cqc visit guidance_bod and apolline

7/31/2019 CQC Visit Guidance_BoD and Apolline

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business of dentistry

PreParing for a cqc visit in 2012Background and IntroductionWith eect rom 1st April 2011, it became a legal requirement or ALL dental practices in England to be registered

with the Care Quality Commission (CQC). Inspections o practices commenced soon ater and up until December

2011 the CQC mostly visited dental practices in response to concern rom other agencies, i.e. PCT, other colleagues,

HSE, disgruntled dental technicians, ex-sta members or patients. These visits, called responsive visits, were oten

shorter and targeted to just the area o concern.

Since December 2011, the CQC has been carrying out routine, ongoing monitoring o compliance inspections andinspectors have been set a target o visiting 15% o all registered dental practices by the end o March 2012. This

involves over 1,000 practices, meaning it is both a signicant and representative sample. Thereater, inspections will

be ongoing.

As the number o inspections has increased, we have collated inormation and eedback on how visits have gone

and below are our thoughts and observations on how a CQC inspector may approach a planned inspection visit to a

dental practice. This cannot be taken as a basis in act as to how your practice visit will be conducted or necessarily

the questions that will be asked as the inspectors seem to vary in their approach, which is not surprising as there

are hundreds o inspectors rom a variety o backgrounds distributed across the whole Country. We have distilled

experiences to date and ocussed on the areas CQC inspectors have prioritised and targeted. We hope this will be

useul to you as you prepare or your ongoing monitoring or compliance inspection visit.

It is worth taking time to explain how the emphasis has shited between CQC visits and visits you may have

experienced beore, such as rom a PCT. A number o essential dierences are explained below.

Shit in emphasisHistorically, all practice inspections have been based around structure and process. However, the CQC is primarily

concerned with the outcomes that people experience as a result o accessing your services.

These terms can be explained as ollows:

Structure is the physical presence o an item

Process is the protocol or using it correctly

Outcome is the result o using the right item in the right way at the right time

So, to provide a practical example, previous inspections might have required sight o a Sta Appraisal Policy and you

might have been asked how oten you appraised sta and that would be the end o the matter. The dierence with

the CQC is that inspectors will speak to various members o sta and ask them when they were last appraised and

how benecial it was and why.

Many providers are working under the misconception that compliance is all about having policies and protocols and,

whilst this may be important, what is more important is what actually happens or your patients as a result. In Volume

40 o Dental Protections Riskwise publication, DPL states You should remember that simply having policies,

procedures and systems in place is not sucient to demonstrate that you have taken steps to ensure that peoples

needs are met and that they experience the desired outcomes.

Shit in accountabilityIn the eyes o the CQC, it is the registered provider and/or registered manager who is accountable or all activities

undertaken by all team members in the practice. This includes being responsible or how all clinicians in the practice

keep their clinical records. (Note that individual clinicians are still personally responsible or their clinical records in

the eyes o the GDC.)

Shit in notice periodThe CQC can arrive on your doorstep unannounced, although this is most unlikely to happen unless they consider

that patients are at signicant risk o harm.

However, because the CQC would like to see your practice in its normal working condition, appointments or the visit

will usually be made anywhere between 24 hours and 6 days in advance. They will not wish patient appointments to

be disrupted and certainly not cancelled.


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Shit in ollow-up and enorcement powers

I the CQC inspector nds shortalls then their regulatory response is determined by two things:

1. Their perception o the seriousness o the shortall

2. Their condence in the providers capability to improve

One o the things that gives them condence is the providers awareness o their shortalls and the presence o an

appropriate action plan.

Following a visit in which shortalls are identied, the CQC willalways ollow this up and see it through to a

satisactory conclusion.I you receive a report that identies shortalls and you do not already have one, you shouldcreate an appropriate action plan.

What would they consider an appropriate action plan?

In a word: SMART

Specifc does it identiy the details o what the concern is, and what action needs to be taken? Does it explicitly say

what needs to be achieved, and who is going to make these changes?

