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Intelligent Monitoring (Band 1 GP Practices)


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Themed Inspections: Focusing on Safeguarding Children

From September 2013 the CQC will begin carrying out a review of how health services keep children safe and contribute to promoting their health and wellbeing.

What will they look at during the review?

  1. “Our inspections will look at the quality and effectiveness of the arrangements that health care services have made to ensure children are safeguarded and to promote the health and wellbeing of looked after children and care leavers.”
  2. Joint inspections with other inspectorates
  3. Joint inspections with other organisations like, Ofsted, Probation services, etc. have been deferred.


CQC Pilot Inspections Reports

Informal Feedback from practices in Dorset and Hampshire who underwent a pilot CQC inspection around August 2012.

In Brief:

  1. The inspectors mainly concentrated on 4-5 essential standards during their visit
  2. At all times they focussed on what the outcome was for patients
  3. Most of the visits took up almost a full day
  4. "True to their word there were few requests for policies."


CQC Pilot Inspections Report

(Informal feedback from Dorset and Hampshire practices)


Top 20 at Risk CCGs

Intelligent Monitoring CCGs Risk

[Data Source: CQC GP Intelligent Monitoring: Datasheet]

Editors Note:

The chances of being next in line for inspection are greater if a large number of practices who are in Band 1 and 2 within a CCG

More importantly the CCG should be considering the knock on effect on its commissioning and tender bids/applications if member practices were under threat, actual or implied.


What do I declare for Outcome 5 - Meeting nutritional needs?

Victoria Howes, GP registration design team leader at the CQC says that meeting nutritional needs outcome generally does not apply to GPs.

However, just because a practice does not provide nutrition to patients, this does not mean they should ignore it or tick it as non-compliant.

‘Non-compliance is a negative judgement. Most practices are not involved in nutritional need so they are able to declare compliance because as far as it applies to them, they do it,’ she says.

Will an NMC number be sufficient instead of a DBS

No. CQC will only accept GMC numbers.  Any partners without GMC numbers will be required to have a CQC-countersigned, enhanced DBS check.

What are the other 12 standards?

The other 12 outcomes relate more to the routine day-to-day management of a service. They are:

  • Outcome 3: Fees
  • Outcome 15: Statement of purpose
  • Outcome 18: Notification of death of a person who uses services
  • Outcome 19: Notification of death or unauthorised absence of a person who is detained or liable to be detained under the Mental Health Act
  • Outcome 20: Notification of other incidents
  • Outcome 22: Requirements where the service provider is an individual or partnership
  • Outcome 23: Requirement where the service provider is a body other than a partnership
  • Outcome 24: Requirements relating to registered managers
  • Outcome 25: Registered person: training
  • Outcome 26: Financial position
  • Outcome 27: Notifications – notice of absence
  • Outcome 28: Notifications – notice of changes

Whilst these standards are being referred to as "non-core", do remember that compliance with these standards is a legal requirement

(To print a Quick Guide to the 28 outcomes  click on the iconpdf30)


Useful BMA and DOH Documents

DOH/NPSA Documents

Click on the icon to view the document


The Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance


The National Specifications for Cleanliness in the NHS

A guide to regular cleaning; including cleaning schedules

BMA Documents


The BMA CQC Registration Toolkit


The BMA Policies and Protocol

Editable Format


BMA - Complaints procedure & protocol


BMA - Confidentiality protocol


BMA - Decontamination policy


BMA - Infection and prevention control policy


BMA - Provision of lifestyle protocol


BMA - Recruitment policy


BMA - Repeat prescribing policy


BMA - Reviewing and acting on correspondence


BMA - Sharing and acting on clinical guidance


BMA - Significant event review template


BMA - Staffing policy


Archives: 2014 CQC Documents

Click on the icon to view the document

The OLD Provider Handbook 

Outlining the new inspection model - Published October 2014)

pdf30 Provider handbook
pdf30 Appendices to provider handbook
pdf30 Response to the consultation on our provider handbook

 Consulation Documents

pdf30 Overview to the Provider Handbook for General Practice
pdf30 Provider handbook
pdf30 Appendices to provider handbook
pdf30 Appendix D: Descriptions of the six key population groups, including characteristics of good and links to key lines of enquiry

Other CQC Documents

These are the official documents drafted by the Care Quality Commission


DBS Checks Guidance for Provider


Changes to the CRB/ISA and DBS Checks


Enforcement Policy


Location - What is a location?


Preparing for CQC Inspections


Provider Compliance Assessment tool


Registered Manager - Step-by-step guide to applying as a new registered manager


Registration Set-up Sample Letter


Regulated Activities by Service Type - Quick  Reference  Guide


The statutory notification forms below, make clear the information you must submit but also ask for additional details to help the CQC understand what has happened and how you responded to it.

You are not required to provide the additional information, but it would be good to do so as it will help the CQC decide whether you handled the event correctly and are continuing to comply with the essential standards without having to visit or contact you.


Statutory Notifications Guidance for non-NHS trust providers

Inspections and Enforcement


Preparing for CQC Inspections


Quality Risk Profile


Warning Notice representations form


CQC Representation Form


Enforcement Guidance: Representations and appeals


Suspension of registration


Cancellation of registration


The completed forms should be emailed to the CQC This email address is being protected from spambots. You need JavaScript enabled to view it.









(OLD) CQC Documents


Guidance about Compliance: Essential Standards of Quality and Safety (The 28 Outcomes)


Action Plan Template (when declaring non-compliance for an outcome)


A Quick guide to the 28 Outcomes


Useful Websites

Click on the icon to go to web page



The Care Quality Commission


Health and Social Care Act 2008


Care Quality Commission (Registration) Regulations 2009


Bespoke guidance that applies to a specific service type


The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010


CQC Fee hike by a whopping 567%

The “consultation” ended on 15th January, so all you can do now is wait to see if the GPC manages to put a stop to this. In the meantime, if you missed this, and can’t be bothered to read the 46 page document, here is a quick summary.

