Since its inception in 2011, the Care Quality Commission (CQC) has evolved the way it inspects and regulates. The first major change was in April 2015, and another evolution is currently underway with the creation of a new single assessment framework.
This time they have taken things slowly and tested every element to ensure it is fit for purpose before going live with it. At every stage during the development of the new framework, they also sought and acted on feedback from all involved.
The CQC has also launched a new portal and this continues to present challenges to the developers with work still required for it to be fit for purpose. Of course, ‘challenges for the developers’ means there are challenges for users and social media channels carry criticism of the portal on a daily basis. Never work with children, animals or IT springs to mind but I am confident they will get there!
What is the new framework?
So, what is the ‘single assessment framework’? The first thing to mention is that it sounds scary when it really isn’t. Needless to say, there has been much scaremongering about the new framework, which given the fact that most people don’t like change may be inevitable.
In plain English, it is a framework in which health and social care service providers, local authorities and integrated care systems are inspected using a single set of criteria. Prior to implementing the single assessment framework, this was not the case. You may already know that from 13 May 2024, the CQC started inspecting dental practices using the new framework.
Unsurprisingly, practices are very keen to understand what is different and how this will affect them. In practice, it is unlikely that your inspection will feel particularly different if your last inspection was in the last few years.
Practices that will notice a significant difference are those that were last inspected before April 2015. There are also practices that have never been inspected, and the CQC will be prioritising both of these groups. I think it is true to say that one of the biggest challenges with compliance is you don’t know what you don’t know, so I think it’s worth looking at what is not changing as well as what is changing.
What is not changing?
Perhaps the most important thing that isn’t changing is that good will still be good. That means if your practice is currently compliant or ‘on balance’ compliant it still will be under the single assessment framework. This is not surprising since infection control and the methods for controlling or eliminating infectious microbes and preventing their transmission have not changed. A similar argument is also true of radiation protection and all the other elements that contribute to having a safe and compliant practice such as health and safety requirements and having sufficient competent staff etc.
On the flip side, practices that need to make improvements will still need to improve.
The five key questions are also not changing with inspectors wanting to know whether your practice provides care that is safe and effective; whether the service you provide is responsive and caring and whether with the governance systems you have in place, this means your practice team is well-led.
Other things that aren’t changing are:
- The regulations are still governed by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
- Risk-based assessments will still be important – this means practices the CQC has concerns about
- The CQC will continue to inspect 10% of dental practices every year
- Dental practices will still not be rated
- The key areas of focus will be very similar to their current areas of focus.
What is changing?
The Key Lines of Enquiry (KLOEs) that have been used to guide inspections since 2015 have been replaced by 34 Quality Statements with practices being required to provide evidence of compliance with the relevant Quality Statement.
For each evidence category practices will be assessed as:
- Regulations met or
- Regulations not all met.
Feedback
There will be a significant emphasis on feedback from patients and team members and good methods of obtaining this are likely to be of particular importance. Whilst an interest in feedback has always been important to the CQC it seems feedback will assume an even more important role under the new single assessment framework.
Feedback is critical to the success of all businesses – how do you know if your patients and team members are happy unless you ask them?
Why bother with compliance?
My view of compliance has always been that practices should not ‘do compliance’ because the regulators tell you to; you should do it because it’s the right thing to do and has considerable benefits.
Benefits of a compliant practice:
- You will be better organised
- Your patients and team members will feel safe
- You should have fewer complaints and fewer significant incidents
- Your team will be less stressed and more motivated
- You get to stay open!
So if your practice is already compliant – well done! And if it isn’t, please get help.
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