Measurable does the action plan say how you are going to ensure that improvements have been made? What

measures are you going to put in place? Who will do this?

Achievable are the measures they are going to put in place, achievable, attainable and sustainable? Has the

provider described the resources needed to implement the changes? Are these in place?

Relevant is the action appropriate to the concern identifed?

Timebound is there an appropriate date by which the improvements will have been made? How will this date impacton people who use services?

I an action plan is not SMART, the CQC has the option o asking you to redo it, or provide them with urther

inormation.

It is not an option to wait or the CQC to visit and tell you what you need to do to comply. They will expect you to

know this, especially as you may have declared yoursel compliant.

I they are not confdent that you can and will make the appropriate changes quickly and eectively, they

are likely to publish a judgement on your shortalls on their website.

What can published CQC judgements look like?

Below are some examples o judgements that have been published about providers on the CQC website that

demonstrate that the old saying there is no such thing as bad publicity (Brendan Behan) doesnt always apply!

Peopledonotreceiveeffective,safeandappropriatetreatment.

Childrenwhousetheserviceareprotectedfromabuse,butvulnerableadultsmaybeatrisk.

Peoplearenotprotectedagainsttheriskofexposuretoahealthcareassociatedinfection.

Theservicedoesnotprovideapleasant,safeenvironmentforpersonsusingtheserviceorstaff.

Peoplemaybeatriskofharmfromequipmentthatisnottforpurpose.

Peoplewhouseservicesmaynotbesafebecausetheregisteredproviderdoesnothaverobustrecruitment

procedures in place.

Peopleshealthneedsmaynotbemetbecausethereareinsufcientstaffwiththerightknowledge,

experience, qualications and skills.

Peopleareatriskofnothavingtheirneedsmetbecausestaffarenotsupportedtoacquireskillsrelevantto

their work.

Following an inspection at which they have identied shortalls, the CQC may also place a statement such as the

ollowing on their website advising the world at large o what they have done and what happens next:

We have asked the provider to send us a report within 7 days o them receiving this report, setting out the action they

will take to improve. We will check to make sure that the improvements have been made.

We have reerred the concerns to Health and Saety Executive. We will check to make sure that improvements have

been made.

Where we have concerns we have a range o enorcement powers we can use to protect the saety and welare o

people who use this service. When we propose to take enorcement action, our decision is open to challenge by a

registered person through a variety o internal and external appeal processes. We will publish a urther report on any

action we have taken.

What might a typical visit be like?

Theremaybemorethanoneinspectoratavisit.

Visitswillnormallylastforatleast3+hoursandtheymaycomebackagain(withanexpert)tocheckin

greater detail or i actions are required. Most o the time will be spent observing how the team interact with

patients, read patient reactions, answer the telephone discreetly, maintain condentiality, handle anxiety in

patients etc.


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Theywillwanttospendtimewithclinicians(about30minutes)andthepracticemanager,nursesand

receptionists.

Theywillaskopenquestionswhichrequiresomedetailintheanswers.Theymayhelpyoubyprompting(not

always) and they may ask the same question in dierent ways until they are satised or they may decide to

look close at this aspect.

Manyofthequestionswillbeaskedofanyoftheavailablestaffduringtheinitialwalkaroundtourofthe

practice. Later, there will be a more detailed session o questions with the practice manager and each clinician.

Theywillalsotaketimetoaskpatientsquestions.Theymayaskyourreceptionisttospeaktopatientsrst

to ask i it is OK to do this and also to collect contact details o any patients who are willing to respond bytelephone enquiry later. Oten the CQC inspector will have produced a short introductory leafet which can

be given to patients. Beore the visit, they may ask that 10 patient records are selected and that the practice

checks with these patients that they consent to their records being examined by the inspector. During the visit

the inspector will choose which o these records to look at with the clinician.

