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Site visits: independent doctors and clinics

Categories:
  • Organisations we regulate

Site visits give us an opportunity to talk to people using your services, your staff and other professionals, to find out about their experiences.

They allow us to observe how you deliver care and to review people's records to see how their needs are managed, both within and between services.

Where services are managed from one location across multiple sites, we are likely to visit a number of the sites during a comprehensive inspection.

Gathering evidence during the site visit

To structure the site visit, the inspection team refers to the key lines of enquiry (KLOEs) in the assessment framework for healthcare services. They also look at any concerns identified beforehand through our monitoring activity. This enables them to focus on specific areas of concern or potential areas of outstanding practice. They collect evidence against the KLOEs using a variety of methods.

People who use services

We will gather the views of your patients, their family and carers, by:

  • speaking with them individually
  • using information from complaints and concerns sent through our website.

We will also send you:

  • posters to publicise the inspection and give people the opportunity to speak to the inspection team
  • comment cards for people to fill in.

We ask you to display these in a prominent position at reception and in other busy areas.

If we include an Expert by Experience on an inspection, they will talk to people at the premises on the day of the inspection.

Your staff

On all inspections, we are likely to speak to a range of staff including:

  • doctors, including locums
  • managers
  • nurses
  • healthcare assistants
  • other clinical staff
  • administrative staff

For larger providers, the inspection team may also hold focus groups with separate groups of staff.

The inspection team will offer to talk to current and former whistleblowers during the inspection period.

Gathering information in other ways

We may also gather information by:

  • tracking a patient's journey through their care pathway
  • reviewing records
  • reviewing operational policies and supporting documents.

We recognise that there are sensitivities about medical records. The relationship between doctors, nurses and their patients is often a close one, with a very strong expectation of confidentiality. Records may include very private and personal information. A member of the inspection team will usually review medical records.

The start of the visit

At the start of each inspection the inspector will meet with your registered manager. If the registered manager is not available they will meet with the most senior member of staff on duty. This introductory session will take no longer than 30 minutes. It will introduce the inspection team and explain:

  • the scope and purpose of the inspection, including CQC's regulatory powers
  • the plan for the day
  • how we will escalate any concerns that we identify during the inspection
  • how we will communicate our findings.

You will have an opportunity to tell the inspection team about:

  • your service, including the context in which you operate
  • any examples of outstanding care and practice
  • any concerns that you have identified about your ability to meet the regulations and what you are doing about it

If we find that you have not told us about concerns that you are already aware of, we will reflect this when we assess the well-led key question.

The inspection team will meet to review the emerging findings at least once during the inspection. This keeps the team up-to-date with all issues and allows them to shift the focus of the inspection if they identify new areas of concern. It also enables them to identify any further evidence they might need in relation to a line of enquiry and relevant facts to corroborate a judgement.

Feedback on the visit

At the end of the inspection visit, the lead inspector will meet with you to provide initial feedback only, illustrated with some examples.

At the meeting, the inspector will:

  • tell you about any issues that were escalated during the visit or that require immediate action
  • tell you if we need additional evidence or if we need to seek further specialist advice in order to make a judgement
  • tell you about any plans for follow-up or additional visits (unless they are unannounced)
  • explain how we will make judgements against the regulations
  • explain the next steps, including how we process the draft inspection report
  • answer any questions

We will need to analyse the evidence further before we can reach final judgements on all the issues and award ratings.

Last updated:
26 March 2019