Feedback from Practice Managers on recent CQC Visits
St James Medical Centre Taunton
We only had two inspectors one of whom was a GP. They arrived at 8am prompt.
We had produced / agreed a timetable of the day, although at some points there was deviation from this. The inspection team was very accommodating for those people who had limited time availability. I would say to just have sufficient cover to be flexible.
The inspectors were personable and friendly but there was rigour in their approach to questioning and inspecting, which is to be expected. It felt like a very intensive day. Interview sessions were very challenging and draining, covering a diverse range of topics. As the day progressed I think it is fair to say that we did feel worried about what we perceived as weak responses to some questions and I think this raises an important point. The inspectors are coming into the practice with the assumption that everything is good. The more challenging lines of enquiry are probably geared towards teasing out what goes beyond good. It is very easy to feel negative about not being able to always give a really good answer or an answer at all in some instances. Generally, I don’t think you should be too concerned about this aspect, although it is human nature.
Our feedback session at the end of the day was a succinct and positive experience and we await the official report. Our concerns about some inability to field questions proved to be unfounded and this reinforces my point at the end of the previous paragraph.
A few more details about our inspection
We were aware of our areas of weakness going into the inspection and were up front about these and had already started to put plans in place to address them. They recognised this self-awareness and I think this was a positive. We had no major surprises.
We ran the practice as normal on inspection day. We had a new nurse starting and a full-on childhood imms clinic which always more than fills the waiting room to capacity!
We have a daily ‘huddle’ at 8.20am and the inspectors joined us for this.
For our presentation we chose not to use PowerPoint. The Registered Manager (Senior Partner and Practice Manager) provided a fairly informal chat covering the history and development of the practice and outlined the main current issues for us as we saw them. To inform this we had prepared a SWOT analysis which we shared with them. We also shared our business plan on a page. We kept to the 30 minutes allotted to us. To support what we had presented, we provided them with a slim folder by way of reference but this was not policies and protocols.
The GP inspector focussed most of his time interviewing the GPs (partners not working on the day came in and were timetabled for interview and helped out generally). This left the lead inspector to focus on virtually everting else. She spent the majority of her time with the Practice Manager but also saw our Lead Practice Nurse, Receptionist, Clinical IT Assistant and the Chairperson of our PPG.
Prior to our inspection we were provided with a prompt sheet for the six patient population sub groups. Against the prompts we completed and submitted details of the services we are providing. It is good to think hard about what you have done and are doing, particularly if it is bit out of the ordinary. The inspector ran through this with the PM even though much of it had a clinical bias. Equally, some GPs were quizzed about administrative issues.
Systems, processes and ‘closing the circle’ were common themes of enquiry for us about clinical and non-clinical areas. Again, this is to be expected.
To sum up we did find the day quite tough. There is a lot of ground for the inspectors to cover. But, provided your systems, communications, team-working are all good, together with a sound knowledge of your practice, including areas for improvement, I think you will be fine.
Wellington Medical Centre CQC Inspection
The inspectors arrived at about 8.30 am and left at about 5.00 pm. The inspectors had not worked together before so spent the first 15 minutes together planning the day. We prepared a detailed timetable for them which they vaguely kept to.
The inspectors were very approachable and fair I felt on the day. I spent the first 15 minutes explaining where we are as a practice as we have had exceptional levels of change in the past few years e.g. new building, merger, clinical system replacement, loss of senior partner.
Minor things (minor to me anyway) that cropped up on the day e.g. one of our 25 sets of disposable curtains didn’t have a date on it, were sorted on the day where possible.
The pace was quite fast but I had a member of admin staff on standby and she was able to correct some of the less important things that were picked up as above.
There were no major surprises in terms of the topics discussed but the following areas were scrutinised with me in real depth:
- Staffing processes
- Health & safety including infection control
- PPG demographic, DES action plan etc
- Patient access
- Strategic plans
Our inspectors spent quite a lot of time with patients. Several of my PPG were present and one of the inspectors spent 1.5 hours with them in addition to randomly catching patients in the waiting room.
