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How the CQC uses clinical searches in on-site and off-site inspections

Solicitor Anna Lemmer explains how the CQC uses clinical searches when it is inspecting GP practices.

Ridouts senior associate solicitor Anna Lemmer
Ridouts senior associate solicitor Anna Lemmer

In a webinar which took place on 22 June 2022, the CQC explained that clinical searches which it has developed are now being routinely used by CQC inspectors in both off-site and on-site inspections of GP practices.

The clinical searches were developed in response to the COVID-19 pandemic and their purpose is to assess how practices are providing clinical care to patients. The searches focus on areas of clinical importance and are meant to identify potential clinical risk in relation to the delivery of safe and effective care.

The hope is that the searches will improve quality and ensure that there is a more consistent regulatory approach.

The CQC is working with Ardens Healthcare Informatics as part of a 12-month pilot to create, review and deliver clinical searches. Practices can access the clinical searches via the Ardens’ website.

How will the searches be used?

During the CQC’s webinar, the presenter said that clinical searches were becoming a more important part of the inspection process. The CQC was keen to stress, however, that the searches should not be used as a substitute to practices’ own existing governance systems, nor as a means to manage care on a daily basis.

Each clinical search is risk based and identifies a cohort of patients who may require closer monitoring. The CQC will run the searches from some of the following domains and select searches to review according to perceived risk:

  • Disease modifying antirheumatic drugs
  • Monitoring of higher risk drugs
  • Medication review
  • Medicines usage
  • Identifying potential missed diagnosis
  • Safety alerts
  • Management of long-term conditions

Our experience

I recently spoke with a GP provider who had received an adverse draft inspection report from the CQC. The draft report alleged that the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which relates to safe care and treatment of service users.

The draft report alleged that the provider had not done all that was reasonably practicable to mitigate risks to the health and safety of service users receiving care and treatment. It stated: ‘Our clinical records searches showed that the practice did not always have an effective process for monitoring patients’ health in relation to the use of medicines including high risk medicines.’

When I spoke to the practice manager about this, they explained that the CQC had harshly criticised the practice for not undertaking blood tests for patients who had diabetes. The practice manager said patients had been invited to attend the practice for a blood test but they had not attended.

Another GP provider I spoke with recently had received a notice of proposal (NOP) to cancel the practice’s registration as a provider. One of the main criticisms in the NOP was that the practice did not have a plan in place for patients who required monitoring of medication but missed their medication reviews.

These experiences show that risk-focused clinical searches are at the forefront of CQC inspectors’ minds. Providers should pay particular attention to this and ensure that their governance systems are robust in identifying issues.

Challenging inaccuracies

Our firm has seen an increase in CQC enforcement activity across the sector and, if you are criticised in relation to clinical searches, it is important to challenge any inaccurate findings. There are always concerns about how inspectors assure themselves of the validity of the data they are relying on to assess risk. The CQC should ensure that any information gathered is properly verified and used to inform proportionate decision making.

Practices should challenge misleading or inaccurate CQC draft inspection reports through the factual accuracy comments process. This is the only opportunity to challenge the factual content of a report.

Sometimes practices decide not to challenge reports because they either do not think that it will make any difference or they do not want to damage an existing relationship with their inspector. However, the consequences of not challenging an inaccurate report can be very serious. If an inspection report goes unchallenged ,and it is subsequently published, there is a presumption that the report is accurate and the content of the report becomes the truth.

  • Anna Lemmer is senior associate solicitor at Ridouts
  • If you require assistance or advice in relation to any issues with the CQC including inspections and ratings, our specialist solicitors can help. Please contact Ridouts Professional Services Ltd using the email address info@ridout-law.com or by calling 020 7317 0340.
Ridouts Professional Services Ltd

Ridouts is a law firm that only acts for care providers. We provide legal, operational and strategic advice when providers are faced with matters that could negatively impact their businesses, such as poor CQC inspections and enforcement action. www.ridout-law.com

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