All providers must comply with all 28 outcomes and there are 16 key outcomes that all dental providers had to

declarecomplianceornon-compliancewithwhentheyregistered.Weareoftheviewthatoutcome3,Feesisalso

very important even though it is not one o the 16. The CQC has said that outcome 5, Meeting nutritional needs,

has limited relevance in dentistry. All dental practices should also have a Statement o Purpose which is covered by

outcome 15.

From the experiences o those who have been kind enough to tell us, they will concentrate on some outcomes

(oten 1, 4, 7, 8 and 12 detailed below) although you may not realise this at the visit because they will move between

outcomes as dierent aspects crop up. They may have selected specic outcomes to ocus on in your practice andthey may amend this to include others i they have concerns when they question sta.

Outcome 1 - Respecting and involving people who use services

Outcome 4 Care and welare o people who use services

Outcome 7 Saeguarding people who use services rom abuse

Outcome 8 Cleanliness and inection control

Outcome 12 Requirements relating to workers

Each inspector will most likely have undertaken a number o visits to dental practices beore they visit yours. They

will thereore be increasingly amiliar with what is normal or expected o a dental practice. It is thereore unwise to

persuade them that you are not required to reach at least the same standards as they have seen provided elsewhere.

You can o course exceed them!

Oten they will try to tour a practice in a logical order rather like a patients visit and will spend some time sitting and

listening in the waiting area. We think that at the moment the CQC visitor will not be inclined to enter a surgery while

treatment is in progress and they certainly will not want to disturb a clinician while working.

They will ask innocent sounding questions that always have a reason behind them. They may make comments like:

Isnt it amazing how oten a room needs redecorating or how do you manage to clean these parts? - especially i

it looks like you dont!

They will be looking or statutory signs, hazards not dealt with or breaches o health and saety regulation. CQC

visitors realise that an inspection visit is a stressul time and are generally very pleasant and may even oer a helpul

prompt here and there. However, they are not there to give you advice or help you to comply.

Conclusion

We hope that you nd this document helpul in planning or your CQC visit. Appendices 1-6 below represent acollation o all the questions we have been inormed have been asked by inspectors to date.

I you eel that your practice would like more support in preparing or your inspection, then please contact Apolline on

0844 8708251 or visit the website at www.apolline.uk.com where a wide range o support services are available.

Keith Hayes

Clinical Director, Apolline LtdHaving worked with Apolline since 2010, Keith has advised many practices on

regulatory and compliance issues drawing on his experience working as a partner

at a large practice and his teaching role at Royal London Hospital in Oral Medicine

and Periodontology. Qualifed in the Faculty o General Dental Practices Certifcate

in Appraisal o Dental Practices, Keith established a new, successul ully private

practice in 2003 where he spent a number o years working until joining Apolline.


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Appendix 1 - What are inspectors likely to ask patients?

Below is a selection o questions that have been asked o patients. This is not an exhaustive list, but a representative

selection:

Doyouhaveenoughinformationgiventoyouaboutoptionsandalternativesbeforeyoureceivethetreatment?

Doyoufeelthatyourprivacyisrespectedanddignityupheldatalltimes?

Ifyouhavebeenanxiousaboutreceivingtreatment,howhasthisbeenhandled?

Areyoumadetofeelwelcome?

Doyoufeelyouaregivensufcienttime? Areyouoftenseenlatebecausethedentistisbehind?

Doyoufeellistenedtobythedentist,nurse,receptionstaff?

Howcondentareyouaboutthecleanlinessofthepractice?

Howcondentareyouthatyourrecordsaresafelyandcondentiallyprotectedinthispractice?

Haveyoubeenaskedforyouropinionaboutthequalityofservices?

Haveyoueveraskedforanotheropinionorneededtobereferredelsewherefortreatment?

Howwasthishandled?

Ifyouhaveevermadeacomplaint,howsatisedwereyoubythewayitwasresolved?

Howeasyisittomakeappointments?

Doyourequireanyadditionalhelpbecauseofanydisabilityandisthisreadilyavailable? Doyourequirepracticeinformationinadifferentlanguageandisthisavailable?

