How is the CQC going to assess and inspect practices in 2015?
Here’s a check list that I have used BEFORE I plan a CQC visit:
· Website for opening hours / NHS/private / services & treatment provided
· Inspection history: Summary including date of last inspection, and including any breaches of regulation(s) or concerns identified at the visit. Date action plan completed.
· Local Area Team (LAT) information return: Date sent and returned - any issues.
· Provider information return: Notes re statement of purpose / compliments & complaints.
· Feedback: A brief high level summary of any patient / other feedback from any other source.
· Registration: Summary of changes to registration and registration issues, including details of the registered manager.
· Notifications: Summary of notifications received at CQC, whether received when needed and within relevant timescales.
· Concerns and enforcement: Summary of any concerns and/or enforcement not already covered above.
You have this information, so why not review it and decide what the CQC will make of it?
What does this mean in 2015?
CQC inspection in 2015 will be based on the following and in my opinion biased heavily towards Safe and Well-led. With this in mind, look down this check list and think about how exactly you could show me evidence that this is happening today in your practice. I’ve put a few examples in each section.
· Lessons learnt and improvements made when things go wrong. Evidence? (risk assessments, RIDDOR, improvements made, changes planned etc.)
· Care assessed to prevent unsafe care and treatment. Evidence? (Medical history checking system, treatment planning, record card audits, retrospective radiograph audit)
· There are systems, processes and practices in place to keep people safe and safeguard them from abuse.
· There are systems, processes and practices in place to protect people from unsafe use of equipment, materials and medicines.
· There are systems, processes and practices in place to prevent healthcare associated infections.
· Potential risks to the service and individuals are anticipated and planned for in advance.
· There are systems, processes and practices in place to ensure all treatment and care is carried out safely.
· Patients are always involved in decisions about their treatment and the practice obtains valid consent and audits records of this. Evidence? (Record keeping audit, patient information in various formats, fees explained and written treatment plans, agreed practice wide system for recording treatment options understood by patient, pros and cons explained, time given for decisions, Mental Capacity Act understood)
· Patients’ needs are assessed and care and treatment delivered in line with current legislation, standards and guidance. Evidence? (new patients survey considered, waiting time audit, opinion survey used, disability access audit performed, practice meeting minutes where GDC/CQC standards discussed, staff sign policy documents, system of governance operated)
· There are effective arrangements in place for referring to other health professionals to ensure quality and continuity of care for the patient.
· Patients’ oral health needs are assessed and care and treatment delivered, or referred, in line with current legislation, standards and guidance.
· Staff have the right skills, knowledge and experience to enable the effective delivery of care and treatment.
· Staff are recruited, inducted and appraised regularly and records are always available on the premises.
· Patients are treated with kindness, dignity, respect and compassion while they receive care and treatment. Evidence? (Confidentiality always considered, patient survey acted upon, waiting times audited, comments book shows many patients are pleased with care, telephone answered promptly and politely with log kept, emergency spaces available every day, complaints tracker shows all complaints handled carefully, staff training logs, privacy and dignity respected).
· Are people and those close to them involved as partners in their care.
· Does the practice promote equality and diversity and recognise the needs of different groups.
· The practice staff routinely listen and learn from people’s concerns and complaints to improve the quality of care. Evidence? (Practice is growing, has plans for improvements, staff levels constant and staff encouraged to develop competencies, complaints handling regularly updated, everybody encouraged to participate, complaints tracker up to date and good comments in book, NHS Choices etc).
· Patients receive an explanation of any need for referral with copy of letter and options/consequences.
· The governance arrangements ensure that responsibilities are clear, quality and performance are regularly considered and risks are identified, understood and managed. Evidence? (There is a written system of governance which is used in training and regularly updated, all staff are competent and have a personal development plan, there is a culture of openness and professionalism).
· How does the practice engage, seek and act on feedback from people who use the service, public and staff.
· How do the leadership and culture reflect vision and values, encourage openness and transparency and promote delivery of high quality care.
Let me ask you a few questions.
In your honest opinion, how do you think your next CQC report will look?
Bear in mind that It only takes one person to sink your ship.
Who actually runs your practice on a day to day basis?
Do you have a plan of where you want to be in a year, or five years?
How are you confident that all your staff know what the standards are?
How do you monitor standards of safety, effectiveness, care, profitability, popularity and are you moving ahead?
This is why you must have a system of Governance, I know this, you know this, the CQC insist on this.
RightPath4 can provide a system of governance mapped to 2015 CQC requirements which is simple to implement and does not cost £thousands or run to thousands of pages. It is easy to bespoke it to your practice and use as an important part of your practice meetings and induction. We have a unique template tool which helps you give confidence to the CQC that your practice is safe, caring, effective, responsive and well-led.
£250, no ifs, buts or VAT
£540 and we’ll deliver it to you and spend a day showing you how to apply it to YOUR practice. There are no ongoing payments, unless you want us to keep prompting you. (We do offer to update you and revisit your practice at a monthly cost of £70 payable by Standing Order, it’s optional though).
I hope we will be able to continue to help you.
Keith Hayes BDS Clinical Director RightPath4 Ltd.,
There when it counts.