What to expect when you're inspected

Inspections by the Care Quality Commission – either announced or unannounced – are now a fact of life for general practices in England. Here James Hedges of the CQC provides some details on what to expect 

ON 1 April 2013, all primary medical service providers in England registered for the first time with the Care Quality Commission (CQC). The Commission’s focus is to look at the impact of care on patients and to ensure that all patients receive safe and good quality care, wherever it is provided.

Inspections by the CQC focus on the experiences people have when they receive care and the impact that care has on their health and wellbeing. Inspectors check their findings in a number of ways - including speaking with staff - before reaching their judgements. Our judgements against the regulations are informed by people’s experience. This is why inspectors spend a lot of their time on an inspection talking to patients.

Before the inspection

CQC receives information from a number of different sources, including members of the public, commissioners, professional and other regulators, as well as notifications, complaints and safeguarding alerts, contract monitoring reports and, where applicable, the last inspection report. CQC inspectors and analysts continually monitor and assess this information.

If a decision has been made that an inspection is warranted then an inspector will call you at least 48 hours before a scheduled inspection to let you know they will be visiting. Responsive inspections, where there are concerns about a service or the care of patients, are likely to be unannounced.

As inspections are carried out at short notice, inspectors won’t ask you to send any information before an inspection, but they may ask you for some details during or after a visit.

The inspector arrives

When an inspector arrives, they will introduce themselves and show their identification. CQC identification badges include a photograph of the inspector on the front and a copy of their warrant on the reverse, signed by the chief executive. If you are unsure about the identity of an inspector please contact the CQC enquiries team on 03000 616161, who can verify details for you before allowing access.

The inspector will want initially to speak to the registered person or the nominated individual. If they are not available, they will ask to speak to a partner and/or a practice manager. They will inform them which of the regulations they will be focusing on during the inspection. They may also request a suitable room or place to use for the duration of the visit which will be used as an interview room to talk to staff and patients.

Inspectors will give you time to organise yourselves after they arrive. However, sometimes they may need to start the inspection before a senior person is contacted, for example if they are carrying out a responsive inspection.

How long an inspection takes will depend on the size of your practice or the range of the services you provide. In most cases it is unlikely to be more than one working day.

During the inspection

they will cross-check what they see and hear against other evidence such as records. They are looking to see evidence that the regulations are not being met; however, where they see or find good, excellent or innovative practice, this will also be included in the report.

Inspectors will speak with managers and members of staff at all levels. They won’t expect all staff to have the same knowledge but they will expect them to understand their role in providing good outcomes for patients and also what to do if they have concerns. Inspectors may also speak with members of your patient participation group (see page 8 of this issue).

One of the tools that an inspector will use is ‘pathway tracking’. This looks at a person’s route through your service and tracks their views of that journey. It is an important part of an inspection as it captures information about a sample of people receiving care or treatment from you and their views about it.

Inspectors may ask to look at specific areas of your service (e.g. how you involve people in their care) and may also ask you to show information such as training records. They will not normally spend a great deal of time reading policy or procedure documents, unless they need to look at them to substantiate other evidence. For example, staff may be asked what training they have completed and how they use it in their role. Inspectors may then want to verify this by checking the training records.

There may be times when it is not appropriate or possible for our inspectors to speak to patients or staff. Where this is the case, you may be asked for information about how you gather feedback, such as patient surveys, and inspectors may ask to see this feedback. You might also be asked for your help to arrange to contact patients after inspectors have left.

The end of the inspection

CQC inspectors may ask for additional information to confirm evidence that has been gathered during the inspection. They may be able to tell you what they require at the end of the visit or they may request it later. If they do ask, it must be provided within 48 hours.

Before an inspector leaves they will meet with you to give you feedback and update you about the inspection. This is also an opportunity for you to give us feedback and ask any questions.

James Hedges is a media officer at the CQC