- Posted Tuesday October 11, 2016
Practice business manager and Thornfields trainer Kay Ellermeyer picks up the story of her CQC inspection from part one, revealing how the day went, sharing what she found out from the experience and reflecting on her key learning points.
The inspection team arrived at 8.00 - remember to get them to sign in! I had reserved three parking spaces for them so they didn’t have to wait around. We were told that we had an hour to give our presentation, but I stretched that out a little by giving them a tour of the site. I felt there was real value in guiding them around the building and pointing out the things they need to see. For example, our cleaners were in at this time so the CQC team were able to check things like different mops and equipment segregation without me even knowing. They had also checked the dates on the plug sockets and listened to a couple of phone calls without me noticing, so it was useful for them too and saved us all lots of time.
We didn’t want a lot of people in on the presentation, but our midwife is one of the people who gives a great service and really is an extension of the team. We made sure she was around and introduced to the inspection team, and they had a couple of minutes with her while I made drinks and they got comfortable in our meeting room.
We didn’t have a projector, so our presentation was more of a chat. I don’t think this was detrimental as the whole culture I wanted to present was open and friendly. I did give them a print-out of the slides and our notes pages, the idea being that even if we didn’t remember to say everything we wanted to, they had it all written down! We also printed one copy of the slides in colour and laminated them; this made some of the more detailed slides easier to read.
The Inspection Team
The presentation team was made up of myself, the lead GP and our lead practice nurse. We hadn’t practiced the presentation but all knew which slides each of us would be speaking about… however it soon became more of a conversation anyway. The team from the CQC made us feel at ease, asking questions that made us feel confident that they were listening and had read the information that we sent them prior to the visit - they were genuinely interested in learning more about the practice. They were normal people doing their job, and I didn’t once feel like they were trying to trick me or catch us out.
The inspection team was made up of a GP (retired), a nurse and a Social Services inspector. I was surprised that there wasn’t a PM, and they told me that they don’t really use the PM inspectors unless there are already known problems in the practice. I had prepared some paperwork for them to make their day easier and presented it in a file – my thinking was that the more organised they thought I was, the less questions they would ask! It included the following:
- A list of staff that were in that day, subjects to discuss and any time constraints
- A list of patients that they could ring for reference – I’d chosen a wide variety, including some from each age group
- A copy of our business plan
- A list of all our SEAs and the backing sheets to show how they were all investigated
- Patient Survey results
- Access Audit results
- GSF lists for the year
- Minutes from clinical team meetings
- MDT minutes
- Fire and Health & Safety checks.
We provided personnel files too, separated into admin and clinical with cover sheets before each file and a tick-list of requirements so I was confident all the right things were in there. We also prepared a policies files - one for clinical and one for business - with cover sheets showing when each of them was due for review and who had responsibility for updating them.
I knew I was short of a few policies, but I told them up-front and added a to-do list at the front which listed all the policies that I hadn’t yet updated - there were about 30 in total.
Conversations with the Team
After the presentation, the inspectors had 10 minutes together then told us who they wanted to see next. The GP wanted to spend time with our own lead GP - this turned into three hours and she was exhausted afterwards!
During this time, various staff members were asked to join them to talk about referrals and the nurse had 90 minutes with our lead nurse talking about QOF, infection control and safeguarding. I was with the Social Services lead, reviewing personnel and policies files page by page. She asked about my role as Practice Manager, our business plan and the way the practice operates. It felt very informal – more like a conversation rather than coming under scrutiny; it was far less stressful than I had imagined.
Once the Inspecting nurses had finished, she asked the rest of the team questions about particular scenarios – what would you do if someone in the waiting room was shaking their child; how do you process urgent prescriptions; what do you do if the emergency button is pressed; where is the defib; how do you tell if an appointment request is urgent or routine?
All the staff felt confident they could answer the inspection team’s questions about their job roles.
By 3pm they were ready to go back into the meeting room to have a post-inspection team meeting. This lasted for about half an hour and then we were called back in for our highlight report. Thankfully they gave us a written overview of what they had found as well, because by this time I was exhausted and I switched off after she said “Your staff were fabulous!”
The feedback is short; there are about five comments and then a couple of areas to develop. These areas are the ones that we had told them about – policy development and clinical audit, so again no surprises. Everything was done with smiles and co-operation rather than scrutiny and a dictatorial attitude.
There seemed to be quite a few questions about the leadership and culture of the practice, like ‘who would you go to if a problem occurred’; ‘is it an open door policy with the management team’; ‘do you feel supported’, ‘do you have any concerns about the way the practice is led’. Everyone commented that they were surprised how much the inspectors knew about general practice.
I guess my overarching advice is;
How do Kay’s experiences match up with your own? What have been the positive and negative aspects of your practice’s inspection? Let us know in the comments section below, and members can head to FPM’s CQC Guidance Area for further insight into the CQC process.