What does an ‘inadequate’ practice look like? Focus on ‘caring’

In the third part of our series, Practice Business explores the factors than can lead to your surgery being deemed ‘inadequate’ – and what you can do to avoid them

CQC inspections focus on five areas, covering how safe, effective, caring, responsive and well-led your practice is. They’re comprehensively outlined within the CQC’s key lines of enquiry (KLOE). If you fail to deliver the service the regulator expects, you could receive a damaging ‘inadequate’ rating.

Describing ‘inadequate’ services simply as those that are ‘performing badly,’ the CQC provides useful guidelines on how practices can to meet its inspection criteria and avoid a negative assessment.

In the third of our in-depth articles we focus on what the CQC means by ‘caring.’

Defining ‘caring’

The CQC defines a caring practice as one where, ”Staff involve and treat you with compassion, kindness, dignity and respect.”

Effective care is provided when:

• People are treated with kindness, respect and compassion, and are offered emotional support when they need it.
• The practice supports people to express their views and be actively involved in the decisions about their care and treatment.
• People’s privacy and dignity are respected and promoted.

Practices may receive an inadequate rating for failing to demonstrate compliance with any of the KLOEs. The CQC notes three specific areas, in relation to care, where practices commonly experience difficulties:

1. Confidentiality issues
2. Failing to support the emotional needs of carers.
3. Lack of respect, dignity, compassion and empathy

1. Keep it confidential

Every patient should expect confidentiality and compassion – where this is missing, a practice will be marked down

In one practice inspected by the CQC staff weren’t following the agreed confidentiality policy; despite a screen being in place, patients in the waiting room able to hear confidential conversations and patient-sensitive information.

The CQC acknowledges that dealing with large numbers of patients , often cramped, waiting rooms can be a challenge in maintaining complete confidentiality but they noted that, in this instance, the practice wasn’t doing ‘all it could’ to maintain confidentiality and privacy.

Practices should make every effort to mitigate potential confidentiality breaches – and be able to demonstrate this to the CQC.

2. Emotional impact

Practices should provide support for those who use primary care services – and those who care for them – to help them cope emotionally with whatever they are experiencing.

The CQC won’t just speak to staff on an inspection – they speak to patients too. Patients they spoke too at one practice weren’t positive about the emotional support they were receiving, with some claiming that they felt staff didn’t act compassionately.

At the same practice, a patient who had suffered a recent bereavement claimed the practice had made no effort to contact them; another said the death certificate had taken some time to be produced.

In reality, not all patients will be happy with your services but, if a number complain or are unhappy, there could be a problem. In one of his valuable blogs, Dr Nigel Sparrow explains the importance of caring for carers, providing some useful advice for all practices.

3. A little respect

Kindness, dignity, care and compassion are core NHS values. When patients aren’t receiving the care they expect and deserve, the CQC will grade you accordingly.

In one example of a care failure, a practice received 21 comment cards – 10 of which were negative. Common themes included difficulty in getting an appointment, a lack of dignity and respect in care and a doctor singled out for not caring enough.

The CQC negatively assessed another practice after they had received negative feedback from 50% of respondents.

In a poor example of dignity in care, one surgery had three treatment rooms with no curtains, leaving patients potentially exposed.

The CQC will explore areas where patient feedback is negative. Where there are variations in care, or explicit examples where patient dignity isn’t respected, they will take action. Kindness, dignity, care and compassion are some of the fundamental standards of care, and should be respected at all times and by all staff.

Further learning

For practices looking for additional guidance Nigel Sparrow, the CQC’s senior national GP officer, has produced comprehensive and clear information on some of the common reasons for receiving an ‘inadequate’ rating.

In the next article in the series we will focus on the importance of being a well-led organisation, and what you can do to safeguard against an ‘inadequate’ rating in relation to this dimension.

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