Until recently CQC has only been carrying out practice visits reactive to negative information. CQC has now commenced regular practice with a target is to visit 15% of registered practices by the end of March 2012.
CQC advises that routine practice visits will always look at Outcome 4 - care and welfare of people who use services and CQC visitors are then free to select other areas. We are advised that many visitors are choosing to look at
- Outcome 10 – safety and suitability of premises and
- Outcome 11 – safety availability and suitability of equipment
CQC also takes the view that one of the best sources of evidence is speaking to patients.
Are CQC entitled to visit practices?
Yes, The Health & Social Care Act 2008 section 60 (1) states that; 'The Commission may for the purposes of its regulatory functions carry out inspections of:
a) the carrying on of a regulated activity…'
Are CQC entitled to see patient records?
Yes, CQC does have the right to examine the records during an inspection without first obtaining each patient’s consent as they have a statutory power to do this. The relevant legislation is section 64 of the Health & Social Care Act 2008.
Section 64 (1) gives the CQC the power to require documents and information. 'The Commission may require any person mentioned in sub-section (2) to provide it with any information, documents, records (including personal and medical records) or other items which the Commission consider it necessary or expedient to have for the purpose of any of its regulatory functions.' The relevant persons at sub-section (2) include:
e) a person who carries on or manages a regulated activity.
Sub-section (4) states that a person who without reasonable excuse fails to comply with the requirement under this section is guilty of an offence and liable on summary conviction to be fined no exceeding level 4 on the standard scale.
The Health & Social Care Act 2008 gives CQC the power to inspect and be provided with dental records.
A situation may arise where a patient was to specifically indicate that he or she does not wish CQC to view his or her dental records. CQC may argue that they have a statutory right to inspect records and do not need the patient’s consent. CQC’s Code of practice on confidential personal information states at paragraph 4.13; '…we will not seek the prior consent of relevant people…because refusal would prejudice our ability to properly discharge our regulatory functions'.
Dental Protection has obtained legal advice on this situation and the advice is that, if a patient has expressly stated that they do not wish CQC to view their records, the Provider should advise CQC of this and withhold the records pending CQC’s response, or in the alternative provide anonymised records so the patient’s identity is protected.
Dental Protection understands that, so far, CQC requests for records have been very general along the lines of asking the provider to choose 5 records and this in itself could avoid the above problem.
Dental Protection advises that if CQC request access to a record when the patient has specifically refused this, that the Provider seeks advice from Dental Protection specific to that circumstance.
Cleanliness and infection control
There appears to have been some confusion in the minds of some practitioners regarding compliance with Outcome 8 - cleanliness and infection control [Regulation 12 Health & Social care Act 2008 (Regulated Activities) Regulations) 2010]. Providers of services must comply with the requirements of Regulation 12, with regard to the Code of practice for health and adult social care on the prevention and control of infections and related guidance
Although Providers must have regard to the Code of practice for health and adult social care on the prevention and control of infections and related guidance (The Code) and The Code is to be taken into account by CQC when making a decision, a Provider may be able to demonstrate that it meets the Regulations in a different way (equivalent or better) from that described in The Code.
A Provider might therefore look to his or her compliance with HTM 01-05 and then look to The Code and demonstrate compliance in that way.
The types of questions a CQC visitor might ask the team include:
- What training have you had?
- Show me how you do x.
- Why do you do that?
- How do you know it works?