Haveyouneededtocontactthepracticeoutofhoursanddidtheserviceworksatisfactorily?


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Appendix 2 - What have inspectors asked team members when they are touring the practice?

Receptionist

Generalquestionsaboutinfectioncontrolandzoning

Howdoyouletpatientsknowthecostoftheirtreatmentincludingpaymentandtheirtreatmentoptions?

Tellmeaboutthepatientjourney

Howdoyouprotectpatientcondentiality?

HowdoestheDataProtectionActaffectthepractice?

Howdoyoucollectpatientfeedbackinthepractice? WhereisthepracticeintermsofHTM01-05requirements?

Howdoyouknowthatpatientshaveunderstoodtheirtreatmentplans?

Howdoyouhandlequestionsaboutthisiftheyaskatthereceptiondesk?

Wheredocondentialdiscussionstakeplace?

Whatisyourunderstandingofthepracticecondentialityarrangementsandhowhaveyoubeentrainedin

this?

Howdoyouapproachhelpingpatientswhoneedextrasupport(disabled,sight/hearingimpaired,children,

communication diculties or other languages)

Howwouldyouhandleanunguardedcommentfromachildorvulnerableadultthatmightindicatetheyareat

risk o abuse?

Whattraininghaveyouhadinawarenessofsafeguardingvulnerableadults?

WhattraininghaveyouhadinChildProtection?

Whoisresponsibleforthisinthepractice?

WhatisyourunderstandingoftheMentalCapacityAct?

Whatisyourpolicyonrestraint?(Note:TheMentalCapacityAct2005referstoprovidershavingarestraint

policy. A number o inspectors have asked practice team members about their restraint policy because they

are used to asking hospitals and care homes this question. Not surprisingly, this has been met with blank

stares. It would be helpul to think about how you would answer this question in your practice as there are very

ew situations in which restraint would ever be appropriate in a dental practice. Examples could be: holding the

patients hand to reassure them i they are especially earul o local anaesthetic injections. Whilst the primary

purpose o such an action would be to reassure the patient, there is nevertheless a possibility that a very

nervous patient would attempt to grab the dentists hand mid-injection, thereby doing themselves and possiblyothers an injury. The act o preventing this could be construed as restraint and team members should be

prepared to answer this question in a condent manner. Another similar example is the patient who is extremely

earul o the drill and tries to grab the dentists hand during treatment. The main thing to bear in mind is that

any restraint used should always be proportionate to the risk o harm. Further inormation on how the CQC

interprets the Mental Capacity Act can be ound on the CQC website at www.cqc.org.uk . Their guidance: The

Mental Capacity Act Guidance or providers was published in December 2011.)

Haveyouhadanypatientmedicalemergenciesandwhenwasyourlasttraininginthis?

Whodoestheriskassessmentinthepracticeandwhatchangeshavebeenneededfromanyrecorded

adverse incidents?

Howdoyoucapturepatientfeedbackandwhathaveyoudoneasadirectresultofthis?

Howarecomplaintshandledinthepracticeanddoyouhaveexamplesofthis?

Ifyouhadaconcernabouttheperformanceofotherswithinthepractice,whowouldyoudiscussthiswithand

what would you do i you were still not satised?


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Clinicians

Howdoyoumakedecisionsabouttherighttreatmentplanforapatient?

Howdoyouensurethateverythinginthepatientrecordisuptodateandnotesarecompleted

contemporaneously?

Howcanyoushowpatientsareinvolvedindecisionmakingabouttreatmentoptionsgiven?

Howcanyoushowyouhavediscussedtherisksandbenetsofanyproposedtreatments?

Howdoyouknowpatientshaveunderstoodtheoptionsandalternativesorconsequencesofadecisiontohave or not have treatment?

Whatwaysdoyouhaveofpresentingtreatmentoptionstopatients?

WhatisyourunderstandingoftheMentalCapacityAct?

