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Transitional Monitoring Approach (TMA) guidance document

by in Compliance, CQC, GP Practice Management

The CQC has and continues to go through a period of change; there’s the ARR, ESF, TRA and now TMA, giving a plethora of TLAs. IMO it’s little wonder that a lot of people may be thinking OMG, IDK what you’re on about. MMW, you’re not alone!

Right, enough of the three-letter abbreviations (TLAs); it’s time to explain. The Care Quality Commission (CQC) introduced the Annual Regulatory Review (ARR) in April 2019 and then due to the COVID-19 pandemic, were forced to introduce the Emergency Support Framework (ESF) in May 2020.

As the months progressed, the CQC were reviewing their approach to regulating and introduced the Transitional Regulatory Approach (TRA) to GP practices on 19th October 2020. In my opinion (IMO) I’m not sure this was the right approach to take, given the pressures practices were and currently are facing; surely the focus should be on supporting practices not inspecting them?

During a recent CQC webinar, it was interesting to see the number of participants asking for support from the CQC, asking for the CQC to make a statement saying something like “Our GP practices are doing a sterling job amidst a global pandemic”. Sadly, this wasn’t heard and instead the overall response was along the lines of, we will be looking at how we can support practices over the coming months.

Maybe support is one of the future strategies of the CQC and I will be closely monitoring the updates and blogs from the chief inspectors on what to expect from the CQC. My view is that the CQC should show support, especially after the incident of a practice being graffitied recently. For now, it’s the TMA until at least May 2021. Will it be all change again then?

Oh my God (OMG), that isn’t the end of the changes?! I don’t know (IDK) why they won’t stop there, but mark my words (MMW), there was (and probably is) more to come. I feel the clue is in the title… ‘Transitional’! So, for now, we are where we are. We’ve reached the Transitional Monitoring Approach (TMA); this is the approach the CQC have introduced, which has a focus on safety and how effectively a service is led.

Don’t be fooled into thinking that the CQC will only be looking at ‘safe’ and ‘effective’; there are a number of questions they can ask, and if you include sub-questions or sub-bullet points then it is actually 56 questions, covering safe, effective, caring, responsive and well led.

Once again, the inspector will be on the blower! But even if you were Bamber Gascoigne or Magnus Magnusson, I’m not sure you’d be able to ask and receive answers to all 56 questions in the time allocated for the TMA call (“our calls may take an hour or two”). Hands on buzzers, your time starts now!

Time is a precious commodity in general practice and there’s so much to do now and at any time of the year, and the question you’re probably asking yourself is, “How am I going to prepare for this? There’s just so, so much going on.”

Well, you all know I like a good quote and one that resonates with a thread posted in the forum about ‘breaking point’ is this one by Drew Carey: “Oh, you hate your job? Why didn’t you say so? There’s a support group for that. It’s called everybody, and they meet at the bar.”

Now I hope you’re smiling; don’t let that stop, because there’s more good news to follow. That news comes in the form of a 28-page guidance document I’ve produced, which covers the questions asked in the Transitional Monitoring Approach, including all sub-bullet points, giving you prompts to get you thinking about what you’re doing (or could be doing) at your practice.

My hope for the guidance document is that it will help you prepare for the call, giving the CQC inspector assurances about how safe and effective your practice is. In the guidance, I’ve given as many prompts as possible and I’ve given as many links to relevant information as I can, all aimed at preparing you for the TMA call.

Remember, you’ve got a chance to shine too; seize the opportunity to tell the inspector what you’ve done well, the challenges you and your team have overcome and what innovative solutions you’ve introduced to ensure your patients can continue to access care when they need to.

Whilst there’s no need to submit responses to the TMA questions, I’m sure you’ll agree that being prepared and drafting your answers, even in bullet-point format, will help you respond to the inspector and maybe, just maybe, keep the length of time you’re on the blower relatively short!

Good luck with the TMA. I hope it goes well. I’d love to hear of your experiences.

Stay safe,

Phil Coates

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