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Preparing the Team for CQC Registration: The First Five Steps

Wednesday 1st Aug 2012

The process of applying to become registered with CQC is now a reality for general practices and many managers are already working through what they need to put in place in order to demonstrate compliance. Getting the practice team ready will be one of the major challenges of the process. CQC have been very clear in communicating to General practices how they intend to assess compliance against the Essential Standards of Quality of Safety – Policies alone will not be sufficient, they want to talk to service users and staff about their experiences. Practice managers will need to ensure that the whole team is engaged in the process, understands what is involved and can demonstrate compliance in their responses.

There are several ways that a manager could ease this process.

Knowledge – all members of the team need to understand some key points:

  • What the Care Quality Commission is and what they regulate
  • The Essential Standards of Quality and Safety
  • How these impact upon the day to day work of the practice
  • What the expected outcomes for patents and service users should be and how the team can help to achieve this

Preparing the team will be vital – and it is not too early to start preparing them!

Step 1

Start with a brief overview in a team meeting outlining the timescales for registration and the key points that will need to be achieved. CQC have some useful resources on their website including a presentation which can be used.

Once the team are aware of the process and key actions, the manager then needs to think of specific training that will help to support the achievement of the standards.

Step 2

Introduce a section into individual or team appraisal to consider what skills and knowledge will be required and how best the team can achieve them. There is little training that could be considered statutory or mandatory in general practice for the non clinical staff but that doesn’t mean that the manager cannot create their own schedule of “required” training. A Training Passport which keeps a track of the requirements and their frequency could help this.


Training delivery – this can be a difficult issue for general practice where they may be few members of staff and difficulties in accessing appropriate courses in accessible locations. Managers should consider the different means of training delivery available to them and introduce the most cost and time efficient means such as:

  • E Learning
  • Joining together with practices to buy in training
  • Cascade systems and feedback
  • Internal experts and resources
  • Sharing existing expertise across a group of practices

Some of the topic areas for training that The Essential Standards of Quality and Safety highlight include:

  • Equality, diversity and human rights
  • Chaperone training
  • Customer Care
  • Confidentiality and information governance

Health and safety training is required by law and other important issues that impact upon the whole team will be:

  • Safeguarding children and vulnerable adults, and;
  • Infection prevention and control

The manager or coordinator of training will need to start planning the training schedule now to ensure that everyone has the skills and knowledge they need in the new financial year.

Step 4

Start building – have a standing item on every team meeting that takes place on at least one aspect of CQC.  Consider gathering evidence across a range of different aspects and get the team involved in suggestions for evidence. A useful way to gather evidence is to consider the different ways in which it might appear:

  • The patients experience gathered through their feedback
  • Your operational systems and processes
  • The training or CPD activity you do
  • Clinical activity and information
  • The documents that support your work

The important thing to remember is that the practice will already have a lot of evidence from your normal day-to-day operation and performance.

  • Patient feedback has been gathered over the last year through the National Patient Experience Survey as well as the local one carried out for the Patient Participation DES
  • Many practices already have a staff handbook with operational protocols in
  • Appraisal and CPD take place regularly for both the clinical and non clinical teams – and don’t forget all the less formal training that takes place in meetings and short sessions
  • Do not forget QOF – In the Clinical Domain this demonstrates that a practice follows best clinical practice and guidelines and understands the needs of their population. There are also many non clinical indicators that support CQC relating to processes and policies
  • Practices should introduce a document library (preferably electronic) that keeps track of all the policies and their review dates and mechanism. This will make it easy to demonstrate to CQC the process for review and communication

Step 5

Keep the engagement going. Put up notices and posters which change on a fortnightly basis – consider key aspects of a different outcome each time. Position the notices carefully – remember that the back of the lavatory door is often a good place to put things!

The team can be actively involved in risk assessments across the whole range of issues including infection control, premises and health and safety and confidentiality. Those carrying out the jobs are often best placed to make suggestions about how risks could be minimised or managed more effectively.

When planning training for the team it is important to ensure that the training is focussed directly upon primary care issues and delivered by trainers who can relate to the practical, day to day problems that occur. As specialists in primary care training, Thornfields have a range of training courses which will support the team and link directly to the outcomes that the CQC will be assessing. See the 'Training Courses' section of the website for details of our in-house programmes and the look out for the new range of public workshops at venues around the country scheduled for launch later this year.

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