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How to achieve a CQC outstanding rating

Thorough preparation is fundamental for a successful CQC inspection, according to a practice that received an outstanding rating. Rima Evans reports.

Practice manager Lin Baillie (centre) and the team at Wigton Group Medical Practice, which was rated outstanding by the CQC (Picture: UNP)
Practice manager Lin Baillie (centre) and the team at Wigton Group Medical Practice, which was rated outstanding by the CQC (Picture: UNP)

Staff at the Wigton Group Medical Practice in Cumbria began preparing for their CQC inspection  as soon as details of the new regime were announced early last year – 10 months ahead of their actual inspection in November.

‘Our preparation began the moment the CQC announced their new rules following their pilot, long before we had an actual inspection date,’ practice manager Lin Baillie, explains.‘We started  to make small changes such as putting disposable curtains in treatment rooms.’

The semi-rural, eight-GP practice was among the first in Cumbria to undergo the new-style CQC visits. Mrs Baillie says that while there were hopes for the best rating possible, the practice didn’t intentionally work towards achieving an outstanding grade.

Strong foundations

Realistically, she points out, no amount of short term preparation can help you achieve the highest rating if the foundation and basics at the practice are not solid, something which takes years of commitment and hard work.

‘Though we prepared for months beforehand, really what we had in place in terms of level of patient care, culture and ethos was the result of long term continuous improvement and planning. So we were confident we were delivering quality care.’

Wigton was rated outstanding in three of five of the inspection areas (being effective; caring; and well-led) and in all of the checks on the six specific services it covers. It was rated as good in the inspection areas of providing safe services and responsive services.

Positive working environment

Mrs Baillie attributes the practice’s achievement to the positive working environment cultivated at the practice, built on values such as team working, mutual respect and trust. 

‘We have a can-do attitude and stable workforce,’ Mrs Baillie says. ‘Nobody is more important than anyone else which can sound trite but that is how it is here. The non-clinical staff are valued very much by the clinical staff. 

‘We also offer integrated care, we don’t work in isolation but alongside all areas of the NHS, with community nurses, for example, and the third sector. Since we moved to brand new purpose built premises 10 years ago we are co-located with the community nursing team which enhances the team building aspect. Communication is much better and working relations are strong. We are very much a part of the community.’

Preparing for the inspection

The ground work put in ahead of the inspection included the lead GP reading up on CQC inspection reports that had already published as well as talking to other local practices that had been through the process to garner tips and advice.

Crucially, Mrs Baillie says, all practice staff were very much involved in the process. Meetings were held to keep them informed and allay any fears. 

‘There is no doubt about it, the inspection was one of the most stressful experiences of my working life,’ Mrs Baillie admits. ‘Perhaps it was self inflicted since it was so important to us all that we didn’t sell ourselves short and did our best to demonstrate that we provide the excellent care and service that we believe we provide.

‘There has also been a lot of negative publicity around the process so naturally staff did have some concerns. We held a session to make it clear what would happen, who the inspectors would talk to, and reassure them that they could be honest with inspectors. It was important we did that.’ 

Inspection day

The inspection itself went smoothly, the inspectors were professional and supportive, explains Mrs Baillie and the practice encountered no nasty surprises. But again this was down to good preparation. 

‘We had carefully read all the material sent to us to ensure we did what they asked, that the inspectors had access to data required and they could speak to a wide range of staff. In our case we even included cleaning staff in that.

’The practice decided to pull together a presentation, led by two of the GPs, to start the day of the inspection. This was useful, explains Mrs Baillie, for showcasing what the practice does well in terms of service provision and workplace culture. 

‘This presentation is optional, but it set the tone of the day so I felt it was useful,' she explains. ‘We included patient feedback and invited a patient to be at the presentation, which myself and a member of the admin team also attended. We talked about patient stories, highlighted why we offered a good service and showed them audit results, demonstrating the effects of improvements that we had made. Being able to show that we don’t just audit for its’ own sake was crucial. I think they were impressed.’

Advice for other practices

What advice does Mrs Baillie have for other practices facing a CQC inspection? 

  • Be in control: Read all the material the CQC sends ahead of the inspection thoroughly so you are ready with the correct paperwork and can make available all the people the inspectors need to speak to.
  • Prepare fully by reading reports from other practices to see what kinds of issues and weak spots are highlighted by inspectors. 
  • Think about easy wins. Changes such as buying disposable curtains or investing in vinyl chairs (rather than fabric) are easy to implement and will tick boxes.
  • Maintain good record keeping, but also show that you act on the results of your audits and service monitoring. ‘Don’t just keep hold of the data on the services you provide, remedy areas of weakness, then re-audit so you can demonstrate the outcome of the improvements you have made.’
  • Involve patients in the process. ‘Most of them are supportive, they will be keen to help and they are usually your biggest advocate. Most practices have a patient participation group, so use it.’
  • Prepare your staff as much as you can and reassure them they are not alone in feeling anxious or nervous. ‘There’s no getting away from the fact that it is very stressful. The process involves non-stop questions. Prepare your staff for that and stay focused. Carry on do your job as you would normally and answer honestly.’
  • Don’t allow negative stories to overwhelm you. ‘Focus on the task in hand put the negative stuff out of your mind.’
  • Remember it’s about team work. ‘To survive the inspection and come out of it successfully requires a whole team approach, the process can’t rely on just one or two people.’

Maintaining the outstanding rating will be the main challenge for the future, Mrs Baillie admits, especially amid the current pressures facing general practice in respect of workload and funding. ‘We need to maintain the culture we have created here but we think we have robust enough systems in place to keep high standards.’

More resources

For more details on how the CQC inspection process works read Medeconomics' guide to CQC inspction

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