The GP inspector spent time with about 6 or 7 of our GPs. We targeted GPs with lead responsibilities in addition to the Senior Partner. The inspector wanted to see the GPs in their rooms Consent, chaperones, capacity were key themes as expected.
I approached the day as a learning opportunity and found it quite a positive experience despite not receiving notification that we were having an inspection until a few days before when I was in Yorkshire ! I arrived back at work on the Monday and our inspection was on the Tuesday.
Lydia Daniel Baker
Cranleigh Gardens Bridgwater
The start was important and we used the standard template you sent over to undertake our power point presentation. This took about 35 minutes but Michelle Golden did ask quite a lot of questions which prompted debate rather than us purely doing the presentation. It was undertaken by myself and one of the partners with a split in that he covered clinical and I did non clinical which seemed to work well. I would strongly recommend that two people to the presentation as it allows time for though reflection when the other person is speaking and you can add to what they say..
We had three people inspect us Dr Ian Neale and Michelle Golden (Head of Primary Medical Services and Integrated Health – South Region, CQC) and Michael Miles CQC Inspector. After the initial discussion they split up Michelle spent a lot of time in the waiting areas speaking to patients and then took an allocation of staff to speak to. Michelle also spent 30 mins plus with representatives of our PPG. Dr Neale interviewed all clinicians in on the day and Michael picked up with me and non- clinical staff.
One person they all spoke to was our reception supervisor and she was questioned 4 times which she found fairly stressful. This person also undertakes our script line and they were very hot on how blank script forms were kept during the day and at night..
Michael Miles our inspector then spent several hours with me and asked for general information including staff files of non- clinical and clinical and one of our salaried Drs. Requested Risk assessments, selected about 12 protocols which he wanted me to print, went through training plans and asked general questions regarding the operational running of the practice.
There was a brief talk out between the inspection team and three of the partners plus myself. There was no instruction on who should attend this and was held for any that could make it. They left about 5.30 and at talkout went through their thoughts for the day pointed out any minor failings and gave us assurance that there were no concerns and that we would be assessed as a minimum of good. With the inspection teams all instructed to test from October they fed back that the final report would take longer than they had anticipated as there were already backlogs in report writing and getting the report through several layers of approval.
Harley House Surgery Minehead
It was a tough day and it turned out to be a great team building exercise, although not one I would have planned!
During the morning Claire our lead inspector met with a few patients for an hour before meeting with our Head Nurse. Dr Simon Rains spent the morning with our registered manager Dr John Higgie and the Practice Manager Ian Wilcox spent the morning with me. At lunchtime they met with our patient group and the other GP’s who were working that day and in the afternoon Dr Rains and Claire met with other members of the team and Ian was with me again for the afternoon.
From a personal point of view I was interviewed from 9:45am until 4:30pm with half an hour for lunch, which was spent finding documentation for other team members. In fairness Ian did say at the start of the day I could ask for a break at any time, but I was optimistic in thinking it wouldn’t last that long. I was very disappointed with the way the day went as we were led to believe that the new style visits were very much patient led, but my reception team tell me only 3 or 4 patients were interviewed and I was certainly asked for a significant number of policies and protocols. Because I was interviewed for such a long time it meant that I was unable to help other members of the team when they were asked for information, which I know in theory the places runs when the PM isn’t it, but anyone is unlikely to want a copy of the last infection control audit or the like to help when I’m not here. Likewise members of staff who weren’t working that day areas of their work that were questioned fell to members of the team who hadn’t be involved and could only answer as best they could.
I did feel Claire was fair in her summing up, although to be honest by then all of us were struggling we were so frazzled. Throughout the day we were asked for further information to be forwarded to Claire and I think it would have been useful to have this listed and agreed during that final meeting. One of the points mentioned by all three inspectors was that we don’t use SMS messaging or email to contact patients, something we as a practice have looked at but feel at the moment is too fraught with information governance issues to be safe. I am not sure this is really something the CQC should really be concerning themselves with?
Still we survived!