The Care Quality Commission (CQC) is an independent body that provides information and regulates the quality and availability of health and social care services in England.
The CQC regulates not only dentists but also hospitals, GPs, ambulances, mental health services, care homes and care in people’s own homes, and services for people restricted under the Mental Health Act.
The aim of the CQC is to ensure that patients receive better care and that standards of quality and safety are met. They also encourage ongoing improvements.
Since December 2014, the CQC has been testing a new approach to the inspection of dental practices, using specially trained inspectors accompanied by dental advisors. The reports focus on whether services provided are safe, effective, caring, responsive and well-led. The CQC have announced that they will be rating services and they will highlight where care is outstanding, good, in need of improvement, or inadequate. This rating system does not apply to dental care services in 2015/16, as they are only inspecting 10 per cent of England’s 10,000 dental practices. The focus will be on those that are a ‘cause of concern’, as dental practices present a lower risk to patients than other environments. However the CQC will be seeking views on whether to provide ratings after 2016.
From April 2015, the CQC has withdrawn its outcomes and replaced them with eleven fundamental standards. However nothing appears to have dropped from the previous outcomes. The significant change is the depth of the inspections. Previously, inspectors would have looked into around five of the eleven outcomes. In future, they will look into all eleven, and will examine them in more detail. This means you can expect the inspectors to spend an entire day carrying out the inspection.
The fundamental standards as mentioned above are:
- Care and treatment must be appropriate and reflect service users’ needs and preferences.
- Service users must be treated with dignity and respect.
- Care and treatment must only be provided with consent.
- Care and treatment must only be provided in a safe way.
- Service users must be protected from abuse and improper treatment.
- Service users’ nutritional and hydration needs must be met.
- All premises and equipment used must be clean, secure, suitable and used properly.
- Complaints must be appropriately investigated and appropriate action taken in response.
- Systems and processes must be established to ensure compliance with fundamental standards.
- Sufficient numbers of suitably qualified, competent, skilled and experienced staff must be deployed.
- Persons employed must be of a good character, have the necessary qualifications, skills and experience, and be able to perform the work for which they are employed (‘fit and proper persons’ requirement).
- Registered persons must be open and transparent with service users about their care and treatment.
The CQC also have a new approach to inspecting dental practices. Their guide to this process is called What to expect when we inspect, and explains what you can expect to happen from eight weeks before the inspection right up to the day of your inspection. It states that:
6-8 weeks before the inspection - CQC will telephone your NHS area team and send them a letter to request information they have about the dental practices to be inspected, such as assessments undertaken, complaints, risks or issues received, and any investigations undertaken.
4 weeks before the inspection - CQC will send an information request to your local Healthwatch requesting information they may hold about the quality of care provided. This will include evidence of good quality care as well as concerns.
2 weeks before the inspection - The CQC inspector will call you to introduce themselves, discuss the new approach and talk through the agenda for the inspection visit. You will receive a letter from the CQC to confirm the date of your inspection and request a copy of your statement of purpose, information on complaints/compliments and staff details. They will also send out some comment cards for your patients to complete and posters to advertise the inspection.
The CQC recommends that primary care dental practices read about the new approach to regulating and inspecting on their website at: http://www.cqc.org.uk/freshstartdental.
On the day of the inspection - The CQC inspector will use a combination of interviews with staff and patients, and reviews of information the practice has such as policies, procedures and data. They will also collect all comment cards completed by your patients and will require to see a range of documentation, including:
- Equipment maintenance certificates (autoclave, X-ray equipment, lasers, compressors, fire equipment etc.);
- Radiation protection file (this needs to be up-to-date - speak to your RPA for more information);
- Selection of audits and action plans;
- Infection control – policies, procedures and records;
- Staff recruitment – policies, procedures and staff files;
- Staff training records – safeguarding, IRMER, vulnerable adults, CPR, CPD, meetings etc.;
- Patient satisfaction survey and findings.
At the end of the inspection the CQC inspector will hold a feedback session with you to share their initial thoughts about what they had found. Following the inspection they will draft an inspection report. You will have the opportunity to challenge any inaccuracies at this stage. They will then publish the final report on the website.
The CQC is always changing and evolving in order to improve the services we offer to our patients. Whilst most of the recent changes apply mainly to other health sectors, it is very important that we exceed the standards expected from us to ensure our patients receive the best standard of care. Details of outcomes, fundamental standards, policies, expectations, guidelines and much more can be found on the CQC website. It may be worth bringing in an external person to prepare you for the CQC inspection, especially if you are new to management and the CQC, or if you require help with preparation.