1. WHAT HAPPENS NEXT? WHAT DO I NEED TO DO? CAN I APPEAL? CQC: After the Inspection EMMA BRAVERY BRAVERY BUSINESS CONSULTING NOVEMBER 2017

2. Todays Presentation Brief review of the Inspection Process End of visit review Rating system Draft Visit Report Factual Inaccuracies Warning Notices Notice to Impose Conditions Special Measures Q&A with Katie Slack PM, Blue Dykes Surgery

6. CQC Schedule Inspection of GP Practice End of Inspection review meeting Production of draft report and rating award CQC Internal quality control Presentation of Draft Report to Practice Electronic copy provided to Registered Manager 10 working days to complete Factual accuracy report – Your opportunity to get the report changed Final reporting and rating published Additional CQC actions Issue Warning Notices Issue Notices to Impose conditions Special Measures Revisit

9. Practice Actions Practice actions Factual Inaccuracies Report Action Plan Representations Regulation Breaches Warning Notices Issue Notice to Impose conditions Make the changes! Prepare for reinspection

12. Understanding Ratings Principle No Rating Principle 6 The aggregated rating will normally be ‘outstanding’ where at least 2 or more of the underlying ratings are ‘outstanding’ and the other underlying ratings are ‘good’. 7 The aggregated rating will normally be limited to ‘requires improvement’ where at least 2 or more of the underlying ratings are ‘requires improvement’. 8 The aggregated rating will normally be limited to ‘requires improvement’ at best where 1 of the underlying ratings are ‘inadequate’. 9 The aggregated rating will normally be limited to ‘inadequate’ where at least 2 or more of the underlying ratings are ‘inadequate’.

15. Draft Report Stage Draft Report Meeting CQC and Provider Potentially NHS England, CCG, LMC Summary of report,highlighting any potential issues and enforcement actions, warning notice or Notice to Impose Conditions Within 2 days electronic report will be sent to Registered Manager – Clock starts ticking! Factual Inacuracies 10 working days to produce a report on any changes you wish to make

19. Factual Inaccuracies You have 10 working days from receipt of electronic report to identify all the incorrect statements within your report

22. Warning Notice Letter Extract 1

23. Warning Notice Letter Extract 2

27. Representations

28. Extract from response to representations I am writing about the representations that we received on 15 October in respect of the above regulated activity, at the following location(s): As the Head of Inspection, I have the delegated power to consider the representations you have submitted in response to the Notice of Proposal issued under Section 26 of the Health and Social Care Act 2008 dated 2 October 2015. I can confirm that I have had no previous involvement in this matter and in accordance with CQC written representations procedure this ensures that my decision is made in an impartial, objective and fair manner. …. My formal decision, therefore, is to uphold your representations. We will not publish a press release on our website and we will not publish a summary of the Warning Notice in the inspection report for your service or on our website.

29. Notice to Impose Conditions Examples:- Increase amount of clinical or management staffing Close your list This is completely separate from the factual inaccuracy stage although it may be based upon information you believe is inaccurate. This is a legal process taken as a last resort You can fight these by providing representations within the time scale stated in the letter. Include every piece of evidence you can, no doubt repeating the evidence in the factual inaccuracy report.

31. Q&A WITH KATIE SLACK PM, BLUE DYKES SURGERY CQC: After the Inspection Emma Bravery, Bravery Business Consulting embravery@hotmail.com 07866 759532