Howcanyoushowyouobtainedvalidpatientconsenttotreatmentinthisrecord?

Howcanyoushowwhenthemedicalhistorywaslastupdatedintheserecords?

Showmehowallergiesormedicalalertsarerecordedonyourpatientrecord

Howwouldyoudealwitharequestfortreatmentfromapatientwhichyoufeltwasinappropriateorunrealistic?

Howdoyourecordyourreasonsforusingdiagnostictests(x-rays,pulptestsetc)andhowcanyou

demonstrate that these have been explained to the patient?

Howwouldyoudemonstratewhatcriteriayouusetojustifytakingradiographsandonlywhenstrictly

necessary?

Howdoyouexplainandrecordthepatientscaries/periodontalrisk?

Howdoyoucheckandrecordsofttissueexaminationsontheserecords?

Howwouldyouexplaintheneedtoreferapatienttoaspecialistorahygienist?

Howhaveyourecordedthisinformationinasetofrecords?

Howoftendoyouassessthecontentandaccuracyofyourpatientrecordkeeping?(i.e.howoftendo

you audit your patient records? What are the results? And what have you done to improve i this has been

necessary?)

Whattypesofqualityassurancemonitoringdoyouundertakeonyourrecordkeeping,radiographsand

reerrals?

Howdoyouapproachoralhealtheducationandhowdoyouassesswhetherpatientshaveunderstoodthis

and acted upon advice?

Showmeinthissetofrecordswherethepatienthassignedatreatmentplan

Howisthelatestclinicalguidance,materialandtechniquesincorporatedintoyourclinicalpractice?

PleaseshowmeyourCPDrecordtodate

Whereareyouinrelationtothe5yearcycleandcoreveriableCPDrequirements?

Howdoyoudeterminerecallfrequency?

Howdoyoudeterminetheneedfor3rdmolarextractionorreferral?


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Appendix 4 - What have they asked team members when they are touring the practice?

Other clinical sta

Whatisyourleveloftrainingandexperienceofsafeguarding,childprotectionandtheMentalCapacityAct?

Wherewouldyouobtaintheinformationifyouhadaconcernaboutabuseandthecorrectlocalpathway?

Whoisthemostrecentnewpracticeemployee?

(Tothisemployee)Whatwasyourexperienceofworkinginthispracticeduringyourrstweek?Whatwereyou

shown and how did you know what the correct procedures are in this practice?

WhatisyourunderstandingofHTM01-05(sometimesdeliberatelymisquotedlookingforcorrection)andhowimportant is this in the practice?

Whattraininghaveyoureceivedoninfectioncontrol,handhygiene,wastesegregationandsharpsinjury?

Whereistheowchartthatdescribeshowtohandletheabovesituations?

Whoisinchargeofoperatingthepracticeinfectioncontrolpolicy?

Canyoushowmewhathappenstoinstrumentsfromthetimetreatmentisnishedthroughtothembeing

sterilised, packaged and stored correctly?

Howdoyouknowthattheinstrumentsaresterilisedeverytime?

Howdoyouvalidatethisprocess?

HowdoyouknowthatALLtheteamalwaysfollowthisprotocolandusethePPEcorrectly?

Howcanyoubesurethatsingle-useitemsareonlyeverusedonce?

ShowmeyourcopyoftheHealthandSocialCareActCodeonthepreventionandcontrolofinfections.

WhatdoyouunderstandyouarerequiredtodotocomplywiththeCode?

Howdoyouguardagainstanybreachofcondentialityofpatientinformation?

Whendidyoulasthaveastaffappraisal?

Whattypesofthingsarediscussedinyourappraisal,forexample,doyouhaveapersonaldevelopmentplan?

Howoftendoyouhavepracticeteammeetings?

Ifyouwerenotpresentatameeting,howistheinformationgiventoyou?

Whendidyoulastpracticeapatientemergency/redrill?

Whendidyoulasthaveahandhygieneupdate/safeguarding/childprotectiontraining?

