• an action plan that addresses the findings of any patient surveys
• a summary of any complaints received in the last 12 months, any action taken and how learning was implemented
• a summary of any serious adverse events in the last 12 months, any action taken and how learning was implemented
• evidence that the quality of treatment and services has been monitored, including evidence of two completed clinical audit cycles in the last 12 months and any other audits, with evidence of outcomes or actions taken as a result
• recruitment and training policies and procedures, eg how staff are recruited and vetted before joining, arrangements for EEA and overseas-trained doctors, and what induction they receive
• number of staff by role (whole time equivalent)
• a copy of the current statement of purpose.

The list isn’t exhaustive, but these items and information are likely to be requested on the day of the inspection. Collate as much as possible beforehand and have it ready:

• significant events
• audits including infection control, cleanliness, and disability access
• risk assessments, with evidence that reasonable action has been taken – an active document
• health and safety documentation
• business continuity plan
• HR staff files, policies and procedures including a locum policy and induction programme
• service operational policies including safeguarding, complaints, chaperoning, medicine management and repeat prescribing
• equipment calibration reports
• PAT testing reports
• palliative care registers
• workforce training matrix and schedule.

• managing risk and learning from mistakes
• health and safety
• CPR
• equality and diversity
• informed consent
• informed decision making
• whistleblowing
• chaperoning
• safeguarding for children and adults
  
  CQC inspectors may want evidence that safeguarding adults and children is discussed in multidisciplinary meetings, and all policies are followed. In particular, they may be interested in information sharing so any matters can be resolved quickly and easily. They may also ask about the management of access to sensitive information, eg the register of patients at risk.
• GP awareness of deprivation of liberty safeguards, the Mental Health Act and the Mental Capacity Act, and what this means for GPs and their patients.

Inspectors may ask to see proof of attendance certificates in connection with staff training.

To help you evidence skills and appraisals for practice nurses, download the RCGP’s general practice nurse competencies.

Inspectors may ask about appointment availability for patients to access:

• female or male GPs and nurses
• pre-bookable appointments in advance
• urgent appointments.

Ensure you’re aware of the systems in place, but also be honest about challenges in achieving good access.

Your practice will need to demonstrate how it works with other service and care providers. Inspectors may ask about:

• any interpreter service used, including access to sign language if required
• the handover to out-of-hours services, especially for patients near the end of life.

The practice may be inspected for cleanliness and infection control; these actions can help to meet minimum standards.

• Ask a practice nurse to lead on the CQC’s regulations for infection control and cleanliness and ensure they’ve adequate training to carry out the role effectively.
• Document – and save in a shared place – infection control audits, cleaning schedules (including deep clean), cleaning logs and training undertaken on a systematic basis.
• Notices and logs when areas were last cleaned, eg in toilets, clinical rooms and waiting rooms.
• Provide hand gel.
• Where practical, ensure carpets are not stained or discoloured.
• Show how the practice mitigates risks including sharp disposal and injury.

Consider how your practice can demonstrate clear leadership, supportive management and a fair culture.

• Conduct frequent staff meetings with a shared agenda and minutes.
• Ensure staff have read, understood and signed up to the statement of purpose.
• Ensure staff feel supported and valued, and have appropriate employment policies, procedures and systems.
• Inspectors may ask for evidence of formal recorded supervised support for the entire workforce.
• Inspectors may wish to talk to staff about whistleblowing and whether they feel safe to do so.
• The entire workforce should be able to identify and learn from mistakes.

Inspectors want to get to the heart of people’s experience of care, so they will focus on the quality and safety of services, based on the things that matter to patients.

• Use past case examples to help demonstrate compliance.
• Describe in detail the service offered and how staff ‘go the extra mile’ to achieve the best possible outcome for all patients.
• Inspectors will talk to patients (pre and post-consultation) about their experience; whether they felt listened to; consent; informed decision making; choice; access to appointments and information about a particular treatment or referral options; prescribed medication, including about the risks and benefits; and general safeguarding.
• Inspectors might sit in the waiting room to listen, talk to patients and observe the greeting of patients at reception.

Inspectors might want to see policies, procedures, guidelines and protocols, but what’s more important is that the practice workforce understands what they mean in operational terms.

Documents must reflect what the workforce does on a daily basis. It may help to have an intranet where the policies can be accessed easily by all.

Ensure the practice is ready to answer questions related to safe staffing and have supporting evidence. For example:

• a robust recruitment and selection policy that meets the equality agenda and minimises risk
• recruitment paperwork, eg advert and interview notes in personnel files
• inspectors may wish to discuss recruitment processes, especially GP locum appointments
• evidence of a staff induction programme with a section on the CQC and disclosure of criminal activity
• annual performance appraisals, documented and saved in an appropriate domain - it is good practice to include a section on managing risk in appraisals, including criminal activity disclosures
• evidence of DBS checks (or risk assessment if non-clinical). Undertake a risk assessment (to include all non-clinical staff without a DBS), take reasonable actions and use it as a working resource.
• HR files for all staff – including locums and partners – with an index of key information.

• the systems in place for risk management and clinical governance, and evidence of any change in practice as a result
• conducting clinical audits
• conducting regular significant event reviews and analysis
• conducting risk assessments and undertaking all reasonable actions incident reporting related to controlled drugs and other medicines, and evidence of learning or action taken
• reviewing and updating the process for staff to read policies, protocols or procedures
• local or national guidance having been taken into account
• reviewing information gathered about the safety and quality of GP services. From reviews, practices can identify any risks and actions to address them, and find ways to improve services
• circulating and acting on clinical guidance, medical alerts, safety alerts and other relevant local or national reports, so staff can change their working practices if necessary.

• any external accreditation process
• records of training and development for all staff
• information on any staff misconduct investigations
• discussing information collected at team meetings, so learning and development needs are identified. Staff should also feel able to raise concerns about risks to patients and staff in confidence at any time.

• the mechanism for patient feedback and comments
• evaluating changes to ensure improvements were achieved
• the procedure for handling complaints – it should be publicised and robust, and comply with local authority social services and NHS Complaints (England) Regulations 2009
• data about the quality of the practice in some form, in public areas of the reception or on the website – eg results of a practice survey or summary of patient feedback from a suggestion box.
• display health and safety information, including the practice’s responsibilities.