- Posted Tuesday June 11, 2013
It has been a couple of months since GP Practices had to register with the Care Quality Commission (CQC) and inspections are already underway. Milehouse Medical Practice was inspected this April and First Practice Management has spoken with Christine Sweeney, Practice Manager at Milehouse to find out more about what exactly happens in a GP Practice CQC inspection.
1. Can you tell us a little bit more about your practice?
Milehouse Medical Practice is based in Newcastle-under-Lyme in Staffordshire. We are a single-handed GP practice in Newcastle-under-Lyme. We have approximately 2000 patients. Milehouse operates a walk-in morning and evening surgery every Monday and Friday, with pre-bookable appointments on Tuesday and Wednesday evenings. We are the only practice in the area operating a walk-in system.
The practice has a full time practice manager, one part-time practice nurse and three reception staff. Due to the type of industry in the area in the past i.e. mining there is a high incidence of patients with COPD (Chronic Obstructive Pulmonary Disease) and IHD (Ischemic Heart Disease). We are housed in a LIFT building (NHS Local Improvement Finance Trust), which we moved into four years ago.
2. What preparation did you undertake with anticipation of a CQC inspection?
We discussed CQC inspections at practice meetings but we did not really discuss what to expect at an inspection, and I suppose this was because we did not know what to expect other than perhaps something similar to a QOF visit. A Practice Manager CQC training session highlighted areas that the trainers expected the CQC inspectors to focus on i.e. Infection control, Equality and Diversity.
3. How did you receive notice of the inspection undertaken in April 2013?
Notification was received on Friday, 26 April by telephone call from the inspector who introduced herself and said she was giving us 48 hours notice of an inspection the following Tuesday, 30 April. The inspector told me what time she expected to arrive and how long she expected to stay.
She confirmed if we had a PPG (Patient Participation Group) and asked for contact details of the PPG Chairperson (myself in this case). She then asked if I would contact members of the PPG and ask if they would be willing to speak with her on Monday afternoon prior to the inspection. I contacted a PPG member who was happy to speak with the inspector on the Monday.
The CQC inspector also said that she would like to speak to patients after they had consulted the GP on Tuesday and suggested we display posters in the practice to inform patients there was an inspection in progress. We displayed a notice in the waiting room and also displayed a notice on the GP consulting room door.
I was told that their visit was to be as unobtrusive as possible and we were to carry on as normal. We actually had a Medicines Management meeting arranged for 11am on the Tuesday so we went ahead with it.
4. What was the reaction from: Staff, PPG members, Patients (Did they know anything about what a CQC inspection is?) and how did you feel?
The reaction from staff was an apprehensive one. However, I reassured them that they did a good job and that they just had to answer any questions as accurately as possible. The PPG member was quite happy to speak with the inspector.
Patients were not aware of what a CQC inspection was and to be honest I don’t think they were really bothered about it.
When told there was a CQC inspector on the telephone my first reaction was “Oh no, not this soon into the year!”. However, after speaking with the inspector, my attitude changed to one of “they need to do their job so let them come in and get on with it”. We run a good practice so we have nothing to fear”.
The GP’s reaction was one of “are we ready for this?”. I said it is too late if we’re not as they’re coming anyway.
5. How was the inspector when she/he arrived? Was she/he friendly?
We had two female inspectors. They were efficient and businesslike, but approachable and friendly.
6. Did she/he explain/did you get a chance to find out the inspector’s background? Was it from the healthcare industry?
The inspectors didn’t offer any information on their background but when asked they told us that one had a nursing background and the other a “community” background and managed a lot of staff.
7. What happened in the visit? What areas of the practice were inspected? How long did the visit last?
The inspectors were put into a vacant consulting room at Milehouse. The lead inspector confirmed the practice details and our regulated activities. She then said that we had declared non-compliance in quite a few areas and asked me why. I said that as I wasn’t sure we were fully compliant in those areas I would rather declare non-compliance and be told we actually are compliant instead of the other way round. She then said that they would be looking at all the areas where we had declared non-compliance to see if we were compliant now.
One of the inspectors came out to speak to staff and patients. The other inspector went through the standards that were declared as non-compliant and asked what we were doing in those areas. Actual inspections of the fridges, drugs’ cupboard and caretaker’s room (for cleaning schedules) were undertaken. Other areas looked at were: A Legionella Risk Assessment for the building, the clinical waste storage area, practice meeting minutes, training certificates, SEAs (Significant Event Audits), complaints, policies, risk assessments, audits and patient surveys.
