CQC Ratings: The Good, the Bad and the Outstanding

Article | Richard Banyard, Director at CQCassist

Are You Ready for Your CQC Inspection?

Formal CQC inspections by the Care Quality Commission (CQC) have now recommenced following a lull during the pandemic.

So, it is time to assess:

• Is this ‘more of the same’ for CQC inspections, or are things now different?

• What current topics are of interest to the CQC?

• How best can I prepare for a CQC inspection?

What’s New?

The main process for CQC inspections remains the same – that is, visits to registered CQC organisations, followed by draft findings, and finally a publicly available report accompanied by a rating: ‘Outstanding’, ‘Good’, ‘Requires Improvement’ or ‘Inadequate’.

However, there are five subtle changes to the CQC’s new approach to inspections:

1. Visiting inspection teams are somewhat smaller.

2. This is coupled with more use of information submitted to the CQC by providers (both before and after an inspection).

3. A more risk-based approach is being adopted, with inspection topics focused on issues identified as needing attention during previous inspections in each provider.

4. There is more use of technology – such as visits and discussions by video link or phone.

5. A more flexible approach is being taken, with more frequent inspections for providers rated as ‘Requires Improvement’ or ‘Inadequate’, and longer intervals between inspections for better performers.

What Are the Key Issues?

Although CQC inspection teams still have the flexibility to review and inspect any aspects of a provider’s performance, some common themes and issues have been attracting particular attention. For example, a recent analysis of CQC inspections of GP practices reveals that the following issues regularly appear:

• Competence of non-medical prescribers.

• Call and recall systems – for example, for vaccinations and immunisations or cervical cytology.

• Responses to COVID 19 – and what safety measures are in place for patients and staff.

• Recording ‘do not resuscitate’ (DNR) orders for patients.

• Checks on whether MHRA safety alerts are being received and actioned.

• Staff training – especially in safeguarding.

• Staff recruitment checks – especially the appropriate DBS checks.

• Staff vaccinations and immunisations – including Hepatitis B, HIV and, of course, COVID-19.

• Systems for reviewing test results.

In addition, some perennial issues are still frequently assessed by the CQC. These include:

• Is there a clear vision and are there clear values for the organisation? Is there buy-in to this across the staff team?

• Is patient access appropriate for their needs – especially regarding the appropriate use of remote appointments?

• Are patients with English as second language being treated fairly and safely?

• Do patients receive relevant and timely reviews of long-term conditions (these have tended to be somewhat neglected during the COVID pandemic)?

• Are medication reviews scheduled and undertaken, making use of primary care pharmacists where appropriate?

• Are staff training arrangements in place and up to date – especially for mandatory training (which since July 2022 includes a legal requirement for staff to be trained in learning disability care for patients)?

How Do I Best Prepare for a CQC Inspection?

The CQC will naturally want to gather information from managers and review hard data, but an area that is often overlooked when preparing for inspections is clear and consistent information for staff.

So, some simple preparatory messages for staff are essential. These might include:

• Don’t panic! The inspectors are not trying to catch you out; they are testing that systems work.

• The CQC want to know staff are happy, safe and well managed – but mainly in the context of whether this underpins effective and safe delivery of care to patients.

• Be honest, open and transparent.

• Be positive.

• Be helpful.

• Tell the inspectors what your challenges are, and shout about what you do well and your successes (or they might miss them!).

• If you don’t know something, say so... but promise to forward the information later.

Finally, here are a few key hints if you’re expecting the CQC inspectors to be calling soon:

• Do get hold of some recent CQC reports from organisations in your local area. These may well give you some advance pointers about which issues may feature in your inspection.

• Don’t rest on your laurels. Several organisations have recently had their rating downgraded from ‘Outstanding’ to ‘Inadequate’. Remember, your rating will only be as good as your last inspection.

• Do check the basics. For example, are employees’ personal files complete? Are systems for recording incidents and accidents up to date? Are staff training arrangements clear and current? Have patient information and leaflets been updated (for example, to cover COVID-19 safety arrangements)?

• Don’t overlook staff inductions. The CQC inspectors may want to talk to your newly recruited staff as well as the more experienced members of your team.

Ultimately, CQC inspections – like death and taxes – are always with us. So do all that you can to incorporate preparations for inspections into your ongoing planning and operations.

Good luck!

Contact us for any help with your CQC inspections or registrations at: info@cqcassist.co.uk

Richard Banyard

Director at CQCassist

Richard Banyard has worked in a wide range of NHS management roles for over 35 years. This included over 10 years at Board and Chief Executive levels.

Richard has also been directly involved in consultancy, and established CQCassist in 2012, which supports organisations with their CQC registrations, preparation for inspections, and all other aspects of support required to ensure CQC compliance.

Richard has a Master’s Degree in Health Services Management and is a fully qualified teacher with a Post Graduate Certificate in Education.