ideas off each other as to how we could demonstrate our compliance in these areas. Where there were jobs to do, we shared them out and I kept a spreadsheet of all the actions, owners and due dates to keep track.
Some of the things we needed to do:
- Write missing policies (and you’ll never guess where we found the templates! Practice Index Plus!)
- Write the odd missing risk assessment (great hint: write a risk assessment to back up the items you have in the doctors’ bags; this went down very well!)
- Check that curtains are in date (and change if due)
- Check sharps bins are: up on the wall, not overfilled and the labels have been written on
- If you have a process for keeping FP10s safe, write it down! The more written processes and policies the better!
- If you have a great process for monitoring fridge temperatures, you guessed it – write it down!
- If you have policies, procedures, forms, documents, etc., give them reference numbers, keep a log, date them and review them annually
- Check the signage around the building – are you really helpful? Do you offer all kinds of assistance to your patients? Sing and shout about it! Put signs up reminding patients what they can ask for at reception (e.g. a room to breastfeed, a glass of water, would you call them a cab if they needed one? Advertise that!)
- Essential signage: the practice’s public liability insurance certificate; Health & Safety sign; fire exit signs
The inspectors usually chat to staff and ask them questions. This is to verify that what they’re learning isn’t just managerial hypothetical nonsense but real-life everyday stuff. We have a lot of staff so it’s hard to ensure that everyone knows everything they should (such as where they can access policies, or where the oxygen is stored, or who the fire wardens are). So, we made a staff handbook, full of information we thought everyone should know, and gave this out to everyone at the start of the second week. Then we went round quizzing people. It works! Try it!
Then, of course, there’s the presentation. Keep it simple and really take the opportunity to show off, but keep it honest. If you’ve experienced hard times, share that; it can only serve to show how well you’ve done despite the hurdles. Include welcome slides, some history of the surgery, a who’s who, some clinical information on the six population groups, and a slide for each of the five areas.
If you think you’re better than just “good”, say so! Give examples of how you comply and explain where you go above and beyond. Include patient feedback from NHS Choices that corroborates what you say.
I was so pleased that we’d put in all that effort because on the day, honestly, it was easy! They really aren’t there to catch you out; they’ll put you at ease and go through their checklist. What they ask for is either available or it’s not. So get ready to have everything available at the touch of a mouse. I had all my policies on the intranet so when I was asked for three specific policies, I had them (phew!) and could bring them up on the screen in a click. The more seamless it is for the inspectors, the better!
Little touches help too. We provided lunch for them and a room with tea and coffee facilities. Making them comfortable can only be a good thing.
At the end of the day, they shared a brief overview of their findings with the partners and me. This is a fantastic opportunity to learn new things, so bring a notepad and take notes. If they offer constructive criticism, thank them and make a note. (It won’t help to be defensive; there’s time to challenge the report later if you disagree.)
All in all, my advice would be to prepare like crazy, involve everyone, and then relax and know you’ve done your best.
One last thing: there are big changes on the horizon in the CQC. Their aim is to reduce the frequency of formal inspections and to move to a more continuous information-sharing system. The portal will be adapted to include more space to upload things like policies when they’re amended, clinical audits, complaints data, etc. The CQC inspectors now work in zones and intend to actually get to know you and work with you to ensure your practice continually complies and improves. They hope this will lead to more surgeries maintaining high standards overall. It will also reduce the need to visit as often because the inspectors will know your surgery and have access to the information that proves your compliance. It’s revolutionary and will change how we see the relationship between the CQC and ourselves. Ultimately, it will be a lot less painful and disruptive and will enable good working relationships between us and them.
HELPFUL: CQC guidance [PLUS]
The CQC guidance document provides an overview of the CQC inspection process, providing links to CQC official guidance and BMA supporting information. Annex A provides a list of policies which may be requested by inspectors; each policy is hyperlinked to the relevant document within the resources section. Annex B offers a guide to enable practices to prepare for an inspection.