At the start of the visit, the CQC inspector will meet with your registered manager. If the registered manager is not available the inspector can meet with another senior member of staff, for example a partner. The inspector should briefly introduce and explain who the inspection team are, the scope and purpose of the inspection, how any concerns they have identified will be escalated, and how their findings will be communicated.
After the introductory session, the CQC will ask the GP practice to present their own view of their performance, particularly in relation to the five key questions and six population groups and to include any examples of outstanding care and practice. There is no specified format or media for this briefing; you can choose whichever format suits the practice. You may wish to include a patient view. This should take no longer than 30 minutes.
Tips on how to prepare for your presentation (Appendix B)
GP practices are now able to submit some notifications on changes, events and incidents, by using a CQC online service account.
Read more information in the CQC notifications for GP providers
Practice leaflet and website
Ensure that the practice leaflet is up to date in line with the GMS/PMS regulations and is available in the practice with equivalent information on the practice website.
CQC inspectors may use websites as a resource to influence its decision making.
- Consider the pros and cons of building a GP practice website
- If you have a practice website, ensure it is regularly maintained and up to date
- Keep your practice information on the NHS website up to date
Create a new webpage containing information about CQC to include the following:
- registration and inspection
- lead contact and deputy for each CQC outcome
- lead contact and deputy for each of the five CQC chapters.
Involve the Patient Participation Group (PPG) in discussions around care, experience, quality and safety.
- GP practices must demonstrate that all people and population groups received the same outcomes, so practices should ask themselves how they will demonstrate this when asked.
- Install a hearing loop in the practice with associated signage.
- Wherever possible, the inspectors will observe interaction of staff and patients (for example, in the reception area). It would be worthwhile the practice manager, a member of the PPG or a colleague from a neighbouring practice sitting in the reception area to act as an observer for a period of time and report back on whether any changes should be made (eg improving confidentiality at the reception desk, making sure posters and displayed information is relevant and clear).
Read more information in the CQC guide working together with the PPG
CQC inspectors may ask the GP practice about how it shares the patterns and trends of complaints and the evidence of change to improve the service offered.
- The practice may wish to consult with patients and the Patient Participation Group (PPG) on at least an annual basis and provide evidence of change.
- Be aware of the human rights approach taken by CQC.
Learn more about the CQC's approach to human rights
Access to appointments
Be aware that the CQC inspector will ask about appointment availability for patients to access:
- female GPs and nurses
- male GPs and nurses
- pre-bookable appointments in advance
- urgent apoointments
Ensure that you are aware of the systems in place, but also be open and honest about the challenges in achieving good access.
Cooperation with other providers of services and care
The CQC will expect the practice to demonstrate how it cooperates with other providers. The inspectors may want to know more about:
- any interpreter service used, including access to sign language if required
- the hand over to the out of hours service and in particular for patients near the end of life.
Demonstrating - managing risk and quality
When monitoring compliance the CQC inspectors may request evidence from the GP practice to demonstrate how they are meeting requirements.
If asked by a CQC inspector to demonstrate compliance, you might use some of the following examples. This is a non-exhaustive list.
GP practice systems and processes
- the systems in place for risk management and clinical governance and any evidence of any change in practice as a result
- conducting clinical audits
- conducting regular significant event reviews and analysis
- conducting risk assessments as and when appropriate and undertake all reasonable actions (see outcomes 8, 10, 11, 14 and 21)
- incident reporting related to controlled drugs and other medicines and any evidence of learning or action taken
- reviewing and updating the process for the workforce to read relevant policies, protocols or procedures
- relevant local or national guidance having been taken into account
- reviewing of all information gathered about the safety and quality of the services GP practices provide. From these reviews practices can identify any risks and the action to be taken to address them and pinpoint ways to improve the service to patients. There is a lot of data available about practices on the CQC website, including its intelligent monitoring report
- circulating and acting on clinical guidance, medical alerts and safety alerts and any other relevant local or national reports, so that staff can change their working practices, if necessary, for the benefit of patients.
Learning and development
- any external accreditation process
- records of training and development for all members of staff
- information related to misconduct investigations of the staff
- discussing key information collected at practice team meetings so that learning and development changes to working practice are identified if necessary. However, the practice workforce should feel able to raise concerns about risks to patients and staff in a confidential manner at any time. See BMA guidance on raising concerns
- having a mechanism for patient feedback and comments
- evaluating changes to ensure improvements have been achieved
- having a publicised and robust complaints procedure for handling complaints from patients, this should comply with the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009
- showing data about the quality of the GP practice in some form, within the public areas of the practice reception or on practice website. For example, results of a practice survey or a summary of patient feedback received via a suggestion box. Similarly, for the safety of patients, display health and safety information (including information about own responsibilities for contributing to health and safety) in the practice reception.
Infection control and cleanliness
The CQC may inspect areas for cleanliness and infection control based on the CQC Outcome 8 requirement. You may find some of these actions helpful in ensuring you meet the minimum standards.
- Ask a practice nurse to lead on CQC Outcome 8 (Infection control and cleanliness) and ensure they have adequate training to carry out this role effectively.