The inspectors arrived at 9.40am and left at 4.40 pm. Due to the fact that the surgery was quite busy, I finally finished supplying evidence by 1pm on Thursday (almost two days later) via email.
8. Did the CQC inspector have any specific concerns and if so, what were they?
The only concern that the inspectors had was about individual(s) learning from incidents but, as the practice was learning (as shown by the minutes of the practice meetings) and putting procedures in place to prevent any further incidents and monitoring, they were happy that we were managing things properly.
9. Which outcomes did you declare non-compliance in and why? What was the inspector’s reaction, i.e. when saying that you were actually compliant?
We declared non-compliance in:
Outcome 1 – Respecting and involving people who use services: This was because we have an issue with confidentiality in the building as the reception area is quite open and patients in the waiting room can hear a lot of what is going on.
The inspectors spoke to me and I explained what we had done to try to sort this problem out and what we were hoping was going to be done by the owners of the building. The inspectors spoke to patients and staff and were happy that we were managing the problem and that we respected patients’ privacy and dignity so they said we were compliant.
Outcome 2 – Consent to care and treatment: This was because we had no specific information about consent available in the form of leaflets for our patients. The inspectors viewed records where verbal consent had been obtained. After speaking to staff and patients the inspectors were happy that we were compliant.
Outcome 7 – Safeguarding people who use the service from abuse: This was because although we had done our Safeguarding Vulnerable Adults training, staff had not undertaken any Safeguarding Children training for three years. After reviewing our policies, training certificates and speaking to the GP and staff members, the inspectors were happy that we all knew what to do if we had any safeguarding issues and we knew what to look out for and who to report issues to.
Outcome 8 – Cleanliness and infection control: This was because at the time of registration, staff were not up-to-date with infection prevention and control training. As this was completed in March and the inspectors looked at training certificates, they were happy that we were now compliant.
Outcome 9 – Management of Medicines: This was because we did not have a Medicines Management Policy. The inspectors did bring up the fact that we do not have a system in place to monitor medicines stock control. This has now been addressed. After speaking with staff who issue repeat prescriptions and the GP the inspectors were happy that patients were kept safe from harm due to the systems we do have in place to monitor medication and reviews.
Outcome 16 – Assessing and monitoring the quality of service provision: This was because I did not think we had conducted adequate patient surveys and audits. The inspectors looked at our QOF audits and surveys done via the PPG and also a survey that we intend to conduct during 2013. They also looked at risk assessments (including assessing the risk of the legionella virus) and service-wide security for staff and patients. They were happy that all audits and risk assessments were evaluated and action plans to improve quality were in place where required. The inspectors also looked at complaints and found that these were investigated and resolved appropriately. They were also adept at “reading between the lines” when going through staff responses to complaints.
10. Will you be able to read the report before it is published?
Yes, a draft report was emailed to the Registered Manager (GP) on 14 May – Two weeks after the inspection. The lead inspector did say it would take about two weeks as they were still getting to grips with the reporting side of things for GP surgeries.
11. Have they notified you when they are due to publish the report and can you contest the report if there is anything you don’t agree with?
The letter accompanying the draft report asks if we have any comments relating to any factual inaccuracies. If so, they request that we collate them and submit one response by 31 May 2013. We can record these types of comments on a Factual Accuracy Form that is included in their email.
The information can be returned to the CQC by email or post. They would review any comments and amend the report it they considered it appropriate to do so. If they did not accept our comments they would explain why.
In this case, we had nothing to add. We were informed that if they did not receive any comments from us by the date specified i.e. 31 May 2013, they would finalise the report and publish on the website.
12. How did the visit end?
The visit ended well apart from the fact that the lead inspector still required some information to be emailed (which was done on the Thursday after the inspection on Tuesday) as I was rather busy throughout the day with practice work and I was unable to supply information as promptly as the inspectors would have preferred.
It wasn't as painful an experience as I was expecting although I did feel as though I was run off my feet all day. I did say that I was happy to have declared non-compliance and been found to be compliant. On a sombre note, the inspector’s parting shot was “heaven help the practices who have declared compliance and are not!”
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