What is it about:

The CQC is aiming to become self-financing as it will no longer be subsidised as much by the government Grant in aid (GIA). Overall, the CQC is running at a loss of some £110m per annum, and if the government does not fund this, then the fees to cover this has to come from the providers.
For GPs, CQC costs £40m to run, but with the GIA of £18.7m the shortfall every year is 21.3m, which is to be recovered by raising fees.

What it means for you

For GPs: Fees will rise by 567%, from £616 to £4,111 (for small practices)
For Community Social Care: Fees will rise by 312%, from £796 to £3,287
For Dentists: It’s a discount of 15%.

What are the choices?

The consultation offered these choices:-

  1. Would you like fees increased over 2 years or 4? Whatever you choose, you will eventually face an increase.
  2. How else do you suggest we get this, let’s have your suggestions. The choice is basically either you pay your own share or we spread it so others chip in to pay your share.

In raw numbers, if you are paying £616 now, the choice is “Would you like to pay £9,809 in fees over the next 4 years or £14,520?” and if you don’t agree, do you think someone else should pay your share?

Are Dentists getting off lightly?

On the face of it, it would look like Dentists are escaping this, and even getting a reduction of 15% in 2017/2018. The question they’re asked “Is it ok if we reduce your fees?” 10,000 dentists will likely vote Yes.

All is not as it seems though, Dentists are not being charged any extra because they were paying their full share right from the beginning as the BDA did not raise as much of a protest as the BMA and GPC, resulting in a very low fee start for GPs.

In essence, what the numbers say is that GPs have been underpaying by 85% and conversely 10,102 Dentists have lost out by paying an extra 85% by comparison, for 4 years from 2011/12, that equates to paying £1,100 per annum instead of just £165 for a “5 chair practice”, a net loss of some £3,750 over the period.

What will higher fees bring for you?

The first thing one would have expected is an increase in the number of inspectors top cope with the considerable backlog on target visits, however the cost budget stays the same as last year, without any obvious indication of an increased workforce, or even inflation for that matter.

We suspect that the changes will come from hints from Prof Field about how his practice expects fewer visits as they have a system of self-assessment and the changes by CQC itself, where a single CQC inspectors will be assigned per CCG.

Second Wave of CCGs to be inspected

The CQC has announced the the next 11 CCG areas that are to be inspected starting from mid June/beggining of July.

The CCGs that have been named are:

  1. Greater Preston
  2. Oxfordshire
  3. Lewisham
  4. Leicester
  5. South Devon & Torbay
  6. Wakefield
  7. Sandwell & West Birmingham
  8. Gloucester
  9. Newham
  10. Sunderland
  11. Cambridge & Peterborough
  12. Hillingdon

The CQC plans that the new inspection teams will include an inspector, a GP, a nurse or a practice manager and a trainee GP and may also include an Expert by Experience.


FAILED Outcome 1: Respecting And Involving People Who Use Services

People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run

Reason(s) for Improvement Notice:

1. Patient Participation Group was not used effectively

  • PPG Group set up in June 2012
  • No record of minutes of meetings since initial set up
  • PPG has not been consulted about the annual patient survey
  • Provider confirmed that no meetings held with PPG
  • Change of practice email address not communicated to PPG group
  • Emails sent by PPG members to old address remained unanswered

2. People's privacy and dignity were not respected

Interviewing patients on the day of the inspection confirmed that:

  • Patient’s medication requirements, etc. were discussed at reception
  • On occasion staff did not knock before entering the room during a consultation


FAILED Outcome 7: Safeguarding People Who Use Services From Abuse

People should be protected from abuse and staff should respect their human rights

Reason(s) for Improvement Notice:

1.    Staff had not received updated safeguarding training for children

  • The practice declared non-compliance on registration
    • Their action plan to be compliant by 01 October 2013 was accepted by the CQC
  • Staff training on Adult safeguarding was declared as up to date
  • On questioning, staff lacked insight into the protection of vulnerable persons who were unknown to them
  • Staff also appeared unconcerned about their lack of understanding on safeguarding

2. CRB Checks [Now DBS checks]

  • Evidence of a CRB check was missing
  • No risk assessment of whether CRB checks were necessary
  • CRB action plan not put into place

Editor's Comment:
Inspectors are picking up on action plans submitted as part of registration with the CQC not having been put into place.  If you had submitted any action plans it would be wise to stick to the timetable or send CQC an update as to why things have not been achieved, rather than being caught out on the day of the actual inspection.

At another inspection the GP practice failed Outcome 12 for not having CRB/DBS and other appropriate checks carried out for their staff.


FAILED Outcome 12: Requirements Relating To Workers

People should be cared for by staff who are properly qualified and able to do their Job

Reason(s) for Improvement Notice:

     New Employees      Existing Employees
  • CRB/DBS checks not carried out prior to employment; nor an application made since.
  • Proof of identity not verified
  • No recent photograph on file
  • Job references not sought at time of employment
  • No photograph nor record of identity checks on file
  • Gaps in staff  employment not accounted for
  • Risk assessments to identify need to undertake the above checks retrospectively not considered






Editor’s Comments:
The area of Suitability of staffing (Outcomes 11, 12  & 13) has a great overlap in the criteria for compliance for each of the outcomes. Failings in one of these could potentially prompt an inspector to review the other related outcomes, leading to a worse compliance report.

Also note that another provider got an improvement notice for Outcome 7 for not having carried out CRB/DBS checks on staff.

To find out who should get a DBS (formerly CRB) check at your practice CLICK HERE.



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