- Evidence of infection control audits, cleaning schedules (including deep clean), cleaning logs and training undertaken on a systematic basis, documented and saved in a shared domain or place as a minimum.
- Notices and logs when areas were last cleaned eg in toilets, clinical rooms and waiting rooms.
- Ensure there is hand gel available in key areas.
- Where practically possible ensure there are no stains or discolouration on carpets.
- The GP practice needs to show how it is mitigating risks to include dealing with sharp disposal and injury.
Make sure your practice considers how it can demonstrate clear leadership within the business and across the team and workforce.
- Conduct frequent workforce meetings with a shared agenda and minutes.
- Ensure the workforce has read, understood and signed up to the CQC GP practice Statement of Purpose.
- Ensure that the workforce feels supported and valued and they have the appropriate employment policies, procedures and systems in place.
- Be aware that CQC inspectors may ask for evidence of formal recorded supervised support for the entire workforce.
- CQC inspectors may be interested in talking to the workforce about whistleblowing and whether staff feel safe to do so.
- CQC inspectors may wish to speak to staff on a one to one basis or as a group.
- Evidence that the entire workforce is able to identify and learn from mistakes when appropriate.
Staff and workforce
Ensure that the GP practice is ready to answer any questions related to CQC Outcomes 12, 13 and 14 and have the evidence to support those answers. You may find the following list helpful in preparing your staff. This is a non-exhaustive list.
- Create a robust recruitment and selection policy that meets the equality agenda and minimises risk.
- Evidence of recruiting new staff to include advert and interview notes in the personnel file.
- Evidence that the GP practice has in place a workforce induction programme to include a section on CQC and disclosure of any criminal activity.
- Ensure staff annual performance appraisals are undertaken and documented and saved in an appropriate domain. It is good practice to include a section on managing risk during the annual appraisal to include any criminal activity disclosures.
- Ensure evidence of DBS check (or risk assessment if non-clinical) is available. Undertake a risk assessment (to include all non-clinical staff without a DBS); take reasonable actions and use it as a working resource and tool.
- CQC inspectors may wish to discuss recruitment processes, in particular GP locum appointments.
Ensure that the GP practice holds HR personnel folders for the entire workforce (including GP locums and partners) in place with an index of key information containing:
- emergency contact details
- professional membership registration
- GMC registration
- NMC pin number
- performers list detail
- indemnity details
- photo ID - CQC inspectors may wish to see evidence in each HR folder that photo ID has been seen during the recruitment process (this may include a photocopy of the document seen or, at least, a record of its type and serial number)
Read a list of example questions aimed at non-clinical staff (Appendix C)
Read hints and tips for answering questions aimed at clinical staff (Appendix D)
Policies and procedures
CQC inspectors may also wish to see policies, procedures, guidelines and protocols if felt appropriate and necessary, but what is most essential is that the GP practice workforce understands what these mean in operational terms.
It is vital for any documents to reflect what the workforce does on a day to day basis. It may help to have a practice intranet site which contains these policies and is easily accessible by all members of the practice.
Your patients, and their experience of care
CQC inspectors want to get to the heart of people's experience of care, so the focus of their inspections is on the quality and safety of services, based on the things that matter to people.
- Use past case examples to help demonstrate your compliance.
- Describe in detail the service offered and how staff go that 'extra mile' to help achieve the best possible outcome for ALL patients.
- CQC inspectors will talk to patients (pre and post consultation) about their experience, particularly around 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.
- CQC inspectors may also like to sit in the waiting room listening and talking to patients and observe the meeting and greeting of the patient at the reception (as mentioned in Section 11 - Patient involvement).
Consider creating patient surveys that incorporate the five questions about services that are provided to people in the six population groups. Familiarise yourself with CQC's population group definitions, as follows:
- older people
- people with long-term conditions
- families, children and young people
- working age people (including those recently retired and students)
- people whose circumstances may make them vulnerable
- people experiencing poor mental health (including people with dementia.
Read more detailed information on these population groups and their definitions
Key lines of enquiry
As part of the new approach to inspecting, CQC inspectors follow Key Lines of Enquiry (KLOE). It is therefore vital to respond adequately to CQC inspector questions to illustrate best the quality and safety of services. CQC will undertake a matrix approach around the 6 population groups, and the 5 categories of questions.
There are five categories of questions:
- Safe - people are protected from abuse and avoidable harm.
- Effective - people's care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.
- Caring - staff are involved and treat people with compassion, kindness, dignity and respect.
- Responsive - services are organised so that they meet people's needs.
- Well-led - the leadership, management and governance of the practice assures the delivery of high quality person centred care, supports learning and innovation, and promotes an open and fair culture.
Most KLOEs are 'mandatory' and must be followed at each inspection. Others are 'additional' and will only be checked if the CQC pre inspection checking suggests they should be.
The KLOEs are underpinned by prompts (CQC have these prompts at hand during inspections) that give examples of how KLOEs can be followed.
Consider the Key Lines of Enquiry approach of asking the GP practice questions during preparing for inspection.
The following guide includes the types of KLOE and types of questions asked within each category
Download the CQC Appendices to provider handbook