Inspecting a GP practice
Dr Ken Aswani describes a typical day as he inspects another GP surgery for the CQC
Dr Ken Aswani
Roles Care Quality Commission GP inspector, NHS Alliance executive member, deputy representative for the RCGP council, lead GP for the Waltham Forest network and GP trainer.
Location Walthamstow, east London. Inspections in various locations around the country
Hours worked per week 60
On a normal day, I wake up at 6.30am and make my way to the practice by 7.30am. But today, I am driving an hour and a half to the Essex coast to carry out a pilot inspection. I became a GP inspector earlier this year and have already learned a lot about how to improve my own practice.
I start to prepare for the inspection a few days before I visit the practice. I read my briefing notes and get in touch with the lead inspector, who assigns me the areas I will be focusing on as part of the inspection: today it is communication with patients, and responses to patients’ needs.
I meet the CQC team to go through the key areas we will be looking at. The team consists of me (the GP inspector), a practice nurse, two CQC inspectors and a lay member. We try to be systematic, so we clarify how the specific areas of the inspection will be recorded, in order to shape the final report.
We have a guided tour of the practice which is useful to get an overall impression.
Some of the staff appear nervous, but the senior partner has confident body language and seems friendly, which puts us and his staff at ease. I try not to let first impressions affect my judgment though.
The inspection begins with our team outlining the schedule for the inspection to practice staff, and addressing any concerns they have.
We interview the staff one by one, and discuss a number of issues relating to quality, including implementing best practice and how staff work as a team and run an effective practice. I speak to the practice manager first, which gives me a clear idea of how the practice works and is run.
As my colleagues begin to interview patients, I check equipment, then review the results of the practice’s patient survey. Patients at this practice give some very positive comments, particularly about access and continuity.
The inspection team meets for a short lunch break to collate findings and to informally discuss first impressions. This allows the afternoon to be more focused.
We also use the break to get to know more about one another. I have never worked with this team before so I find out more about their own careers.
Many of the local GPs have returned from their home visits. This is a fruitful time to get their perspective. They show
a great level of commitment and shared ethos in the discussions we have.
The team retires to the staff room – given over to us today – and I start to write up my notes. I also give clinical advice to other members of the inspection team on the evidence they have gathered so far. For example, I advise on a clinical audit that the GPs had undertaken, and ways the findings were followed through.
Other team members finish their interviews and begin to write up their findings. The lead inspector systematically checks through all the evidence that the team has gathered.
It’s time to give feedback to the lead partner and practice manager. It takes about an hour and we cover the practice’s strengths (elderly care), areas for improvement (staff training) and an area that needs prompt attention (infection control). My favourite part of the inspection is highlighting areas the practice excels at.
Advice is offered about practical areas for improvement but on the whole the practice performance is positive. We take our time to enable staff to ask questions.
The team looks relieved when we tell them what they’ve done well. I am always aware of how nerve-racking inspections can be, but being on the other side has made me less anxious about when my practice goes through one.
I start the 90-minute journey back home. Although supper is delayed, I don’t mind the sacrifice for a worthwhile day’s work.