- ‘Effective’ means that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.
- Each patient that visits your practice should receive a comprehensive assessment to establish their oral health requirements.
- Staff competencies and appropriate training are a key focus for CQC inspectors.
- Providers should provide information and support to patients to ensure that they fully understand their care and treatment options and provide consent.
- Audits are an essential tool to help to monitor the effectiveness of your systems and procedures in working practice.
Are you working effectively?
To answer this question, CQC’s definition of ‘effective’ needs to be understood. In How CQC Regulates Primary Care Dental Services: Provider Handbook, March 2015, the CQC states: “By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence”.
However, what does that mean to us in our dental practices? Well, CQC inspectors have an inspection handbook that contains inspection prompts. These are the questions that are likely to be asked during an inspection and for which you will need to provide evidence. So, let us drill down into the effective inspection prompts and explore what they mean to us in everyday practice.
The effective inspection prompts
E1 – Are people’s needs assessed and care and treatment delivered in line with current legislation, standards and evidence based guidance?
Each patient that visits your practice should receive a comprehensive assessment to establish their oral health requirements. This should include an up to date medical history, an intra and extra-oral mouth cancer screening, a discussion with the patient about any presenting complaint and the treatment options available to them (including the pros and cons and costs of treatment).
Your patients’ care and treatment should be planned and delivered in line with guidance from NICE, FGDP, GDC and The Department of Health. Selection criteria for radiography, sedation and domiciliary care should also be adhered to. Any discrimination on the grounds of age, disability, ethnicity, gender, etc. should be avoided when making decisions about a patient’s care.
It is an obligatory requirement to audit each clinician’s clinical records on an annual basis. However, if there are any issues highlighted, audits should be conducted more frequently (i.e. quarterly) to ensure that improvements are being upheld. A random, representative amount of patients’ records for each clinician should be audited.
E2 – Do staff have the skills, knowledge and experience to deliver effective care and treatment?
Staff competencies and appropriate training are a key focus for CQC inspectors. You need to demonstrate that each team member is up-to-date with their continuous professional development (CPD), has a comprehensive personal development plan (PDP) (even principal dentists) and receives an annual appraisal. It is very important to show how learning needs of each individual are identified. Skills gap analyses (SGAs) are not a mandatory requirement currently but are an ideal way to drill down into the skills, knowledge and attitudes of each team member and highlight where and at what level training needs to be injected. The bottom line is that staff are trained to deliver safe, effective and responsive care and are supported to maximise their skills and abilities.
E3 – Are there effective arrangements in place for working with other health care professionals to ensure quality of care for the patient?
Referral guidelines and procedures should be understood and accessible to all team members and contact numbers for referral centres and hospitals accessible at all times. In an inspection, staff may be asked about referral pathways, particularly their understanding of procedures to escalate a fast-track referral, for example, a suspicious lesion.
Under the General Data Protection Regulations (GDPR) guidelines, staff also need to be aware of what is or is not legally acceptable when sharing personal and sensitive data with a third party. Each team member should have received GDPR training and understand your practice’s policy and procedures for processing patients’ data. Team members should have an intelligent awareness of how to process data in an appropriate and timely fashion. Understanding our patients’ rights within GDPR is key to this function.
E4 – Is people’s consent to care and treatment always sought in line with legislation and guidance?
Providers should provide information and support to patients to ensure that they fully understand their care and treatment options. This may include a comprehensive website, advice and aftercare leaflets and giving time for patients to ask questions about their care to enable them to make an informed decision about what they would like to happen and give valid consent to treatment.
Patients are interviewed during CQC inspections and could be asked if they are supported by your dental team to make the right decisions about their care. Therefore, it is vital that you have measures in place to give patients the time that they need to make an informed decision about their care. This is more important than ever if you have a nervous patient, a child or vulnerable adult in the care of your practice.
Monitoring effectiveness is key to success
Audits are an essential tool to help to monitor the effectiveness of your systems and procedures in working practice. They assist in highlighting areas for improvement and any discrepancies in your systems. If improvements need to be made, it is essential that actions are documented and signed off and dated as part of your quality assurance procedures. There are seven obligatory audits that CQC inspectors will ask to observe during an inspection. The bottom line is that inspectors want to see that you are driving continuous improvement in your practice and putting measures in place to ensure that you are aspiring to best practice in every area of work.
- How CQC Regulates Primary Care Dental Services: Provider Handbook, CQC, March 2015: https://www.cqc.org.uk/sites/default/files/20150611_dental_care_provider_handbook.pdf
Use the following item in the Toolkit to put the ideas in the article into practice:
- Form – Key lines of enquiry evidence prompts audit: effectiveness of the service (already online)
- Form – Action plan to support key lines of enquiry audit: Effectiveness of the service
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