Practice Plan’s Amy Hansford looks for answers to the questions you’re asking.
What issues are ‘hot’ with the CQC, and how can I prepare for them?
Many practices tell us they struggle to keep abreast of what feels like a never-ending series of rapidly changing regulatory requirements they need to comply with, and, unsurprisingly this is a source of concern to them. Added to that is the need to ensure that the whole team is involved in compliance and that they understand the role they play in ensuring the whole team is ready for a CQC inspection at any time.
To find out about how practices can ensure they are prepared for their CQC inspection, I asked Pat Langley, CEO of Apolline, for her advice on any updates and hints and tips on how best to prepare and also on anything that has changed, I asked Pat: What issues are ‘hot’ with the CQC, and how can I prepare for them?
Pat: ‘Well the answer is pretty much the same things as have always been ‘hot’! That’s not to say there aren’t a few new things that have risen up the regulatory agenda. With that in mind, I will share some ‘new’ news and some old news about what the CQC is looking for when they inspect your practice.
The CQC’s remit is to inspect dental practices (and all providers of health and social care services) to ensure they are providing care that is safe, effective, caring and responsive and that practices are well-led.
The two areas that most practices still ‘fall down’ on are the safe and the well-led categories.
Demonstrating that you provide safe care
Think about all the things you do all the time to ensure that your patients are protected from abuse and avoidable harm. This is a very long list and includes things like:
- Everything to do with infection control and the management of healthcare waste
- The use of correct Personal Protective Equipment (PPE)
- Everything to do with environmental cleaning
- Everything to do with radiation protection
- Everything to do with being able to respond effectively to medical emergencies
- Everything to do with sedation (if applicable)
- Health and safety, risk assessments, Control Of Substances Hazardous to Health (COSHH), legionella
- Safer sharps and Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR)
- Electrical, gas and fire safety
- Everything to do with safeguarding
- First aid
- Everything thing to do with prescribing and administering medicines.
Not such a long list you might say but…
Every item on the list has a number of component parts, meaning that the list is very long indeed so it’s no wonder that this key question often has gaps that practices are required to rectify.
‘New’ news in the ‘safe’ category
Firstly, there’s sepsis. Dental practices should be aware of the signs and symptoms of sepsis and have plans in place for what they will do in the event that sepsis is suspected, either from a dental or a non-dental cause.
Sepsis is a life-threatening condition that can arise when the body’s abnormal immune response to an infection causes organs to start failing.
Practice teams should ensure they are aware of the signs and symptoms of sepsis and should know that onset and deterioration can often be rapid.
The following are symptoms to look out for:
- Altered mental state
- Malaise
- Shivering
- Muscle pain
- A failure to pass urine in the previous 18 hours
- Breathlessness and increased breathing
- Increased heart rate
- Low blood pressure
- A non-blanching rash and cyanosis of the skin, lips or tongue.
Your ‘out of hours’ telephone message should clearly state that any patient suffering from a dental infection that is making them unwell should seek immediate assistance from the local Accident and Emergency department.
CQC inspectors may ask a practice how they would manage a case in which the extraction of a lower third molar has led to infection that does not respond to conventional antibiotic therapy.
Safeguarding
The second bit of ‘new’ news is that the fourth edition of the publication, ‘Safeguarding Children
and Young People: Roles and Competencies for Healthcare Staff’ was published in January 2019.
This states that level three safeguarding training is required by all ‘clinical staff working with children, young people and/or their parents/carers and/or any adult who could pose a risk to children and who could potentially contribute to assessing, planning, intervening and/or evaluating the needs of a child or young person and/or parenting capacity’.
The document then later only refers to level three training being required by paediatric specialists, which appears to conflict with the statement about competency requirements above. At the time of going to press we are awaiting clarification of what will be required.
Demonstrating that your care is effective, caring and responsive
The important things here are:
- Regular patient records audits
- Clinical audits
- Obtaining feedback from your patients and acting on it
- Handling complaints effectively
- Providing out-of-hours advice and treatment.
Demonstrating that your practice is well-led
Being able to demonstrate that your practice is well-led is extremely important, not just because it is the biggest area that the CQC finds issues with, but also because a well-led practice will be a calmer, less stressful environment to work in, and you should also be more successful financially.
- Evidence of good leadership
- Supportive management structure and processes
- Regular team meetings with actions followed up
- Recording significant incidents with evidence of actions taken to prevent a recurrence of adverse events
- Clearly defined roles and responsibilities
- Robust recruitment processes
- Comprehensive induction and ongoing role-specific training
- Regular appraisals with personal development plans.
So, there you have it – easy really isn’t it?! Except of course it isn’t easy. Ensuring that you stay on top of everything you need to do to ensure you provide care that is safe, effective, caring and responsive and that your practice is well-led is not easy at all. And often the biggest worry is ‘you don’t know what you don’t know’. There is help out there for those who find it all too difficult and overwhelming.’
My thanks to Pat for sharing her expertise in this area. Remaining compliant with the regulations is a vital part of successful practice management, and with these refresher points and updates the whole team should feel a little more confident in their ability to meet the CQC’s requirements. There is also helpful advice to be found on the CQC’s website https://www.cqc.org.uk/ particularly under their ‘myth-busters and tips for dentists’ section.
Pat will be part of two CQC, Complaints and Compliance panel discussions in the Dental Business Theatre presents ‘The BIG Questions’, programmed by Practice Plan and sponsored by Wesleyan Bank. The panels will take place between 3.45pm – 4.30pm on Friday 17th May and 11.15am and 12noon on Saturday 18th May. For more information visit: http://www.practiceplan.co.uk/events