Care Quality Commission (CQC) – A New Era?
The Care Quality Commission (CQC) began operating on 1st April 2009 and was created to regulate and inspect health and social care services.
Since its inception, a number of additional services have come under its umbrella, including Primary Dental Care Services as of 1st April 2011, and from 1st April 2015, a new format was implemented for inspections.
In this blog, we take a look at the CQC inspection checklist and what it means for dental practices…
Life before the CQC
Prior to the CQC taking over the regulation of Primary Care Dental Services, NHS Dental Practices would be assessed by Dental Reference Officers (DRO), which often involved the DROs observing a dentist at work.
The advantage of this system was that as DROs were qualified dentists, they understood the required standards to be met in terms of treatment.
In addition to the above, all Dental Practices were governed by the GDC and were expected to meet the standards set by them.
There was no on-site inspection process by the GDC; dentists, as professionals, were left to ensure they maintained those standards, and the majority did in order to maintain their business and reputation.
There was no apparent need for an overhaul of the system. There was no public outcry regarding the quality of dental practices and no high-profile cases of errant dental practices.
However, as with many areas of life, the Government took the view that this additional layer of regulation would benefit the public, in principle creating a more effective and standardised regulation of Primary Care Dental Services.
CQC – The Beginning
From 1st April 2011, the CQC was tasked with regulating Primary Care Dental Services.
The first hurdle of the old regime was for Providers of Primary Care Dental Services to register with the CQC. Each Provider had to show from the outset in the application form that it was meeting the ‘essential standards’.
The application form ran to 42 pages, setting out each regulation and asking the practice to state whether or not they were compliant and, if they were not, how they would become compliant. In addition, guidance was provided on how to meet the essential standards, which comprised 174 pages.
On top of the registration form, each Provider had to have a ‘Statement of Purpose’. Needless to say, the registration process alone was both complex and time-consuming.
After the registration process, nearly all Providers underwent an inspection. This involved further preparation and time to ensure the ‘essential standards’ were being met. The plan was that follow-up inspections would then take place every two years thereafter to ensure continued compliance.
However, the CQC grossly underestimated its workload, and it took up to April 2015 to complete the initial inspections – and even then, the task was still incomplete!
The concern with this inspection regime was that it was a ‘tick box’ exercise undertaken by non-professionals.
Whilst, on the face of it, a few underperforming practices may have improved, questions were raised as to whether it improved the overall quality of care; for example, did it prevent injury, and were patients safer?
The general feeling amongst dentists is that no, overall, it did not, and instead, it placed substantial administrative burdens on them that took them away from the practice of dentistry.
Whether a mark of successful regulation or not, the GDC and NHS England reported increased complaints about dental professionals.
Given that the CQC inspection process aimed to focus on a patient’s experiences and ensure they were being treated fairly, it suggests a change was indeed needed.
A New Era for the CQC?
In its report, ”A fresh start for the regulation of primary care dental services”, the CQC acknowledges that when it started regulating dentists, it did not get the model right.
The report confirmed that the CQC had inspected nearly all of the 10,102 dental practices registered. However, one in eight was not meeting the regulations compared with one in five in adult social care.
Furthermore, in the majority of cases where inspectors re-visited practices, the concerns raised had been addressed.
The CQC, therefore, identified that the dental profession presented a lower risk to patient safety compared with other areas inspected by the CQC.
Following a review of the inspection regime, two Regulations came into force on 1st April 2015, creating new ‘fundamental standards’.
These fundamental standards apply to all regulated activity, not just Primary Care Dental Services. You can find guidance on the fundamental standards here and examples of notable practices for dentists here.
As a result of the new standards and the review of the existing inspection process, on 5th April 2015, the CQC implemented a new system for regulating Primary Care Dental Services.
The new system for CQC inspections explained
- The removal of the rating system for Primary Care Dental Services
- The introduction of five questions about the service: Are they safe? Effective? Caring? Responsive to people’s needs? Well-led? These will be used to ensure the fundamental standards are being met
- In order to answer these five questions, inspectors will use ‘key lines of enquiry’ (KLOE) and prompts. These KLOE and prompts, along with examples of how they can be met, can be found in the Provider Handbook
- As before, there are two types of inspection, but these have been re-labelled ‘Comprehensive’ and ‘Focused’ inspections. Registered Providers will conduct a comprehensive inspection and will usually look at the Practice as a whole. A Focused inspection will either be a follow-up or be responding to a particular concern or issue
- Clinicians will be involved where necessary with the inspection process
In addition to the Provider Handbook, you can read our article CQC Inspections, a practical guide to answering the five key questions, which help you meet the five questions and fundamental standards.
Positive changes to the CQC inspection
Under this new checklist, there is more flexibility than in the previous process. Under the section ‘Making judgements’, it states:
These examples of what we would expect to see in demonstration that the characteristics of each key question, and fundamental standards, are being met. The KLOEs and examples of evidence are not an exhaustive list or a ‘checklist’. We will consider the context of the Practice when we look for evidence.
Therefore, the KLOEs and prompts do not need to be followed to the letter. As long as the registered Provider can show the five questions and fundamental standards are being met, they should be free to run their Practice as they see fit.
The Handbook is much more user-friendly; the five questions each have the relevant KLOEs set out and examples of how to demonstrate these have been met.
The relevant Regulations are referred to under each question, but the document does not specify the Regulation and avoids legal jargon.
Having in place good Practice policies and procedures, having regard to patient satisfaction, ensuring legal documentation is completed, and training and managing staff effectively will significantly assist when preparing for a CQC inspection; all the elements needed to run a successful business in any event.
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Please note that the information contained in this article was correct at the time of writing. There may have been updates to the law since the article was written, which may affect the information and advice given therein.