HaveyouhadanenhancedCRBdisclosure?

Ifyouhadaconcernabouttheperformanceofanymemberoftheteam,wouldyouknowtowhomyoucould

speak or advice?

Howdoyoufeedbackanycommentsmadebypatientstotherestoftheteam?


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Practice manager

This is oten the longest session since it will involve some repetition and also some checking o records and policies.

It is extremely unlikely that the CQC inspector will want to sit down and closely scrutinise every last policy document

that you have. However, they will want to look at a representative selection and they will be looking or certain

important eatures o each:

Isituptodateandhasitbeenbespokedtothepractice(practicename,detailsetc)?

Doesitdescribeexactlywhathappensinyourpractice?

Hasitbeenreadandunderstoodbyallcurrentmembersofthepracticeandisitsignedbytheteammembers

who are currently employed?

Hasitbeenupdatedwithanyrecentchanges(likehealthcarewastechanges2011)?

Doesithaveareviewdatewithinayear?

Doesitformpartoftheinductionprocessandongoingtrainingthroughouttheyear?

In other words, they are checking that it is not just a generic policy that sits collecting dust in the corner o the oce!


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Appendix 6 -Other questions

Below is a selection o questions that have already been asked or might be in uture visits. Please note: Not all

practices will be asked all questions.

Howdoyouknowhowoftenthecliniciansperformqualityassurance/recordaudits?

HowdoyoutrackthatallGDCregistrantsmaintainregistrationandindemnity?

HowdoyoukeeprecordsofcliniciansCPDandteamtrainingschedules?

Doyouhaveanexampleofapatientinformationleaet?

Howoftenisthisupdatedandinwhatlanguagesisitrequired? CanyoutellmeaboutyourpracticeStatementofPurpose?

WhowroteyourStatementofPurpose?

Howdoesthepracticedealwithcommunicationdifcultiesoraccessproblems?

Wherearecondentialdiscussionswithpatientsorstaffheld?

Howusefulhaveyourmostrecentpatientsurveysbeen?

Canyoushowmehowactionshavebeentakeninresponsetocomments?

Howhaveyouusedstaffsatisfactionsurveys?

Howwelldoyoufeelyouinvolvepatientsindecisionsabouthowthepracticeisrun?

Howdoyouknowthatalloftheteamunderstandtheprinciplesofobtainingandmaintainingconsenttocare?

Howcanyoushowthishasbeendiscussedatameeting? DopatientsalwaysknowiftheyarereceivingtreatmentundertheNHSorprivately?Howcanthisbe

demonstrated?

DoallthecliniciansfollowNICEguidelinesonrecallintervals?

Whatadverseincidentscanyourecallinthepractice,howaretheyrecorded,whatwastheoutcomeandhow

have you ensured that this should not happen again?

Whatemergencydrugsandresuscitationequipmentdoyoukeep?

Whochecksthisandcanyoushowmearecordofthechecks?

Howcanyoubecertainthatdrugshavenotexpired?

WhenwasthelastCPRtrainingattendedbytheteamandcanyouproducethecerticates?

Whatincidentswouldyourecordinyouraccidentbook?

Whathaveyoudonetoreducearecurrenceofsuchincidents?

DoyouhavecurrentdetailsofHepBvaccinationofallstaffexposedtoBBVexposurerisks?

Howwouldtheteamensurethattreatmentsoffereddonotconictwithethnicorpersonalbeliefs?

Howcanyoubecertainthatallreferralswithinoroutsidethepracticeconformtothepracticereferralpolicy?

(Includes reerrals to the hygienist)

Howwouldyoudealwithaninstanceofinappropriatereferralsbeingmade?

Whatleveloftraininghasbeenreachedbytheteaminsafeguardingandchildprotection?

Whatfurtherupdatesareplanned?

Howoftenisthisdiscussedinapracticemeeting?

Wouldyouhavetheminutesofrecentmeetingswhichconrmthediscussionsthatoccurred?

Whoisinchargeofthispolicy?

