How we survived our CQC inspection
Practice manager Rachael Duff explains how she prepared staff and patients, built rapport with inspectors on the day and dealt with their immediate feedback
We are situated in Cottingham, East Yorkshire. We have approximately 4,500 patients registered with us and 16 staff who mostly work part-time. We provide minor surgery and other enhanced services as well all the core services to patients. We are a PMS practice and had our CQC inspection on 12 June.
I worked with my lead-nurse reading through all the essential standards a few months ago. I concentrated on business and organisation, and the lead nurse focused on the clinical side of the business. (The CQC welcomed this approach, as it engaged staff in the process).
I contacted a local dental practice that was inspected recently. The manager from the dental practice visited our practice and shared lots of tips with staff.
We prepared job lists, which I distributed throughout the practice, as a way of sharing the workload and preparing staff. This also demonstrated team engagement. I put a lot of time and effort into this process, because I understood the potential consequences of not doing so.
I was contacted by the CQC on Friday morning to be told about their inspection at 9.30am the following Wednesday. They also notified me about some of the outcomes they were looking to inspect during the inspection.
Staff were surprisingly calm I feel because they were prepared as much as me. However, they were worried as CQC inspections are relatively new. They were especially worried about what they would be asked, and if they would let the team down.
The chairperson and PPG members were calm and very helpful. I invited a couple of PPG members to the CQC, which was appreciated and beneficial to the practice, patients, as well as the CQC. Most patients knew about CQC inspections and I informed those who did not know, as I was keen to demonstrate an open and transparent practice to the CQC. I arranged for a random selection of patients from each clinic to talk to the CQC on the day. I pre-arranged this and the patients consented. The CQC told me in advance when advising us of the visit that if they could not speak to patients on the day, they would contact them afterwards. However, I felt it was better getting this out of the way at the inspection.
I felt a little weighed down because if it all went wrong, was it my neck on the line, even though I am not the registered CQC lead. However, I was extremely excited that at last, the CQC inspection was happening and we could get it out of the way. I was nervous, mainly because of the bad press surrounding the CQC.
What we did
The inspectors who visited us were engaging, friendly, unobtrusive and they allowed me to guide the inspection. At the end of the inspection, feedback was provided in such a way that we were happy to listen and take their comments on board. It was a positive experience and I believe this CQC inspection was conducted more professionally than any similar PCT visit that I can recall. We had three visitors (two inspectors and one clinical advisor) and they shared information about their backgrounds. One of the inspectors had been a nurse for over 24 years and a cabinet officer advising on health policy for several years after that. They all knew the primary care system.
However, I’d like to point out that they did not specifically question our clinicians on their clinical work, only around matters such as safeguarding, equality, diversity, mental capacity, confidentiality, systems and processes. They asked me about GP revalidation and how I ensure CPD and training are evidenced. They also looked at two staff HR files and asked me to explain the appraisal process, which they verified by speaking to staff.
They arrived at 9.30am and left the practice around 2pm. They outlined the areas they were looking at and said that they would like to speak with patients and staff independently, explained how they would convey their feedback at the end of the visit and report on the inspection.
They inspected Safeguarding Children, Safeguarding Adults, Dignity and Respect, Equality and Diversity, Complaints, Staffing, Infection Control and Premises (including Health and Safety and Risk Assessments). They went through each area in turn and had the Essential Standards with them to tick off in order to cover everything. They asked me to evidence policy, matrixes and any other related documentation before speaking with other staff on each indicator. To save time, they were happy to be emailed policies/documents after the inspection. Details about staff training and how training is managed were discussed in depth. Staff training is an area where managers need to be cautious as the inspectors verify with staff anything they might have been told or read during the inspection. I fully expected this and therefore tested staff to ensure that all the training information had been absorbed by them. They also observed the reception and patient interaction for about 30 minutes.
During our CQC visit, the clinical advisor went into a separate room to speak with patients about the service (which I pre-arranged) whilst the two inspectors carried out the inspection.
We were lucky as the inspector verbally fed back that the practice was run well, organised and a pleasure to inspect. They felt that the staff were knowledgeable and felt valued. Furthermore, they were pleased that everything I said stacked up when staff were questioned. They told me they had no concerns or recommendations. They even commented that we were the most prepared practice they had seen for a long time, including dental practices and care homes who’ve been registered longer than us.
There were a couple of negative comments from patients, but nothing more than expected and mainly around everyday matters such as opening times on Saturdays and so on. Patient comments were fed back for learning purposes. They also appreciated that I arranged ‘one-to-ones’ with between the inspectors and a random selection of patients, which gave a balanced view.
The visit ended with an excellent two-way feedback session. The inspector also gave me her contact details saying we could call her with absolutely any queries at all. They thanked us for a positive experience and positively commented about the staff. They also asked for our feedback on the visit.
We received our inspection report in a draft format. I could have gone back to the CQC with any amendments, which they would have changed if they agreed, but this is not guaranteed. To be honest, they were so thorough in their feedback that I could guess the content of the report even before we received it. I was told the report is published 14 days from when the draft report is shared with us, because it has to go through a formal Quality Assurance process first. However at the time of writing we still hadn’t received the draft and expect the final report to take another week or two once the draft is finalised.
We can respond to the draft, and my impression was that everything would be ironed out at that point. However, the CQC inspectors did not mention what would happen if we didn’t agree with the report. However, I assume they have a complaints process in place.
Top tips for a CQC inspection
- Be prepared. I produced a welcome pack with several bits of useful information, which was really appreciated. It also helped eliminate later questions that were answered in the welcome pack.
- Introduce inspectors to staff and offer to leave them alone together so you demonstrate you are happy to have your systems and processes tested.
- Don’t be defensive. If you haven’t done something they ask about, just say ‘I’m sorry I haven’t done that.’
- Let the CQC inspectors know that you are happy to absorb their feedback and learn from it.
Rachael Duff is a practice manager in East Yorkshire. She is a member of First Practice Management (FPM).