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Outstanding CQC Inspections in General Practice

Dr Robert Varnam Head of General Practice Development, NHS England & GP, The Robert Darbishire Practice, Manchester on improving the quality of General PracticeDr Robert Varnam Head of General Practice Development, NHS England & GP, The Robert Darbishire Practice, Manchester on improving the quality of General Practice

News and updates from today’s conference looking at Outstanding CQC Inspections in primary care; learning lessons and sharing good practice.  Chaired by Dr Amir Hannan GP Tameside & Glossop PCT (@amirhannan) and with a keynote opening address from Ruth Rankine Deputy Chief Inspector of General Practice Care Quality Commission.

Ruth Rankine's PowerPoint Presentation

Dr Robert Varnam; "I think what’s really interesting is process changes, there are four common challenges to process change. Human resistance to change, so you have the tech redesign and then working with the team to implement this. Evidence, getting the evidence is vital. Also as GP’s we’ve been used to being everything to everyone and we need to find a way to leave the skilled tasks to the skilled people and allow clerical work to be delegated, and regulation systems have been so far inflexible and we need to challenge new ways of working."

Ruth Rankine; "We are finalising a methodology for remote and online services. The inspector will always lead the inspection to ensure the service is working but we will always need specialist advisors as services are changing like digital services and we are currently recruiting in this area.

With regards to post inspection feedback, on they day they will get high level verbal feed back post inspection but we do have to be careful as the team wouldn’t have had time to corroborate but if we have immediate concerns that would be communicated straight away. Then the draft is normally available 30 days post inspection then the KPI’s around 50 day but it does depend on the size of the practice."

The onsite inspection process and preparing for inspection
Dr Judith Dawson
GP Partner and Trainer Weavers Medical, and Inspector Care Quality Commission

PowerPoint Presentation

"Highlight your excellent areas, I cannot stress that enough, we want to hear about this, and tell the inspector about any current issues because if you don't your staff will, so it's better to be upfront about it with the inspector. If you've got temporary or new staff you need to ensure they are involved as they are often left out of the process.​"

Pre-event abstract: The onsite process and preparing for an inspection
Getting ready for a CQC inspection is a daunting task and one which many primary care teams find very stressful. However, adequate preparation, knowledge of how an inspection is run, and a clear presentation of your practice strengths will help the achieve the best outcomes 

For the inspecting team, the information sent to them ahead of the inspection itself is used to try and gauge an idea of the practice’s strengths and weaknesses. This will be obtained via the CQC intelligent monitoring process and amalgamates information from a variety of sources: CCG intelligence, NHS Choices comments, PACT data, the practice Qof performance and the practice website. 

Looking at this yourself in advance may give you ideas of where questions may asked ,for example is your diabetic QoF data less good than usual because of long-term sick leave in the diabetic team ? Using this information, the inspecting team will already have tried to identify areas that they may wish to look at, either of good or poor performance so this should form part of your own information gathering process.

Clearly  you will wish to gather together documentation that the CQC team is likely to want to see, and there is a good summary of this information on the BMA website on
www.bma.org.uk/e,ployment/gp-practices/service-provision/care-quality-commission/cqc-inspection
It is worth thinking of having this in a pre-prepared folder which you can update regularly so that it is always available and making sure that key members of the team know where to access it.

Doing a “practice walk through “ to ensure the best presentation and check all the equipment is in place is clearly imperative. Ensure that you draw up a timetable for the day yourself so that members of staff are free to meet the inspectors, and consider when it will be possible to arrange for the inspectors to speak to PPG members or other  service users eg local nursing homes. New staff or new learners within the organisation are always very important as the inspectors are likely to want to check their induction and knowledge on key areas such as safeguarding. Identify a quiet room for the inspectors to use during the day.

On the day, the first part of the inspection is your chance to show the inspectors the strengths of your practice through your presentation. Try to involve the team in identifying areas of excellence, and if you are aware of areas of challenge eg staffing or premises issues, make sure that you are open about them early in the process. Remember key areas which the inspectors will look at ,as well as the  different population groups (older people, families and young people, long term conditions, those who are vulnerable, those with poor mental health and working age individuals. You can expect a focus on safeguarding, infection control, data security and team working.

80% of those practices inspected have received a rating of good, with 4-5 % having been rated outstanding. Those which are rated as outstanding tend to have developed a strategic approach to healthcare across their community setting. The most important  message however is that you need to identify and communicate to the inspectors what is outstanding in your practice. Careful preparation and a clear presentation will allow this to happen.

These are my personal views and do not represent the view of the CQC.  


Future events of interest:

Complaints in Primary Care: General Practice Complaints Handling for GPs, Nurses and Practice Managers
Thursday 20 October 
Hallam Conference Centre, London

Medically Unexplained Symptoms/Somatic Symptom Disorder
Friday 21 October 
De Vere West One, London


27 September 2016

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