WhereisthereinformationthatdescribesthecorrectlocalarrangementsforChildProtectionandthe

saeguarding o vulnerable adults?

WhoholdsanE-CRBatthepractice?IstheProviderversioncountersignedbytheCQC?

Whatriskassessmentshavebeenmadefortheneedforotherteammemberstoholdthese?

Whatactionwouldyoutakeifyoususpectedachildwasatriskofabuse?

WhoisyourInfectionControlchampion/lead?

Whattraininghaveyou/hastheteamhadoninfectionprevention?

Howfrequentlyarechecksmadeofthis?

Whendonewstaffreceiveinductiontrainingininfectioncontrol?

Howcanyoubecondentthatallteammembersunderstandtheimportanceofcorrecthealthcarewastearrangements?

Howiswastestoredsafelyandsecurelyinthepractice?

Howiswastelabelledcorrectly?


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Canyoushowmewasteandconsignmentnotesandexplainhowyouhaveconductedawastepre-collection

audit?

Howdoyouknowemergencydrugsarekeptsafelyandaccesscanbeachievedrapidly?

Whenwasthislasttested?

Haveyoueverhadamedicalemergencyandhowlongdidittakeforparamedicstoarrive?

Whatwastheoutcomeofthis?

Didyoumakeanychangestoyourpracticeproceduresasaresult?

Whoundertakesthepracticeriskassessments,whattypesdoyoudoandhowoften?Haveyousomewrittenrecords o these?

HowdoyouknowthestaffhaveallreadandunderstoodtheHealthandSafetypolicyinthispractice?

Howdoyouensurethatalltheservicingandcerticationofequipmentiskeptuptodate?

Pleaseshowmethefollowingcertication:Couldbepressurevessels,x-rayequipment,servicingagreements,

radiation protection le etc. The inspector will also look at all statutory signage as they tour the practice and

check that local rules, emergency signage, out o hours, complaints, no smoking, employers liability, Health

and Saety poster, x-ray warning signs, re exits, trickle charge lighting i appropriate etc are all in place.

Whatarrangementsareinplaceifthepracticehastobeclosedbecauseofunforeseencircumstances?

Whatcontingencyarrangementshaveyoumade?

Hasthisoccurredandwhathappened?

Howoftenisx-rayequipmentcheckedandbywhom? Canyougivemeanexampleofanoccurrencewhich,ifitshouldoccur,youwouldberequiredtoreporttothe

CQC?

HastheHSEbeeninformedinwritingofthepresenceofyourradiographicequipment?

Doesanyoneneedtoweardosimetrybadges?

Hasanyonehadmercury-screeningtests?

Howdoyouensurethateveryoneworkinginthepracticeislegallypermittedtodoso?

Isyourstafnglevelsufcienttoallowyoutoworkifamemberofstaffisoffsickoronholiday?

Showmeyourpracticeorganisationplanner

Canyoushowmewhatwouldbethetypicalcontentofastaffemploymentle?

Howoftendostaffhaveappraisalsandwhatmightbediscussed? Doyouuseagencystaffandwhatwrittenarrangementsareinplaceforthis?

Howcondentareyourpatientsaboutthequalityofservicesyouprovide?

Howdoyouknowthis?

Whatevidencehaveyougotofactionstakenasaresultofpatientfeedback?

Canyoushowmeevidenceofacomplaintthatwasresolvedandthatgavethepatientincreasedcondencein

the practice?

Doyoutrackallcomplaintsfromstarttoconclusion?

Whoisresponsibleforhandlingcomplaints?

Ifapatientisnotsatisedbythepracticecomplaintsprocedure,towhomshouldtheybereferred?

Howcanyoubecondentthatallpatientshaveanewmedicalhistoryproformacompletedregularly?

WhoisregisteredwiththeInformationCommissionersOfceinrelationtotheDataProtectionAct1998?

Didyoureachcompliancewithlevel2InformationGovernanceby31stMarch2012?

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