The Care Quality Commission is the independent regulator of health and social care in England. It inspects all registered care providers on a regular basis to ensure that safe and effective care is given to patients in a caring, comforting and supportive environment. A team of inspectors would typically consist of nurses, doctors, social workers, and other relevant professionals who are experienced in their respective fields. Depending on inspection ratings, if a care provider is failing to provide an acceptable and standardised level of care then the CQC has the power to restrict the provider’s registration, fine them, or restrict the type of care a health or social care provider can give.
An impending Care Quality Commission (CQC) visit to any trust expectedly tends to cause a lot of anxiety amongst all staff members working in a trust. This is more so among doctors because although we are experts in the medical care of our patients, patient driven safety protocols on the wards or in community mental health teams (as well as other administrative and managerial information that doctors tend to be less sure about) will more often than not make doctors worried about an inspection. Central & North West London (CNWL) NHS Foundation Trust had its CQC inspection in the last week of February this year. The trust was well prepared for the inspection but both senior and junior doctors expressed concerns regarding the nature and type of questions they could be asked and what was generally expected of them.
Bearing this in mind, Dr. John Lowe, director of postgraduate medical education at CNWL, got into talks with the directors at the trust’s quality and service improvement department to discuss how best to address the aforementioned problems. Registrars were then contacted to determine who could help. Two other registrars and I indicated interest and were tasked with developing a factsheet for doctors that would contain a list of questions that were likely to be asked by a CQC Inspector.
Getting the required information:
I took a lead on this because in 2013 while I was working as a specialty doctor for another trust in London. I had been interviewed by CQC inspectors and had a fairly good idea of questions and concerns that they would want both inpatient and community team doctors to address.
First of all I visited the CQC website and also called the CQC to make informal inquiries. I then called or met up with four previous colleagues (two senior doctors and two nurses) who had worked with me at my previous trust to discuss the factsheet. They recalled questions they had been asked and also gave me tips on how they answered difficult questions.
I compiled a list of questions based on the aforementioned sources as well as my previous experience and submitted the questions to the associate director of the quality and service improvement department. The service and quality improvement department had staff members who had also previously worked in other trusts that had been previously inspected by the CQC. One of their managers had actually previously been a CQC inspector. The quality and service improvement department were thus in a position to review our questions and filter out the ones that did not need to be included in a CQC doctors factsheet. The other two registrars drew up and submitted questions which they thought would be pertinent.
A CQC Factsheet for Doctors was subsequently produced in late January. The factsheet had several headings and had relevant questions under each heading that a doctor working on a ward or in the community could be asked by a CQC inspector. The factsheet was published in the trust’s weekly newsletter on the 30th January 2015, three weeks before the CQC inspection. It was also emailed to all the trust managers, directors, and doctors. Each medical team in the trust discussed relevant parts of the factsheet and produced answers that reflected their practice.
Even before the visit, we started receiving positive responses from doctors working all over the trust about how useful the factsheet was. The director of post graduate medical education was impressed by and suggested that I try to get it published so that other doctors working in other mental health trusts could use it to get themselves ready for a CQC inspection. I think what really topped the good feedback we got before the visit was the even better feedback we got after the visit from various consultants and senior doctors. They said that they had been asked most of the questions in the factsheet and felt that the trust had really been supportive of its doctors by producing such a factsheet.
I am currently trying to liaise with the quality and service improvement department to determine a way to objectively measure the feedback we got regarding the factsheet, and possibly produce a quality improvement report based on the feedback. To take a look at the CQC Factsheet for Doctors, just click here.