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CQC Inspection: The Know-How Guide

A CQC Inspection is a daunting experience for most GP practices, but here’s an article we have put together that gives you guidance and support in ensuring that your visit goes as smoothly as possible.

What is the CQC?

The Care Quality Commission (CQC) is the independent regulator of all health and social care services in England. It ensures that health and social care services are providing patients with safe, effective, compassionate and high-quality care, whilst encouraging care providers to improve in their services.

The CQC asks five key questions to any provider of care. These five questions are the cornerstones of any inspection: is the practice safe, is it effective, are the staff caring, are they responsive to the needs of people, and are they well-led?

The CQC also looks at the care provided specifically to six different population groups: older people, people with long-term conditions, families, children and young people, working age people, vulnerable or at-risk patients, and people experiencing poor mental health.

Every GP practice must also ensure that the CQC’s fundamental standards are met and adhered to.

Meeting the CQC’s fundamental standards at a CQC Inspection

GP practices must abide by certain standards. These include the fundamental standards – the standard below which care must never fall. Everybody has a right to expect that the following standards are met from their GP practice, these can all be found under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

  • Person-centred care
  • Dignity and respect
  • Consent
  • Safety
  • Safeguarding from abuse
  • Food and drink
  • Premises and equipment
  • Complaints
  • Good governance
  • Staffing
  • Fit and proper staff
  • Duty of candour
  • Display of ratings

For further information and in-depth examples of all the standards, please see:
https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulations-service-providers-managers

Get ready for pre-inspection

Before your GP practice can provide any services to the public, it must apply for CQC registration and meet certain pre-requisites. Guidance on how to apply for registration with the CQC can be found here.

Prior to a CQC Inspection, the CQC will provide you with a letter of notification, notifying you that an inspection will occur. In most instances a two-week window is given prior to the inspection, allowing for minimal disruption in services. The comment cards and posters signifying an impending inspection should be suitably placed.

Key documentation to prepare prior to the CQC Inspection

The CQC inspectors will request to see good clinical governance and management of the practice. Record-keeping and documentation should be made viewable to the inspectors and below are a non-exhaustive list documenting what you may be asked to present. It is always a good idea to have the following documents ready prior to the inspection:

  • Personnel contracts: including DBS, staff contracts and appraisals, employers and medical indemnity insurance, and staff handbooks.
  • Personnel policies: including policies relating to confidentiality, access to records, disciplinary and grievance matters, equal opportunities, bullying and harassment, equality, working hours and whistleblowing.
  • Audits to include governance relating to infection control and disability access. Practices should have a nominated Infection Control Lead.
  • Health and Safety documentation: Health and Safety Policy, risk assessments, waste disposal processes, COSHH, RIDDOR, fire precautions and evacuation policies, equipment maintenance (PAT testing reports), and medical alerts documentation.
  • Operational policies relating to safeguarding, complaints, chaperoning, identifying minors, repeat prescribing, controlled drugs, out-of-hours arrangements, home visits, and medicines management.
  • Business continuity plans.
  • Palliative care registers.
  • Patient services and information: practice leaflets, up-to-date website and NHS Choices site.

On the day of a CQC Inspection

At the start of the inspection, the inspector and/or inspection team will meet with senior members of the practice team. This brief meeting will detail who the inspection team is, an outline of what to expect, the purpose of the inspection and how the findings will be communicated back. Ensure that on the day of the inspection, your practice is promoting the services and care it provides in the best manner.

GP practice staff will then be asked to deliver a short presentation, allowing practices to give the CQC their own view of the performance of the practice. Some of the points that the presentation can outline include: all the services that the practice provides, access to appointments and triage, examples of training, how it listens to concerns, identify specific patient cases in anonymity where safeguarding issues were raised, and the use of translators or the hearing loop system to accommodate all patients. The presentation should discuss the five questions the inspection will ask, especially in relation to the six different population groups, whilst also including any examples of outstanding patient care.

The inspection team will then focus on areas of concern and areas where the practice is performing well based on the introduction. The team will collect evidence in relation to these matters by finding out the views of the patients using the services of the practice. this will be done by using the comment cards and speaking to patients individually and in groups. They will also speak to staff and gather information relating to the five key questions. Other inspection methods include observing care, reviewing records, looking at documents and policies, and inspecting the facilities.

Feedback after a CQC Inspection

At the end of the inspection, the inspection team will meet with senior members of the practice team and give a summary of the key findings from the inspection, make mention of any issues that need addressing, identify where immediate action is to be taken, outline plans for future inspections and how the judgements and findings will be published.

GP practices will be rated for the five key questions, and finally given an overall rating based on their performance. GP practices will be rated as either: Outstanding, Good, Requires Improvement or Inadequate.

When completed, the rating will be published on the CQC’s website and must be displayed in the GP practice and the practice’s website.

How GP pharmacists can help at your CQC inspection

GP pharmacists are experts in medicines and can prove to be invaluable at a CQC inspection. Pharmacists are already accustomed to a GPhC inspection and can help your practice achieve the top rating at its inspection. The CQC will ask to see the systems in place for safe storage and handling of controlled drugs, how often patients get a medication review, medicines safety alerts, repeat prescribing processes and reviews, triage, and handling of common ailments. All of these are areas where a GP Pharmacist can offer expert support and assistance.

GP pharmacists are allowing healthcare teams working in GP practices to give better local care to patients, allowing patients to see highly trained healthcare professionals specific to their needs. Pharmacists working in GP practices make a positive impact on patients, provide excellent clinical assessment and treatment plans, are experts in the knowledge of medicines and contribute greatly to health economics. They are also experts in providing lifestyle advice to treat long-term conditions and improve patient’s safety.

Having GP pharmacists in practice allows GP’s to better manage their time and to focus their skills on where they are most needed, diagnosing and treating patients with more complex conditions. Take a look at our Services page for more information on how our Clinical Pharmacists are working in GP practices.

Interested in becoming a GP pharmacist? Then please send your CV and a cover letter to info@firza.net 

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​This article was written on behalf of Firza by Hassan Riaz from Pharmacy Mentor.