Prepare to be investigated

The independent practitioner’s experience of the Care Quality Commission can be daunting. Solicitor Paul Ridout relates some experiences he has come across and gives useful advice to doctors who find themselves in the firing line.

The Care Quality Commission (CQC) has the powers to inspect without warning or notice. It is courteous but not friendly. 

It is entitled to view all books and records. Its inspectors must be given access to computers and patient information – doctors can use patient confidentiality as an  excuse to refuse access. 

The CQC will see its role as public protection. It is entitled to have access, to probe and to challenge. It does not have to make appointments. 

One practitioner was surprised to arrive at work to: 

 Find inspectors in his rooms; 

 Have postponement of the visit declined; 

 Be challenged to justify his business and medical practice. 

We advised full co-operation – the CQC is entitled to behave in this way. Be careful and make notes and records of what transpires. 

Another practitioner found their prescribing practice under challenge, stating ‘But that is my professional judgment; that is none of your business’. 

Not so. The CQC is entitled to seek justification. If not satisfied, it may take enforcement action. 

De-registration/enforcement

The CQC has a range of powers. It operates on relevant information; for example, patient complaints, staff whistle-blowing, concerns from pharmacists and GPs – particularly NHS GPs.

A senior and experienced consultant surgeon was surprised and infuriated to be asked to justify surgical intervention decisions. 

This demand was by a CQC team without relevant experience. They act on their advice as to direct clinical judgements. The CQC expected detailed justifications in diagnosis procedures and after-care.  

Such challenges are rigorous. However intimidating, unpleasant and time-consuming this may be, the only safe response is careful and reflective explanation. 

The CQC will scrutinise patient notes and criticise shortcomings. The privacy of the practitioner is not recognised. 

Failure to co-operate; failure to justify a challenge to an inspector’s competence – these can all lead to deregistration and the destruction of the practice. 

Be careful! Do not ignore push back. And, where appropriate, recognise mistakes. Show the ability to reflect and learn, however irritating. 

Conclusion

The CQC is an important force in medical practice. The law gives it an important role in public health care protection. 

Be careful, recognise the role and work with the CQC, not against them.

 

How the CQC affects how you practise

The CQC regulates all medical practice – independent or NHS. It does not directly address the licence to practise, but it is a systems regulator of operations. 

It works closely with the GMC, and adverse enforcement by the CQC will usually lead to fitness-to-practise concerns from the council. 

Medical practice without CQC registration is a criminal offence. Before achieving registration, the CQC will expect applicants to demonstrate fitness to operate. This must be done by delivery or policies of business and professional management. Simply being licensed by the GMC is not sufficient. 

Applicants must prepare policies. Those must detail every part of the proposed practice. They must be relevant to the individual practice. 

The applicant must know and understand the policies. There will be an interview. The applicant must be prepared and demonstrate business competence. 

Applicants have found this challenging because it is an extra level of compliance. 

Paul Ridout (right) is a solicitor and founder of Ridouts Professional Services Ltd, a law firm acting for health and social care providers, including doctors, and advises on regulatory matters affecting their business, including CQC inspection and enforcement